Various factors contribute the development of cardiovascular complications in type 2 diabetes mellitus (DM2): hyperglycemia and components of insulin resistance syndrome, including obesity, dyslipidemia and arterial hypertension. All of them should be considered in therapeutic strategies. In the beginning of 21st century new pharmacological agents were developed leading to the major changes in DM2 treatment. So, an ideal treatment should have not only a glucose-lowering effect, but other (“non-glycemic”) actions affecting multiple coexistent factors. Since the novel classes of antidiabetic drugs with additional favorable pleiotropic effects independent from direct glucose-lowering effect have been introduced, the choice of an appropriate agent has become more complicated and requiresindividual approach and wide knowledge in this area. The present articles reviews various groups of glucose-lowering agents and their effects on blood pressure level in DM2 patients. We believe it will help to make the right individual choice of an antidiabetic agent taking into account its pleiotropic effects.

Adipose tissue plays a crucial role in the regulation of energy homeostasis, insulin sensitivity, and lipid/carbohydrate metabolism. These actions are mediated by both actions of a number of non-secreted proteins and hormones produced in adipocytes. Adipose tissue is a complex, essential and highly active metabolic and endocrine organ. It does not only respond to afferent signals from hormone systems and the central nervous system but also produces and secrets factors with important endocrine functions. These factors include leptin, adiponectin, resistin, cytokines, complement components, plasminogen activator inhibitor‑1, proteins of the renin-angiotensin system. Adipose tissue is also a major site for metabolism of sex steroids and glucocorticoids. Hormones produced by adipose tissue play a critical role in the regulation of energy homeostasis, lipid and carbohydrate metabolism, reproduction, cardiovascular function and immunity. The hormones (leptin, adiponectin, resistin) and cytokines (tumor necrosis factor-α, interleukin‑6) produced by the adipose tissue are the link between obesity and obesity-related complications. A review discusses the role of these hormones in the regulation of energy homeostasis and insulin action. This article presents an overview of the endocrine functions of adipose tissue and discusses the structure, function and clinical significance of adipokines. The purpose of the present review is to summarize the most important aspects of the biology, actions, and regulation of these hormones and to give an updated concept based on recent publications.

Estrogens do not only play an important role in functioning of cardiovascular system but are also involved in various pathological processes. Currently, the problem of interaction between estrogens and immune cells involved in atherosclerosis is crucial. Decline in estrogen levels is associated with low-grade chronic inflammation and high risk of cardiovascular disease and mortality. However, the data on the interactions between estrogens and immunocompetent cells are contradictory. The present review summarizes the results of global studies and assesses their contribution toward better understanding of molecular mechanisms underlying anti- and proatherogenic effects of estrogens. On the basis of recent experimental and clinical data we review molecular aspects of interaction between estrogens and different types of estrogen receptors expressed by macrophages, cardiac mast cells and dendritic cells. The problem of oppositely directed (anti- and proatherogenic) effects of hormonal influence is discussed. Clinical rationale for further studies is given.

Objective. To evaluate effects of hormone replacement therapy with drospirenone on cardiovascular system in postmenopausal hypertensive women.

Design and methods. Sixty-three postmenopausal women with hypertension I–II degree, abdominal obesity and climacteric syndrome were examined. During the first month all patients received telmisartan, then women were randomized into two groups — the first group (n = 30) continued treatment with telmisartan, participants of the second group (n = 33) took hormone replacement therapy: estradiol hemihydrates 2 mg + drospirenone 1 mg (HRT) in addition to antihypertensive therapy. Weight, anthropometric measurements, blood pressure (BP), diastolic function were evaluated.

Results. There were additional BP lowering effect, significant decrease in weight and abdominal obesity parameters in group treated with HRT. Improved diastolic function of the left ventricle was more marked in HRT group, but there were no significant differences between two groups.

Conclusions. HRT with drospirenone has beneficial effects on cardiovascular system in postmenopausal hypertensive women with abdominal obesity.

Objective. To examine the rate of insulin resistance (IR) in groups of different cardiovascular risk in hypertensive patients and to evaluate the effect of IR on risk factors and vascular lesion.

Design and methods. The study included 150 patients (82 men and 68 women). Patients were divided into five groups: groups 1–4 included patients with hypertension (HTN) and different level of cardiovascular risk (the SCORE model), 5th group was the control group. Each of the groups was divided into 2 subgroups: patients with and without IR.

Results. IR was verified in all groups of cardiovascular risk, but it was predominant in very high-risk patients. IR correlated with body mass index and hypertriglyceridemia. IR rates were equal in middle- and high-risk patients. IR was associated with myocardial remodeling in high-risk group.

Conclusions. HOMA-IR index is an important biological marker of the presence of cardiovascular risk factors in hypertensive patients. We believe that an estimate of IR may help to personalize health care and improve the prognosis of hypertensive patients, even in patients without clinical manifestations of IR and impaired glucose metabolism. Further research is needed to study the role of identifying IR in the definition of medical approaches in HTN

Background. Increased renin-angiotensin-aldosterone system (RAAS) activity plays an important role in hypertension development. However, the associations between RAAS, hypertension and vitamin D status are not completely elucidated.

The aim of this study was to assess the role of vitamin D in hypertension development.

Design and methods. We studied blood pressure (BP), plasma aldosterone concentration (PAC) and plasma renin activity (PRA), PAC/PRA ratio, serum 25 (OH)D and parathyroid hormone (PTH) levels in 657 women aged between 30 and 55 years.

Results. We did not find differences in PAC, PRA and PAC/PRA ratio in women with hypertension and normal blood pressure level. The serum 25 (OH)D and PTH levels were comparable in hypertensive and normotensive women (48,95 ± 2,09 vs. 47,61 ± 1,03 nmol/l, p > 0,05, and 42,42 ± 2,76 vs. 40,68 ± 1,28 ng/ml, p > 0,05, respectively). A positive correlation between PTH level and PAC/PRA ratio (r = 0,25; p = 0,008) in normotensive subjects was found. There is a negative correlation between 25 (ОН)D level and PAC (r = –0,23, p = 0,01), PRA (r = 0,22, p = 0,02) in women with abdominal obesity, and a positive correlation between PTH level and PAC/PRA ratio (r = 0,51, p = 0,03) in non-obese women.

Conclusions. The results of this study demonstrate a possible role of vitamin D deficiency in hypertension development.

Objective. To determine whether cardiac autonomic neuropathy (CAN) influences the development of arterial hypertension (HTN) in patients with type 1 diabetes mellitus (T1DM).

Design and methods. We examined 60 patients with T1DM (37 women and 23 men, mean age 40,3 ± 1,3 years) and 40 healthy controls (21 women and 19 men, mean age 30,0 ± 0,6 years). Clinical symptoms of CAN as well as instrumental parameters were assessed. The following methods were used: spectral analysis of heart rate variability, blood pressure changes during tilt-test, the Valsalva maneuver, test with deep respiration, hand-grip and cold-pressor test, an index 30/15, arterial and cardiopulmonary baroreflexes. Blood pressure monitor (Finometer) and occlusion plethysmograph (Dohn) with parallel registration of electrocardiogram were used for data assessment.

Results. Clinical symptoms of CAN had 39 patients with T1DM (65%), in 30 of them CAN was confirmed by instrumental methods. In 9 patients without clinical manifestations CAN was diagnosed instrumentally. The most frequent disorders in T1DM patients were the reduction of spontaneous arterial baroreflex (69%), cardiopulmonary baroreflex (64%), and heart rate variability (49%). HTN was diagnosed in 37 T1DM patients (62%) and was more frequent in patients with autonomic dysfunction (р < 0,05).The patients with CAN had longer duration of HTN (5,7 ± 2,80 vs 2,3 ± 2,80 years, р < 0,05) and higher HTN degree (χ2 = 8,06, р < 0,01) than patients without CAN.

Conclusions. Cardiac autonomic neuropathy contributes to the development of HTN in T1DM patients. Implementation of instrumental methods for timely diagnosis of CAN is reasonable in T1DM patients.

Objective. To analyze relationship between thyroid status and target organ damage system in patients with arterial hypertension in combination with primary hypothyroidism (subclinical and compensated).

Design and methods. We enrolled 42 women with primary hypothyroidism and concomitant hypertension aged from 50 to 75 years old. Patients were divided into two comparable groups, the first group included 24 hypertensive patients with subclinical hypothyroidism, the second group included 18 hypertensive patients with compensated hypothyroidism. All patients underwent echocardiography and assessment of endothelial function. Lipids were measured in all patients.

Results. Target organ damage, including left ventricular hypertrophy, left ventricular diastolic dysfunction, and endothelial dysfunction were comparable in both groups. The associations between thyrotrophic hormone and the levels of cholesterol and triglycerides were also similarin both groups.

Conclusions. Subclinical hypothyroidism is neither associated with worsening of hypertension-related target organ damage, nor affects significantly lipid profile.

Background. Thyroid hormones regulate vascular contractility and relaxation. Subclinical hypothyroidism (SH) can cause arterial stiffness and an increase in peripheral vessel resistance. It can lead to atherogenic dyslipidemia, hyperhomocysteinemia and potentiate atherogenesis in coronary artery disease (CAD) and hypertension (HTN).

Objective. To study thyroid function in CAD and HTN, as well as its role in atherogenesis and to specify indications for screening.

Design and methods. We examined 870 CAD patients, who underwent coronarography. Height, weight and body mass index (BMI) were assessed in all participants. The HTN degree was evaluated based on history data. Lipid profile and homocysteine level were assessed before coronarography. Thyroid-stimulating hormone (TSH) level was measured by reagents of 3 generation in order to evaluate thyroid function.

Results. Seventy percent of enrolled patients were overweight or obese. Obesity rate was 2-times higherin women than in men. Obese patients more often had HTN 2–3 degree (32,5%), than patients with normal BMI (14,3%). SH was diagnosed in 12,1%. There was a positive correlation between BMI and TSH in all groups. SH was associated with atherogenic dyslipidemia, hyperhomocysteinemia, and multiple coronary lesions. SH patients had higher risk of HTN. Conclusions. TSH level should be assessed in all patients at cardiovascular risk.

Background. Hypertension (HTN) is an independent factor of cardiovascular morbidity in acromegalic patients. Obstructive sleep disordered breathing (SDB) is the most common respiratory impairment in acromegaly and is considered one of the mechanisms underlying the development of HTN in acromegaly.

Objective. Тo assess blood pressure (BP) parameters and prevalence of HTN in naive acromegalic patients depending on the presence of moderate-to-severe SDB.

Design and methods. Forty-eight naive acromegalic patients [11 men, 37 women, median age 53,5 (27–76) years] were recruited into the study. All subjects underwent clinical examination including office BP measurement, full polysomnography, twenty-four-hour BP monitoring (24‑hour BPM).

Results. SDB, namely obstructive sleep apnea (OSA), was found in 36 (75%) patients. Thirteen patients (36%) had mild, eleven (31%) — moderate and twelve (33%) showed severe OSA. The latter two groups (moderate-to-severe OSA, further referred as patients with OSA) were compared to patients without OSA (non-OSA). In patients with OSA office diastolic BP was significantly higher than in patients without OSA (р < 0,03). According to 24‑hour BPM mean 24‑hour, daytime and nighttime BP levels were significantly higher in patients with OSA as compared to non-OSA subjects. The rate of elevated office (χ² = 3,85; р < 0,05), mean 24‑hour (χ² = 4,8; р = 0,03) and nighttime BP (χ² = 5,23; р < 0,03) was significantly higher in OSA group, while the frequency of daytime HTN was similar in both groups.

Conclusions. According to the office measurement and 24‑hour BPM the BP parameters and HTN prevalence were higher in patients with OSA. According to our data, a polysomnography study should be recommended in patients with newly diagnosed acromegaly in order to detect ones at higher risk of HTN development

Background. Obese adolescents are at a greater risk of vitamin D deficiency, which is related to bone and metabolic changes. Vitamin D deficiency is associated with a higher prevalence of metabolic syndrome, type 2 diabetes mellitus in children and adolescents.

Objective. To evaluate efficacy and safety of 3‑and 6‑month therapy with 1500 IU and 2000 vitamin D months in obese children and adolescents, and to assess whether increased circulating 25‑hydroxyvitamin D (25 (OH)D) level is associated with improved markers ofinsulin sensitivity and resistance, serum leptin and adiponectin levels and reduction of body mass index (BMI).

Design and methods. Altogether 66 obese children and adolescents (mean age — 12,6 ± 2,2 years; BMI — 32 ± 6,22 kg/m2 , 25 (OH)D: 16,7 ± 5,58 ng/ml) were recruited from the Pediatric Endocrinology Unit from Almazov North-West Medical Research Centre and were assigned to receive either vitamin D3 (1500 IU/day and then 2000 IU/day) as a part of their standard care. Anthropometric parameters, adipokines (leptin, adiponectin), fasting glucose, insulin, triglyceride levels and HOMA-IR (Homeostasis Model Assessment of Insulin Resistance) were measured at baseline and at 2 follow-up visits at 3 and 6 months.

Results. Vitamin D deficiency has a high prevalence in both obese and non-obese children from St Petersburg. Vitamin D 1500 IU per day was prescribed to obese children for 3 months followed by 2000 IU per day during subsequent 3 months. At 3 and 6 months vitamin D supplementation was associated with an increase in the serum levels of 25 (OH)D, adiponectin and insulin sensitivity. However, BMI and serum leptin level remained unchanged in the majority of children. The unfavourable changes in some of the indices in 6 month might be due to the decreased adherence to treatment.

Conclusions. Diet vitamin D supplement (1500 and 2000 IU/day) is effective to normalize plasma level of 25 (ОН)D in 40% of children. It leads to an increase in adiponectin level and a decrease in HOMA-IR and triglyceride level, but it does not affect BMI. Diet vitamin D supplement may be an effective additional approach to obesity management associated with the favourable metabolic and cardiovascular effects.

Objective. To study some markers of endothelial dysfunction depending on the type of autonomic system activity in patients with chronic prostatitis.

Design and methods. Altogether 183 patients with chronic prostatitis were enrolled. The following parameters of endothelial function were assessed: endotheliocyte count, nitrate and nitrite content, concentration of von Willebrand factor.

Results. Autonomic imbalance was found, and increased sympathetic activity (sympathotony) was verified in 70% cases. The level of nitrates and nitrites is decreased, while the concentrations of von Willebrand factor, endothelin and homocystein were increased. Reactive hyperemia test showed lower brachial artery dilation in patients with increased sympathetic activity, as well as the decreased sensitivity of brachial artery to the shear stress.

Conclusion. Endothelial dysfunction is characterized by the increased level of von Willebrand factor, endothelin and homocystein in patients with chronic prostatitis. The activation of sympathetic nervous system plays the key role in the pathogenesis of endothelial dysfunction in patients with chronic prostatitis.