In spite of availability of numerous drug treatments for arterial hypertension (HTN), there is a need for new approaches, especially in case of treatment-resistant forms. Available new interventional methods for HTN are briefly reviewed with focus on approaches in early stages of development beyond the most studied and discussed renal denervation: baroreflex activation therapy, carotid body ablation, arteriovenous fistula, neurovascular decompression, deep brain stimulation and spinal cord stimulation. Most of these approaches affect blood pressure level through modulation of autonomous nervous system activity. Some of them (e. g. renal denervation and baroreflex activation therapy) are modern technical modification of the methods which were used to treat HTN in the past century. Other methods (e.g. deep brain stimulation, spinal cord stimulation, arteriovenous fistula) were under development for other indications. All of these approaches are still far away from implementation in routine clinical practice. Further investigations of safety and efficacy in the randomized clinical studies are warranted together with technical optimization and definition of patients’ subgroup who will benefit from precise approach together with efficacy criteria and predictors.

The objective of this study is to evaluate the efficacy and safety of renal denervation in patients with resistant hypertension and other cardiovascular diseases. The method of renal denervation is based on radiofrequencymediated destruction of renal sympathetic nerves going within the renal artery wall. Initial clinical success of renal denervation in Symplicity I and Symplicity II trials was replaced by more cautious approach after results of Symplicity III. In this study the renal denervation resulted in reduction of blood pressure after procedure but failed to prove the significant difference between main group (renal denervation) and group with imitation of denervation (sham-procedure), which was the clinical efficacy endpoint. The safety endpoint was the incidence of 30‑day complications (vascular complications at puncture site, occurrence of renal artery stenosis, progression of renal insufficiency). There was no difference in the rate of complications between denervation group and shamprocedure group. Subgroup analysis (according to patients’ clinical and demographic characteristics) demonstrated the clinical efficacy of renal denervations in patients younger than 65 years and in Caucasian patients. There are also clinical data, indicating clinical efficacy of renal denervation in the treatment of cardiovascular diseases, associated with high activity of sympathetic nervous system: chronic heart failure, sleep apnea, atrial fibrillation, ventricular arrhythmias.

Renal denervation is a novel promising approach for resistant hypertension management and it is getting more widespread. In recent years, this procedure has been studied not only as a method of additional reduction of blood pressure in non-responders to standard antihypertensive therapy, but also as a way of influencing other syndromes and diseases, which are related to sympathetic hyperactivity. The article provides a review of clinical trials of renal denervation in patients with insulin resistance and diabetes mellitus, left ventricular hypertrophy, heart failure, obstructive sleep apnea syndrome, atrial fibrillation and chronic kidney disease. Despite the controversial results of studies of renal denervation in patients with hypertension, there are more clinical data on the positive effect of the procedure on carbohydrate metabolism, left ventricular hypertrophy reduction and ejection fraction. The results of studies of renal denervation in patients with obstructive sleep apnea syndrome, as well as in patients with paroxysmal atrial fibrillation, are very interesting, though limited. There are more data on the safety of renal denervation in patients with chronic kidney disease. There are a lot of ongoing trials of renal denervation in different cohorts.

Objective. To assess the impact of the position-dependent changes of the main renal venous blood flow on systolic blood pressure (SBP).

Design and methods. We measured blood pressure, blood flow in the renal veins, and resistance index in patients with pathological kidney mobility (PKM). Based on the difference between the maximum and minimum velocity of renal venous blood flow several groups were identified, namely, groups with normal venous blood flow, with borderline and severe alterations of venous outflow. Based on the sum of the rotation angles (according to the excretory urogram and ultrasonography wedge and tilt test in three planes), patients were divided into three groups: I rotation degree — sum of rotation angles 40°, II — from 40° to 70°, III — 70° and above.

Results. We found a relation between SBP and both velocity and resistance indices in both renal vessels. There is an increase in the incidence and amplitude of SBP fluctuations in patients with all rotation degrees with the direct association with the severity of PKM. The classification of PKM patients based on the sum of rotation angles measured by ultrasound and Doppler examinations is highly efficient, and the accuracy was 89,13%.

Conclusions. The changes in renal veins seem to contribute to the SBP elevation. The measurement of BP in six static states can enable new insight on the physiological BP changes and will help early diagnostics and verification of pathogenic factors responsible for the development of hypertension in patients with PKM and position-dependent changes of the main renal venous flow.

Objective. The purpose of this work was to study how selective activation of сentral adrenergic and imidazoline receptors influence functional state of the blood baroreceptor reflex (BR) in the short and long-term regulation of blood pressure (BP) at rest and under emotional stress.

Design and methods. Experiments were conducted on awake Wistar rats. Clonidine (1 and 10 mg/kg) was used for adrenergic receptors activation, moxonidine (10 and 100 mg/kg) was used for imidazoline receptor activation. Emotional stress was caused by sound signal (a ring).

Results. Studies demonstrated that the activation of central imidazoline receptors does not change BP level, while alpha 2‑adrenergic systems play a major role in the central regulation of vascular tone and cardiac function. Both imidazoline and alpha 2‑adrenergic systems participate in functioning of baroreceptor reflex.

Conclusions. Emotional stress-associated imidazoline receptor activation restores initial BR and reduces BP elevation in rats. Alpha 2‑adrenergic systems do not have a significant impact on cardiovascular manifestations of emotional tension.

Objective. The aim of this study was to investigate the vessels and stroma in renal tubulointerstitium in IgAnephropathy.

Design and methods. The coefficient of arterial obstruction was assessed. The laboratory and pathological studies (including immunohistochemistry CD31 and quantitative/semi-quantitative assessment of pathohistopathological changes: atrophy of tubules, local sclerosis, perivascular sclerosis, sclerosed glomeruli, the coefficient of obstruction of the arteries with a diameter greater than 100 microns) were performed.

Results. The serum creatinine level inversely correlated with the obstruction coefficient (r = –0,83, p < 0,05), and positively— with perivascular sclerosis (r = 0,64, p < 0,05). There was a statistically significant positive correlation between CD31+ and creatinine (r = 0,60, p < 0,05), and between CD31+ and arterial obstruction coefficient (r = –0,75, p < 0,05).

Conclusion. The results suggest that the changes in the vascular structure, and therefore the hemodynamic in renal parenchyma may be responsible for fibrosis in the tubulointerstisium in IgA-nephropathy.

Objective. To study clinical differences of arterial hypertension (HTN), to conduct both standard comparative analysis of 24‑hour blood pressure (BP) monitoring and cosinor-analysis for chronobiological assessment of HTN circadian rhythms in shift workers of the Arctic polar region and native residents of Tyumen city.

Design and methods. Altogether 373 patients with HTN stage I–II (control group) and 144 patients with HTN stage I–II (comparative group) were examined and underwent 24‑hour BP monitoring, echocardiography, brachiocephalic artery ultrasound, treadmill ergometer test, 24‑hour ECG Holter monitoring.

Results. In the conditions of Arctic shift work, clinical implications of HTN were more evident and associated with structural heart alterations, high frequency of atherosclerosisin brachiocephalic arteries, dyslipidemia, low exercise tolerance and level of adaptive potential. In northern citizens with HTN circadian BP profile was associated with low circadian rhythm indices, high BP variability, mainly night hyperbaric overload that explains high frequency of HTN circadian BP profile («non-dipper» and «night-peaker»). Chronobiological disturbances in HTN circadian rhythm in shift workers was caused by the malfunction of correspondence in internal and external cueing of physiological processes (desynchronosis) influenced by the conditions of shiftwork.

Objective. To evaluate the lipid disorders and expression of fibroblast growth factor 21 in young and middleaged men with multiple cardiovascular co-morbidities.

Design and methods. The study included 40 men with cardiovascular diseases (CVD) and 10 healthy men. All participants underwent complex psychological tests, laboratory and instrumental cardiovascular assessment. Fibroblast growth factor 21 (FGF21) was measured by ELISA using BCM Diagnostics SK00145–01 kits (BCM Diagnostics, USA).

Results. The level of FGF21 was 3‑fold higher in patients with CVD (269,02 ± 27,4 ng/l) compared to the 1st control group (94,87 ± 12,3 ng/l). The FGF21 level was 224,02 ± 15,3 ng/l in the group with CVD without anxiety-depressive symptoms (2nd group), 350, 54 ± 25,3 ng/l in CVD patients with anxiety (3rd group), and 756,1 ± 38,7 ng/l in CVD patients with depressive symptoms (4th group). In patients with CVD there was a decrease in Apo A‑I (159,76 ± 15,6 mg/dl) and Apo C–II (10,02 ± 3,7 mg/dl) compared to the control group (184,3 ± 193 and 41,1 ± 9,5 mg/dL, respectively). Also there was an increase in Apo B (119,62 ± 18,1 mg/dl) and Apo C–III (10,86 ± 4,2 mg/dl) compared to the controls (96,9 ± 11,8 and 3,9 ± 1,1 mg/dl, respectively). FGF21 correlated with serum Apo C–III, total cholesterol and low density lipoprotein cholesterol, triglycerides and Apo C–II.

Conclusions. Patients with multiple cardiovascular co-morbidities have a 19% increase in Apo B and a 3‑fold increase in Apo С–III (with the subsequent increase in the ratio “Apo B/Apo A‑I”). Thisis associated with the reduction of Apo A‑I for 13,3%, a 4‑time decrease in Apo С–II, and a three-fold increase in FGF21 compared to the controls and may increase the risk of cardiovascular complications. Serum level of FGF21 positively correlates with Apo C–III, total cholesterol and low-density lipoprotein cholesterol, triglycerides and Apo C–II, while there was no evidence of a link with Apo A‑I, Apo B, high-density lipoprotein cholesterol. FGF21 is strongly correlated with the severity of dyslipidemia and may be considered an independent marker of lipid metabolism impairment.

Background. To date, the response of blood pressure to the increased salt intake, which is considered to be a cardiovascular risk factor, and, in particular, arterial hypertension (HTN), is well investigated. The threshold of salt sensitivity (TSS) is a usual measure to assess the level of nutritional sodium intake. However, existing methods for evaluating nutritional sodium intake are difficult to implement in routine practice.

Objective. To develop a rapid method for the salt sensitivity threshold determination in clinical practice.

Design and methods. The first phase of the study was the comparison study of the developed method with test strips (12 and 3) and the Henkin’s method (12 sodium chloride solutions) in healthy volunteers. Depending on TSS all subjects were divided into 3 groups: low TSS — less than 0,16%, average — 0,16%, high — more than 0,16%. The second stage of the study included the TSS determination by the 12 test-strips in 40 men with masked HTN (1st group) and 59 men without diagnosed CVD (2nd group — healthy individuals).

Conclusions. Rapid method by the use of test strips is comparable with the original Henkin’s method, is easy to carry out and can be conducted using 12 or 3 test strips. TSS depends on age (increases in people older than 40 years) and on the presence of cardiovascular disease (for example, masked HTN).

RETRACTED

The recent guidelines by European Society of Cardiology and European Society of Hypertension (2013) recommend measurement of systolic central blood pressure in diagnostics ofisolated systolic hypertension in young adults. Enhanced amplification of pulse pressure is common in young people, resulting in the increased systolic peripheral blood pressure, while central blood pressure is remaining unchanged. The article reports on the case of spurious systolic hypertension in young male led to the error in the findings of occupational medicine experts. Measurement of central aortic blood pressure solved the problem. Isolated systolic hypertension in young adultsis not true hypertension, and it should not be considered as a limitation for professional and other activities.

This article reviews some issues related to the long-term administration of antithrombotic drugs for primary and secondary cardiovascular prevention. It does not address initial management of acute coronary syndromes or periprocedural use of antithrombotic therapies. We review the pros and cons regarding acetylsalicylic acid (ASA) therapy in primary prevention based on the available evidence, including recent data linking ASA with cancer protection. We do not include other antiplatelet therapies (e. g., clopidogrel alone or in combination with aspirin) or oral anticoagulation (e. g., warfarin), because they are not likely to be used in primary prevention setting. Recent guidelines depend on the accurate assessment of cardiovascular risk as part of decision-making process. While awaiting the results of several ongoing studies, we argue for a pragmatic approach to use low-dose ASAin primary cardiovascular prevention and discussits use in patients at high cardiovascular risk. Patients with diabetes mellitus are known to have an increased risk of cardiovascular events. Low dose ASA is recommended for secondary prevention, as for primary prevention it can be prescribed in patients with diabetes mellitus and at high cardiovascular risk. Antiplatelet therapy is the standard of care for the secondary prevention of coronary artery disease and ischemic stroke. However, it is associated with increased risk of bleeding, first of all gastrointestinal bleeding. Prescription of proton pump inhibitors along with antiplatelet therapy reduces the risk of upper gastro-intestinal bleeding.