Background. Hypertensive kidney disease is one of the long-term complications of poorly controlled arterial hypertension (HTN). This is the second most important cause of the development of chronic kidney disease (CKD) after diabetes mellitus. HTN is one of the key pathogenetic factors contributing to the progressive deterioration of the renal function. Objective. The purpose of this study was to study the overall prevalence of chronic kidney disease in patients with HTN. Design and methods. We performed a retrospective study (analysis of data on outpatient episodes within the period 2021–2024), which included all outpatients older 18 years treated at the Almazov National Research Medical Center with a diagnosis of HTN (essential (primary) hypertension). A total of 4126 patients with HTN were included in the study. According to electronic outpatient records, the main clinical and laboratory parameters were evaluated and CKD was diagnosed. Results. According to the analysis of the CKD prevalence depending on the HTN stage, patients with stage 1 HTN showed no CKD, while it occurred in 39 % (753) of patients with stage 2 HTN (CKD C1 in 48 patients, CKD C2 in 96 patients, CKD C3a in 540 patients, CKD C3b in 69 patients) and in 55 % (862) of patients with stage 3 HTN (CKD C3a in 235 patients, CKD C3b in 286 patients, CKD C4 in 323 patients, CKD C5 in 18 patients). Conclusion. In a large sample of outpatients with HTN we demonstrated a high prevalence of CKD.

Background. The relationship between metabolic risk factors, chronic kidney disease (CKD), metabolic-associated fatty liver disease (MAFLD), and cardiovascular diseases (CVD) is highlighted in the concept of сardiovascular-kidney-liver-metabolic syndrome (CKLMS), which is closely associated with competing risks of adverse outcomes. The impact of the burden of CKLMS remains poorly understood in chronic heart failure (HF) in national cohorts. Objective. To evaluate the frequency of CKLMS components, their combinations, and their impact on the long-term prognosis of patients with HF with mildly reduced ejection fraction (LVEF) (HFmrEF) and post-infarction cardiosclerosis. Design and methods. This was a retrospective analysis of data from a prospective, observational, single-center study involving 160 men (median age 62 years) with post-infarction cardiosclerosis and HFmrEF I (15 %) / II (85 %) NYHA functional class, who had been examined in 2018–2020. All patients received optimal medical therapy for HF and concomitant diseases. Follow-up was conducted through telephone contact / clinic visit at intervals of 6-12 months. The average follow-up period was 5 years (62 [49–64] months). Fatal events were assessed (total mortality, death from CVD and non-cardiovascular causes). Depending on the presence of CKLMS diseases (at the start of observational study), namely: obesity, type 2 diabetes mellitus (T2DM) / impaired glucose tolerance (IGT), CKD, MAFLD patients were divided into phenotypic groups. Results. A high frequency of CKLMS diseases was observed. Arterial hypertension (HTN) and dyslipidemia were detected in 92 % and 100 % of patients, respectively. Obesity/overweight and T2DM/IGT were registered in 43 % / 44 % and 32 % / 3 % of patients, respectively. CKD and MAFLD were diagnosed in every fifth patient. The presence of two or more CKLMS diseases was observed in 33 % of the participants. HTN was registered in 91 % of cases in the absence of the analyzed CKLMS diseases; in 96 % of cases in the presence of one, and in 98 % of cases in the presence of two or more CKLMS diseases. The most common phenotypic group of HFmrEF was represented by a combination of CKD + T2DM/IGT + obesity. The five-year survival rate of patients with HFmrEF was 76 %. The leading causes of death were CVD and cancer. The CKD, LVEF, and N-terminal brain natriuretic propeptide (NT-proBNP) were independent predictors of poor prognosis. The presence of CKD in a patient with HFmrEF was associated with a more than 3-fold increased risk of mortality: OR 3,5; 95 % confidence interval (CI) 1,45–8,40; p = 0,005. The highest five-year mortality was observed in individuals with CKD + T2DM/IGT (obesity in 71 % of cases) and CKD + T2DM/IGT + MAFLD (obesity in 69 % of cases). Conclusions. Patients with HFmrEF and post-infarction cardiosclerosis had a higher frequency of metabolic syndrome components: together with a high occurrence of HTN, at least two CKLMS diseases (obesity, T2DM/IGT, CKD, MAFLD) were detected in every third patient. Phenotypic groups of HFmrEF within CKLMS associated with CKD had the most unfavorable prognosis. The presented data confirm the need for an interdisciplinary approach to the management of patients with HF and the use of a personalized strategy based on pathophysiological phenotypes. 

Atherosclerotic renovascular hypertension is one of the most common causes of resistant hypertension in elderly age. However, this cause of hypertension often remains undiagnosed and untreated. The article describes a clinical case of resistant arterial hypertension in an elderly patient with a single kidney (history of nephrectomy), complicated by chronic kidney disease, acute kidney injury, recurrent episodes of acute heart failure and myocardial infarction. The cause of resistant arterial hypertension was established — critical atherosclerotic stenosis of the renal artery of solitary kidney. Angioplasty and stenting were performed in the critical condition of the patient, but it was justified. Successful revascularization resulted in control of hypertension, cessation of episodes of acute heart failure and acute kidney injury. The stable clinical condition persists for more than two years. This article contains modern concepts of diagnosis and management of renovascular hypertension, special attention is paid to indications of renal revascularization.

Background. The combination of renal and heart failure is characterized as cardiorenal syndrome (CRS) and represents a significant clinical problem associated with an unfavorable prognosis for patients with arterial hypertension (HTN). Combination therapy, including antihypertensive and antiproteinuric drugs, as well as lipidlowering and antiplatelet agents, theoretically has the potential to improve cardiovascular and renal outcomes in patients with nephrosclerosis and chronic kidney disease (CKD). However, there is currently conflicting information regarding the role of cardiac glycosides (CGs) in promoting renal protection in patients with hypertension, stage C2 CKD, and chronic heart failure (CHF), and the safe administration of these drugs in patients with comorbid conditions is often challenging. Objective. To evaluate the effect of antihypertensive therapy with secondand third-generation beta-blockers (BB) in combination with angiotensin-converting enzyme inhibitors (ACE inhibitors) and diuretics with the addition of glycemic control (GCU) on signs of subclinical glomerular and tubular damage in patients with essential and nephrogenic hypertension, stages C2 and C3a of CKD, and persistent atrial fibrillation (PAF) combined with CHF with preserved ejection fraction (pEF) in functional classes I and II, based on the dynamics of albuminuria and excretion of urinary biomarkers of tubular damage, neutrophil gelatinase-associated lipocalin (NGAL), and kidney injury molecule-1 (KIM-1), over a 3and 6-month follow-up. Design and methods. The observational study included 44 patients (12 men and 32 women, aged 42 to 76 years, mean age 56,8 ± 9,4 years) with essential and nephrogenic hypertension (with chronic pyelonephritis outside of exacerbation), with C2 and C3a stages of CKD and with PAF in combination with CHFpEF (FC I-II). All patients were divided into 2 groups according to clinical indications. In the 1st group (n = 18), combined antihypertensive therapy with ACE inhibitors, β-blockers and diuretics was carried out with simultaneous administration of CG for heart rate (HR) control. In the 2nd group (comparison, n = 26), similar antihypertensive therapy was carried out without CG, and HR was controlled by β-blockers. At baseline, 3, and 6 months, the impact of the prescribed therapy on tubulointerstitial and glomerular kidney damage was assessed in both groups based on changes in urinary concentrations of the biomarkers NGAL, KIM-1, and albumin. Results. In the group of patients with hypertension, CKD, and PAF with CHFpEF receiving CGs, an increase in mean glomerular filtration rate (GFR) and a decrease in serum creatinine levels were observed after 3 and 6 months, compared with the comparison group. Moreover, CG therapy was associated with an increase in albuminuria in all patients, which was not observed in patients receiving combination antihypertensive therapy (ACE inhibitors, beta-blockers, and diuretics) without CGs. Conclusion. The use of CGs in combination with antihypertensive therapy had a positive effect on renal nitrogen excretion in patients with hypertension and pulmonary fibrosis with CHF and was characterized by a decrease in serum creatinine and, accordingly, an increase in mean GFR. However, it was also accompanied by an increase in albuminuria. These data indicate the need for an individualized approach to CGs prescribing in patients with pulmonary fibrosis and CHF combined with HTN and CKD.

Objective. To characterize the frequency of various symptoms of pheochromocytoma/paraganglioma (PPGL) considering the clinical form of the disease and main tumor characteristics. Dеsign and methods. The study included medical records of 254 patients examined and operated for PPGL with detailed information on disease symptoms, including data obtained through standardized questionnaires. Depending on the PPGL manifestations, all patients were divided into 4 groups according to the clinical manifestations. Results. In the cohort, the most common symptoms were hypertensive crises (55,1 %), a feeling of tachycardia (54,3 %), constant increase in blood pressure (40,6 %), headache (39,4 %), sweating (32,3 %), and general weakness (28,0 %). The following symptoms were more common (Fisher's exact test with the Friedman-Hamilton extension was used) in patients with paroxysmal and mixed forms of the disease in comparison with continuous and asymptomatic forms: sensation of tachycardia (64,1 % and 61,3 % versus 25,0 % and 9,4 % for the subgroups, respectively; p < 0,001), headache (51,3 % and 35,5 % versus 16,7 % and 15,6 %; p < 0,001), dizziness (17,1 % and 25,8 % versus 0,0 % and 6,3 %; p = 0,024), hand tremor (27,4 % and 15,1 % versus 0,0 % and 3,1 %; p = 0,002), fear and anxiety (23,9 % and 25,8 % versus 0,0 % and 6,3 %; p = 0,027), feeling of hot flashes / fever or chills (30,8 % and 20,4 % versus 0,0 % and 9,4 %; p = 0,010), sweating (38,5 % and 36,6 % versus 8,3 % and 6,3 %; p = 0,001). The patients with paroxysmal or mixed forms of the disease manifested with the highest number of complaints. The total number of complaints correlated with the maximum systolic and diastolic blood pressure (BP) values, but not with the usual BP values. The classic triad of PPGL symptoms (headache, sweating, tachycardia) was present in 11,8 % of patients. Conclusion. The article provides detailed data on the symptomatology of PPGL in general and for individual clinical forms of the disease. The obtained data indicate that the main driver of clinical symptoms in PPGL is the presence of paroxysms during the disease course. Comparing to previous years, PPGL manifestations became less pronounced over time, which is likely due to improvements in PPGL diagnosis and refined diagnostic algorithms for patients with adrenal incidentalomas.

Objective. To study the relationship between increased average daily blood pressure (BP) variability before the disease and the severity of COVID-19 in hospital based on a retrospective analysis of patient records and to assess its prognostic value in patients with arterial hypertension (HTN) under Arctic shift work conditions. Design and methods. We analyzed 518 medical records of patients treated at the Gazprom Dobycha Yamburg LLC hospital in the Yamburg settlement (from June 2020 to March 2021). From these records, 94 men aged 35–59 years with HTN and confirmed COVID-19, as well as ambulatory blood pressure monitoring (ABPM) and echocardiography (EchoCG) data (October 2019) were selected. Results. Among HTN men, 18,1 % had mild COVID-19, 58,5 % had moderate COVID-19 and 23,4 % had severe COVID-19. Patients with the severe course showed differences in ABPM parameters including 24-hour diastolic BP (DBP24) variability (p = 0,045), nighttime systolic BP (SBPn) variability (p = 0,006), 24-hour and nighttime heart rate (HR24 and HRn) (p = 0,002; p = 0,049). There were differences in the number of leukocytes (p = 0,031) and monocytes (p < 0,001); glucose (p = 0,004) and amylase (p = 0,037) levels in blood plasma in hospital. With the 1-mmHg increase in DBP24 variability, the risk of severe COVID-19 increased by 1,6 times associated with the 1,5-fold increase in glucose levels and the decrease in monocyte levels by 6 %. The formula for calculating the risk of severe COVID-19 was developed: F = −1,299 + 0,460 × DBP24 variability − 0,092 × HR24 + 0,381 × Glucose − 0,492 × Monocytes (%). The area under the ROC curve was 0,909 (p < 0,001), which corresponded to excellent model quality with a cutoff point of 0,230. The model showed high sensitivity (87,5 %) and specificity (83,3 %). Conclusion. The proposed formula for calculating the risk of a severe course of COVID-19 can be used to identify high-risk groups in order to take preventive measures in time and reduce the risk of cardiovascular complications during periods of worsening epidemiological situation in a shift medical facility.

Objective. To determine the risk factors for arrhythmia recurrence after scheduled cardioversion in patients with persistent and long-standing persistent atrial fibrillation (AF) and to assess the impact of circulating biomarkers of fibrosis and inflammation on the risk of arrhythmia recurrence. Design and methods. The study included 122 patients with persistent and long-standing persistent AF who underwent either electrical cardioversion (n = 61) or pharmacologic cardioversion (cavutilide) (n = 61). The study groups were matched in terms of sex, age, and clinical characteristics. Prospective follow-up of patients was carried out for 12 months after cardioversion. Results. The efficacy of electrical cardioversion and pharmacologic cardioversion with cavutilide was comparable (53/61 (86,9 %) vs. 52/61 (85,2 %), p = 0,794). The frequency of AF recurrence within 12 months after cardioversion did not depend on the method of sinus rhythm restoration and was 31/53 (58,5 %) in the electrical cardioversion group and 26/52 (50,0 %) among patients who underwent pharmacologic cardioversion (p = 0,383). Further analysis was conducted in groups of patients with arrhythmia recurrence and those maintaining sinus rhythm for 12 months after cardioversion. The most significant clinical predictors of AF recurrence were metabolic syndrome and congestive heart failure. Analysis of instrumental and laboratory data established that patients with arrhythmia recurrence had more severe atrial dilation, diastolic dysfunction, larger values of epicardial fat thickness, and higher concentrations of blood biomarkers of fibrosis and inflammation. According to multivariate regression analysis of echocardiographic parameters, the most significant predictors of recurrence were the left atrial volume index (LAVI) and epicardial fat thickness. An increase in LAVI greater than 49,5 mL/m² increased the risk of AF recurrence after cardioversion by 2,2 times (relative risk (RR) — 2,215, 95 % confidence interval (CI) 1,396–3,517, p < 0,001), and an epicardial fat thickness greater than 4,55 mm increased the risk of arrhythmia recurrence by 2,4 times (RR — 2,420, 95 % CI 1,570–3,731, p < 0,001). Analysis of laboratory parameters revealed that the concentration of growth differentiation factor 15 (GDF-15) was most strongly associated with the risk of AF recurrence within 12 months after cardioversion (Beta — 0,001, odds ratio — 1,001, 95 % CI 1,001–1,002, p < 0,001). A blood concentration of GDF-15 more than 2432,6 pg/ml increased the risk of arrhythmia recurrence within one year by 2,6 times (RR — 2,593, 95 % CI 1,510–4,451, p < 0,001). Conclusion. The most significant predictors of arrhythmia recurrence within 12 months after cardioversion in patients with persistent and long-standing persistent AF are the following: metabolic syndrome, congestive heart failure, LAVI, epicardial fat thickness, and serum GDF-15 concentration.

Background. Clinical manifestations, remodeling of the cardiovascular system and changes in the hemostasis system in pregnant women with different body mass index (BMI) in combination with chronic arterial hypertension (CHTN) are of significant clinical interest. Obesity in pregnant women is one of the most significant causes of complications in both mother and fetus. Additional diagnostic criteria for cardiac remodeling in pregnant women with CHTN in combination with different BMI, as well as hemostasis indicators characterized by the tendency to hypercoagulation, have been identified. Objective. To identify the most significant diagnostic and differentialdiagnostic criteria of hemostasis indicators, as well as cardiovascular system remodeling, in pregnant women with CHTN combined with obesity, overweight, and normal body weight, during different periods of pregnancy. Design and methods. The study was conducted to assess the clinical condition of pregnant women with CHTN and various BMI throughout the gestation period. We analyzed a total of 2,244 individual cards of pregnant and postpartum women of the antenatal clinic (2021 — 584, 2022 — 612, 2023 — 546, 2024 — 502), and selected cards of patients (120 in total) with CHTN. In addition, we analyzed 120 outpatient records from the clinical and diagnostic department, where the patients were followed by a cardiologist. All the women were of European descent and were of young age (according to the WHO classification), ranging from 19 to 43 years old (mean age of 33 ± 1,28 years). The distribution of the groups was based on the classification of BMI. The first group (n = 68) included pregnant women with CHTN and obesity (BMI ≥ 30 kg/m2), the second group (n = 24) included pregnant women with CHTN and overweight (BMI = 25–29,9 kg/m2), and the third group (n = 28) included pregnant women with CHTN and normal weight (BMI = 18,5–24,9 kg/m2). BMI was assessed at the patient's first visit to the maternity hospital consultation (in the first trimester of pregnancy). In all women, we assessed clinical factors, laboratory and diagnostic tests, and the structural and functional state of the heart. Results. In the group of pregnant women with verified CHTN and obesity, the size of the left atrium is significantly larger than in the groups of women with CHTN and overweight or normal body weight. Additionally, pregnant women with CHTN and obesity have specific features of the hemostasis system, such as an increase in the number of platelets throughout gestation. Dynamic monitoring of hemostasis indicators showed a tendency towards an increase in the level of soluble fibrin monomer complexes (SFMC), indicating an increased tendency for the body to develop a hypercoagulable syndrome.

Primary aldosteronism is a common cause of secondary arterial hypertension; however, its recognition may be substantially complicated by concomitant chronic kidney disease. Altered regulation of the renin-angiotensin- aldosterone system (RAAS), the effects of antihypertensive therapy, and the absence of typical laboratory features may create an atypical diagnostic profile and delay diagnosis. This article presents a clinical case of primary aldosteronism in a young patient with chronic kidney disease and resistant arterial hypertension, characterized by the absence of hypokalemia and by non-suppressed renin at the initial evaluation. After confirmatory testing and withdrawal of therapy affecting the RAAS, adrenalectomy was performed, and morphological and immunohistochemical examination confirmed an aldosterone-producing adenoma. This case illustrates the limitations of standard screening criteria and highlights the need for comprehensive interpretation of clinical, laboratory, and morphological findings when primary aldosteronism is suspected in patients with chronic kidney disease.