Objective. To determine the role of the sympathetic nervous system in the genesis of vasorenal hypertension.

Design and methods. In Wistar rats renovascular hypertension was created by renal artery (RA) clipping in the model of “two kidneys — one clip”.

Results. A stable blood pressure (BP) increase was observed only in
38 % of rats with clipped left RA. Preceding left kidney denervation did not prevent hypertension development, but successive transection of right renal nerve led to the decrease of BP in rats with vasorenal hypertension.

Conclusions. Based on our experiments, we suggest that different mechanisms are involved in the genesis of vasorenal hypertension, and changes in the activity of the sympathetic nervous system are important factors contributing to the BP increase as a result of afferent signals from ischemic kidneys.

The discovery of the epigenetic regulation and the existence of trans-generation transfer of epigenetic changes became a revolutionary finding in modern medicine. These changes are mediated by environmental factors and lifestyle. The understanding of the underlying mechanisms elucidated pathogenesis of some non-infectious chronic pathologies including the diseases of musculoskeletal system, autoimmune diseases, tumors, psychiatric disorders, neurodegenerative disorders. Later, the epigenetic mechanisms were shown to play role in the development of cardiovascular diseases and diabetes mellitus. Nowadays the main, fundamental mechanisms of epigenetic regulation are established, and potential therapeutic approaches targeted at various epigenetic components are under development. This paper reviews different molecules that are studied and are approved. The studies in cardiovascular diseases are ongoing. Epigenetic mechanisms are involved in development of cardiovascular events, and other pathologies, as well as in regeneration of damaged organs and tissues, in the maintenance of pluripotent and regenerative characteristics of cell populations. Collected data will help to understand disease pathogenesis and to develop new prevention and treatment approaches.

Objective. To study and compare the daily changes of parameters of central pulse wave (PW) with the traditional indicators of 24‑hour ambulatory blood pressure monitoring (ABPM) on the brachial artery (BA) depending on daily profile in different age groups.

Design and methods. Successful ABPM of brachial and central BP (> 85 % valid readings) was performed by oscillometric BPLab VASOTENS system (“Petr Telegin”, Nizhniy Novgorod, Russia) in 84 untreated hypertensive subjects (mean age 55,8 ± 9,6 years, male 36,9 %, clinical BP 152,6 ± 9,2 / 94,8 ± 8,2 mm Hg). The device allows to derive aortic BP and augmentation index (AIx) from brachial PW. Gender differences of central BP and AIx were evaluated in different age groups: < 55 (14 men, 23 women), 55–60 (7 men, 16 women), 61–70 years (10 men, 14 women). Differences were considered significant at p < 0,05.

Results. Nighttime central BP was disproportionately higher than daytime values, proven by a smaller difference between BP in BA and the aorta at night compared to daytime parameters. AIx@75 was higher at night than during day. The differences between systolic BP (SBP) and BP in BA and the aorta was 10,4 ± 2,2 and 11,4 ± 1,0 mmHg in daytime and lower at night — 8,1 ± 2,0 and 9,0 ± 1,8 mmHg. The number of non-dippers and night-pickers according to aortic SBP values was greater than according to SBP assessed in BA. Men had slightly higher levels of brachial and aortic SBP than women. More profound nocturnal decline of brachial and aortic SBP was found in in women than in men. Despite comparable heart rate, AIx@75 was higher in women at all time periods, however, nocturnal increase in AIx@75 was significantly more evident in men.

Conclusions.Central BP was disproportionately higher at nighttime than during the day, proven by a smaller difference between BP in BA and the aorta at night than during the day. AIx and its diurnal variation are characterized by gender-associated differences across all age group and are dependent on SBP daily profile. This finding should be considered when interpreting the results 24‑hour monitoring of central BP and requires

further investigation of its prognostic value.

Objective. To study the relationship between arterial stiffness, augmentation index and the structure of the carotid arteries with daily blood pressure (BP) profile in patients with essential hypertension (HTN).

Design and methods. Altogether 155 patients with HTN aged 30–70 years were examined. A physical examination, glucose, creatinin level and lipid profile (low- and high-density lipoproteins, and triglycerides) (biochemical analyzer Sinсhron SX‑4 DELTA, Beckman, USA), duplex scanning of carotid arteries (Sequoia‑512, Acuson, USA), and arterial stiffness assessment by pulse wave contour analysis (Angioscan‑01, Angioscan, Russia) were performed.

Results. Augmentation index was associated with the nocturnal BP reduction in hypertensive males, but not females. In males, augmentation index was 6,8 ± 11,5 %, 12,7 ± 10,9 % and 14,5 ± 7,7 % for the dippers, nondippers and night-peakers, respectively (p < 0,05–0,01). In females, it was 19,9 ± 9,4 %, 20,7 ± 8,2 % and 17,1 ± 9,9 %, respectively (p > 0,05). The lowest values of augmentation index (15,6 ± 14,8 % versus 21,6 ± 13,4 % for non-dippers, p < 0,02) were found in patients with normal circadian BP profile. In addition, more severe carotid atherosclerotic lesions were found in non-dippers (23,2 ± 18,8 %) compared to dippers (13,7 ± 14,5 %, p < 0,01).

Conclusions. Patients with HTN and abnormal circadian BP profile show higher augmentation index and more severe atherosclerotic lesions in carotid arteries.

Objective of the present study was to estimate the concentrations of methylated derivatives of L‑lysine and L‑arginine in patients with blood circulation disorders.

Design and methods. We examined plasma samples of 151 patients with cardiovascular diseases, including 86 patients with aortic aneurysm and 47 with aortic stenosis, as well as normal subjects divided in two age groups. The concentrations of trimethyl-L‑lysine (TML), symmetric dimethyl-L‑arginine (SDMA) and asymmetric dimethyl-L‑arginine (ADMA) were determined by liquid chromatography after solid phase extraction.

Results. Decreased TML level was found in all patients, regardless
of diagnosis, but there was an increase in ADMA and SDMA concentrations in comparison to healthy individuals (p < 0,001). These changes were accompanied by an increase in the concentration of lactic acid. TML decline was lower in the subgroup of patients with aortic stenosis compared to the subgroup with aortic aneurysm (p < 0,05), and there was no difference in lactate/pyruvate ratio and homocysteine level compared to healthy people. No significant correlations between TML and ADMA, TML and SDMA were found.

Conclusions. Patients with different cardiovascular disorders demonstrate an altered level of markers of mitochondrial and endothelial dysfunction. Determination of blood TML level allows monitoring of protein methylation in the body. Being a precursor of carnitine, TML may characterize the changes in fatty acids transport relating to mitochondrial dysfunction development.

Objective. To compare the efficiency of atorvastatin monotherapy and combined therapy (atorvastatin and fenofibrate) in type 2 diabetes mellitus (T2DM) depending on the genotype of S19W apolipoprotein A5 gene polymorphism (APOA5).

Design and methods. Altogether 135 patients with T2DM were enrolled, 114 women and 21 men (mean age 59,3 ± 0,3 years) taking biguanides, with HbA1c < 8,0 %. None of them received lipid-lowering therapy. Clinical data, serum lipids and genetic variants of АPOА5 were assessed. Atorvastatin monotherapy (20 mg/day/3 months) was initially prescribed with subsequent change to the combination therapy by atorvastatin and fenofibrate (20 mg + 145 mg/day/3 months).

Results. Three-month monotherapy led to a significant reduction in triglycerides (TG) and very low density lipoproteins cholesterol (VLDL-cholesterol) levels in patients with SS genotype compared to carriers of SW genotype (p = 0,015 and p = 0,025, respectively). At the same time, after 3‑month combination therapy no differences were found between АPOА5 variants. There was a trend towards greater reduction in total cholesterol, TG, and VLDL-cholesterol in SW-carriers compared to SS-carriers. There was a paradoxical decrease in high density lipoproteins cholesterol (HDL-cholesterol) in patients with SW genotype, while it remained unchanged in patients with SS genotype.

Conclusions. Our results suggest that polymorphic variants in АPOА5 may affect pharmacogenetics of lipid-lowering therapy in T2DM.

Objective. To assess the screening prognostic indicators of cardiovascular system, basic types of metabolism in young males with prehypertension, depending on the values of glucose 1‑hour after glucose load in standard oral glucose tolerance test (OGTT).

Design and methods. The study included 105 patients with prehypertension who had fasting euglycemia, normal glucose tolerance and did not suffer from cardiovascular or other clinically relevant internal diseases. Based on the results of OGTT study participants were divided into two groups according to plasma glucose level 1‑hour after glucose load. The 1st group included 58 patients with one hour post-load glucose level < 8,6 mmol/L (mean age 38 ± 5 years). The 2nd group included 47 patients with one hour post-load glucose level ≥ 8,6 mmol/L (mean age 39 ± 5 years). The groups were matched by gender, age, body mass index, office blood pressure. Hemodynamic, electrocardiographic, echocardiographic and laboratory biochemical parameters were evaluated. The obtained data were processed using Statistica for Windows (version 10.0). Student t‑test and Pearson correlation were applied (criterion χ 2).

Results. We found significant differences in serum uric acid levels (p = 0,005) and the ratio apolipoprotein B / apolipoprotein A1 (apoB/apoA1, p = 0,04) between groups 1 and 2.

Conclusions. Young males with early post-load hyperglycemia and prehypertension are characterized by unfavorable lipid and purine metabolism changes in the absence of structural-functional cardiovascular alterations.

Background. Physiological pregnancy from conception to birth affects both the woman’s body as a whole and cardiovascular system, in particular. In some cases, there is a failure of adaptive mechanisms of the cardiovascular system without clinical manifestations. As a consequence, such complications as pre-eclampsia, hypertension, pregnancy, fetal growth retardation syndrome and others can develop.

Objective. To evaluate the indicators of arterial rigidity, and their association with blood pressure, heart rate, age, parameters of Doppler study of uterine arteries during pregnancy and after delivery.

Design and methods. In a cohort prospective study, 31 women with physiological pregnancy without somatic pathologies were included (age from 19 to 34 years, mean age 26 years). The following parameters were assessed: arterial stiffness and Doppler study of uterine artery blood flow, anthropometric and clinical indicators.

Results. On average, the studied values vary within 7 % during pregnancy. There was a significant association between age and augmentation index, arterial rigidity index in the second trimester. Pulse wave velocity increases by the third trimester, and returns to the baseline values in postpartum period. Arterial rigidity index increases throughout gestation period. In the third trimester, uterine artery hemodynamics (including the systolic-diastolic ratio, pulse index and resistance index) varies depending on the time of the reflected wave propagation. In the early postpartum period, augmentation index decreases, at the same time heart rate raises significantly. A strong association between arterial rigidity index and the time of the reflected wave propagation is observed.

Conclusions. The indicators of arterial stiffness, measured by the used technique, demonstrate adaptive changes during pregnancy and are promising to forecast potential cardiovascular diseases associated with arterial elasticity changes.

Objective. The objective of this research was to estimate frequency of vitamin D deficiency and insufficiency in pregnant women with preeclampsia.

Design and methods. This is a cohort retrospective and prospective study. From September 2013 to June 2014 we enrolled 99 pregnant women (mean age 29 ± 2,1 years) with preeclampsia (main group, n = 48) and with physiological pregnancy (control group, n = 51). Blood samples were taken from all women for 25 (ОН)D detection. All patients were citizens of St Petersburg and Leningrad region. All of them took multivitamin complex containing vitamin D 400 IU.

Results. Vitamin D deficiency was found in 73 % of women in the main group, while there was not a single case of vitamin D deficiency among controls. The occurrence of vitamin D insufficiency was 25 % and 14 % in the main and control groups, respectively. Only 2 % of women in the main group had normal level of vitamin D, while the rate of normal vitamin D level achieved 86 % in the control group (p < 0,0001).

Conclusions. The frequency of serum vitamin D insufficiency (less than 30 ng/ml) is 2,5‑fold higher in pregnant women with preeclampsia than in control women. The role of vitamin D level (insufficiency and deficiency) as a risk factor for preeclampsia development should be considered in pregnancy.

Objective. To assess the prevalence of metabolic syndrome (MS) and its components in residents of Kaliningrad.

Design and methods. We examined 312 people, stratified by sex and age: 151 males (48,4 %) and 161 females (51,6 %). All subjects were interviewed using a questionnaire. Physical examination included anthropometry (waist and hip circumferences, weight, height), and blood pressure measurements. Fasting plasma lipids and glucose were assessed in all subjects (Hitachi‑902, Roche reagents). MS was defined according JIS (2009) criteria.

Results. The prevalence of hypertriglyceridemia differ significantly in men and women — 51,0 and 34,8 %, respectively (p = 0,004), the prevalence of MS was significantly higher in men compared to women in the youngest (25–34 years) age group (53,3 and 16,6 %, respectively, p = 0,003) and older (65–74 years) age group (75,9 and 46,7 %, respectively, p = 0,02). A significantly lower prevalence of MS (16,6 %) was found in women aged 25–34 compared to the age group 45–54 (63,6 %) and 55–64 years (62,2 %) (p = 0,03 and p = 0,02, respectively).

Conclusions. In a sample of residents of Kaliningrad MS and its components are highly prevalent, in particular, high prevalence of hypertriglyceridemia was found in men compared to women. Significantly higher prevalence of MS was found in in the youngest and the oldest age group of men compared to women. The prevalence of MS in women significantly increases with age, reaching maximum at the age of 45–64 years.

Conditions of early development largely determine the occurrence of chronic diseases in the remote life period. The impairment of perinatal nutrition could promote the development of metabolic disorders and cardiovascular complications in the adult life. Metabolic status, arterial stiffness, target organ damage and genetic biomarker (telomere length of peripheral leucocytes) are described in two patients who survived the Siege of Leningrad during the Second World War in different periods of life. First patient underwent starvation at the age of 19 years; second one was born during siege of Leningrad. Baseline visit at V. A. Almazov Federal North-West Medical Research Centre was performed in 2011, the follow-up visit — after 3 years in 2014. Results suggest that intrauterine starvation (also additional impact during infant period) is associated with more significant cardiovascular damage in second patient who was born in besieged Leningrad and was not evacuated. The clinical cases demonstrate the long-term effects of starvation in childhood and biomarkers of aging depending on starvation period.

The aim of the investigation was to compare the efficiency of individual and group preventive consultation in hypertensive patients with high cardiovascular risk.

Design and methods. Altogether 200 hypertensive patients with cardiovascular risk factors, who had undergone clinical examination three months before, were included. All of them underwent individual (the first group, n = 100) or group (the second group, n = 100) preventive consultation. The compliance to the medical recommendations and their awareness about risk factors, as well as anxiety level and life quality were evaluated by questionnaires and tests. The initial medical documentation was screened for the relevant medical data, including the achievement of target blood pressure (BP).

Results.
Three months after preventive consultation, 42 % patients in the 1st group and 20 % in the 2nd group did not follow medical recommendations regarding antihypertensive therapy. Target BP was achieved in 43 and 50 % patients in the 1st and 2nd group, respectively. Fixed combination drugs were taken by 83,3 and 96,8 % patients in the 1st and 2nd group, respectively (such as perindopril arginine / indapamide — Noliprel A and Noliprel Forte).

Conclusions. Insufficient efficiency of the individual and group preventive consultation is due to poor compliance to the recommendations concerning cardiovascular risk factors correction. This results from the poor awareness and relatively satisfactory quality of life.