The phenomenon of variability of blood pressure (BP) has been studied for a long time, but recently, it has made a comeback in scientifi  c literature. This is mostly due to the fact that numerous studies have confirmed the importance of BP variability in predicting cardiovascular risk, although the effect of various parameters of variability does not have the same level of cardiovascular risk due to different underlying pathophysiological mechanisms. Interest in BP variability is due to and based on a series of studies carried out by P. Rothwell et al., who analyzed variability in BP in heterogeneous populations. In particular, the analysis of the ASCOT-BPLA trial showed high signifi  cance of intervisit variability of ВР and predicted stroke and coronary events. In light ofthese data, the variability of ВР is a promising new target for antihypertensive therapy. A statistically significant decrease of this index indicates the stability of the achieved results following treatment. The most convincing evidence in this respect, are those for the combination of amlodipine and perindopril.

The reviewed data concerning modern performance about the changes of left atrium in hypertension are cited in the paper. Haemodynamic, neurohumoral, molecular, electrophysiologic pathogenic factors of left atrium structural and functional remodeling in this disease are discussed. Changes of left atrium as hypertensive target organ presents an essential (and as a rule the earliest) sign of cardiovascular continuum.

Objective. To test the hypothesis, that the arterial baroreceptor refl  ex plays the key role for the phenomenon of visceral systems adaptation for long-term afferent drive.

 Design and methods. In Wistar rats the model of the «two kidneys, one clip» vasorenal hypertension was carried out. The sino-aortic denervation was performed in one group — before the left renal artery clipping, in the other group — 8 weeks after the left renal artery clipping.

 Results. The renal artery clipping led to the increase of blood pressure only in 17 % of animals with intact sino-carotid-aortic mechanoreceptor zones. The absence of hypertension in these animals might be due to the cardiovascular adaptation phenomenon to prolonged afferent action from ischemic kidney. Denervation of mechanoreceptor zones before the clipping of the renal artery contributes to the development of hypertension in 100 %. However, the denervation of sino-carotid and aortic zones performed 8 weeks after the renal artery clipping in rats without hypertension, does not affect blood pressure level.

Conclusion. We suggest, that the absence of hypertension after renal artery clipping is due to the adaptation of the circulatory system to a long-term afferentation from the kidney, and the denervation of large vessels mechanoreceptor zones does not alter this process. At the same time, the damage of the arterial baroreceptor refl  ex before renal artery clipping interferes in the visceral systems adaptation to afferent action and contributes to the arterial hypertension development.

Objective. To study blood velocity in arterioles in hypertensive patients by doppler.

 Design and methods. We assessed blood velocity in 90 patients with essential arterial hypertension (AH) and in 83 patients with type 2 diabetes mellitus (DM2) with AH («Minimax-Doppler-K»), and in 102 control subjects: during systole (Vs, cm/s), diastole (V_d, cm/s) and during the mean blood flow cycle (V_m, cm/s). Then spontaneous changes of blood velocity were recorded during 1 minute. In patients with DM2 association between blood velocity and disease duration was studied. In 43 hypertensive patients V_s and V_d were defined after treatment.

 Results. Hypertensive patients had the highest blood velocity, lower values were defined in healthy people, and hypertensive subjects with DM2demonstrated the lowest blood velocity. Fluctuations in blood velocity during systole were the highest in healthy people, less in hypertensives and the smallest in subjects with DM2 and AH. Variations of blood velocity during diastole were the highest in AH patients, less in patients with DM2 with AH and the least in healthy subjects. Blood velocity in arterioles is lower in patients with the longer duration of DM2. In treated hypertensive patients blood velocity in arterioles reduces. Conclusion. By assessment of blood flow velocity in arterioles we can evaluate the functional state of these vessels in hypertensive patients.

Objective. To evaluate the role of magnetic resonance spectroscopy (MR-spectroscopy) in the study of cognitive functions in patients with metabolic syndrome (MS).

Design and methods. The study included patients with MS (10 patients without cognitive impairment and 11 subjects with cognitive dysfunction). All patients underwent neuropsychological testing, and cognitive evoked potential for the assessment of cognitive functions. Brain metabolism was studied by proton MR-spectroscopy.

Results. In patients with MS and cognitive impairment, and without cognitive dysfunction no morphological changes in the brain according to the magnetic resonance imaging (MRI) were found. According to MR-spectroscopy of the brain in patients with MS and cognitive dysfunction the metabolism impairment is primarily associated with the increase in lactate and inositol.

Conclusion. Indicators of neuropsychological testing, the cognitive evoked potential are associated with the violation of brain metabolism in patients with MS and cognitive impairment.

Objective. To study several medications and their combinations in non-threatened hypertension worsening captopril, and moxonidine, captopril + nifedipine, captopril + moxonidine.

Design and methods. We include326 patients (253 females) aged 45–89 years who referred for the urgent health care due to the non-threatene hypertension worsening. Mean duration of hypertension was 20,6 ± 0,6 years. Special questionnaires were fille in, heart rate, blood pressure by Korotkoff method, and electrocardiogram were registered.

Results. Moxonidinwas shown to be more effective in patients with the sympathetic hyperactivity, captopril — in patients withouincreased sympathetic activity. The combination of captopril and nifedipine was associated with the reductioof therapy effi  ciency, and the combination of moxonidine and nifedipine — with its increase. Moreover, administration of captopril and nifedipine led to the higher rate of side effects, compared to the combination moxonidine and nifedipin.

Objective. To study several medications and their combinations in non-threatened hypertension worsening captopril, and moxonidine, captopril + nifedipine, captopril + moxonidine.

Design and methods. We include326 patients (253 females) aged 45–89 years who referred for the urgent health care due to the non-threatene hypertension worsening. Mean duration of hypertension was 20,6 ± 0,6 years. Special questionnaires were fille in, heart rate, blood pressure by Korotkoff method, and electrocardiogram were registered.

Results. Moxonidinwas shown to be more effective in patients with the sympathetic hyperactivity, captopril — in patients withouincreased sympathetic activity. The combination of captopril and nifedipine was associated with the reductioof therapy effi  ciency, and the combination of moxonidine and nifedipine — with its increase. Moreover, administration of captopril and nifedipine led to the higher rate of side effects, compared to the combination moxonidine and nifedipin.

Objective. Recent studies suggest high prevalence of vitamin D deficiency and its association with metabolic disturbances. However, the available data regarding the relationship between vitamin D level, vitamin D receptor gene polymorphisms and components of metabolic syndrome seem to be contradictory. We examined the interrelations between serum 25(OH)D and vitamin D receptor gene ApaI polymorphism with the parameters of metabolic syndrome.

 Results of the study showed that 83,4 % of the study population had vitamin D deficiency/insuffiiency and vitamin D level inversely correlated with body weight. Correlation analysis showed that women with vitamin D deficiency had higher risk of obesity and decreased high-density lipoproteins level than women with normal 25(OH)D level. Moreover, women with vitamin D deficiency showed a tendency for having impaired glucose metabolism. We did not fisignificant associations between vitamin D level and blood pressure and metabolic syndrome. AA, Aa and aa genotypes prevalence and A/a allele incidence of ApaI vitamin D receptor gene polymorphism did not differ significantly in study population and control group. A allele carriers had higher total cholesterol and low-density lipoproteins levels than other genotypes carriers.

Objective. To determine the criteria for the application of preventive measures for individual computer program «Medical and psychological prevention of complications, and the normalization of physiological parameters in a hypertensive patient».

Design and methods. With the financial support of the Government of the Russian Federation, the State contract № 6464r/9021 of 28.12.2008, we have developed and registered in the Federal Institute of Industrial Property preventive medical computer program «Medical and psychological prevention of complications, and the normalization of physiological parameters in a hypertensive patient» № 2011618469, state registration number 01200951860. We examined 180 patients (120 hypertensives and 60 controls) aged 20–70 years (mean age 35,5 ± 7,2 years), patients of the main group had a primary diagnosis of hypertension (I, II, III degree). We performed clinical neurological, standard laboratory and instrumental diagnostic examinations and psychodiagnostic testing, as well as the pulse measurements by cardiointervalography followed by mathematical analysis of the data by a special program.

Results. Analysis of reactions in the interim period of adaptation (14–21 day) has shown its important role to predict the outcome of preventive measures. According to our data 88,2 % patients with hypertension III degree and 94,4 % patients with hypertension II degree demonstrated normalization of the blood pressure and improvement in general state, and the approach was beneficial in 100 % patients with hypertension I degree. Mean recovery time after hypertensive crisis was 15,0 ± 5,0 minutes in patients with hypertension I degree, 30,0 ± 10,0 minutes in patients with hypertension II degree (p < 0,001), and 45,1 ± 27,4 minutes in patients with III degree (p < 0,05). Patients, who used personal computer software, demonstrated the reduction of irritability, fatigue, improved sleep, memory, increased work effiiency, disappearance of sleepiness, and there was an increase in self-confidence.

Conclusions. Thus, our results show that the use of individual computer program «B/P rate» leads to the reduction of the frequency and duration of hypertensive crises, as well as to the improvement of cognitive function and psychosocial parameters.

Objective. To examine the clinical signifi  cance of polyfunctional 24-hour Holter monitoring with simultaneous recording of electrocardiogram, blood pressure (BP) and respiratory efforts by respiratory inductance plethysmography (Incart, Russia) and functional features of young men with prehypertension or mild arterial hypertension with different profi  le of night arterial blood pressure (BP) decline («dippers», «non-dippers», «over-dippers»).

Design and methods. We examined 43 adolescents and young men aged 16–26 years (mean age 19,4 ± 0,5 years). All of them underwent echocardiography («Vivid 7», GE); 48,8 % of patients were overweight or obese (body mass index, BMI > 24,9 kg/m2), and BMI was comparable in all groups. Results. Breathing disturbances (apnea/hypopnea episodes) were found in 86 % patients and were positively related with high frequency (HF) spectrum power of heart rate variability (HRV) at night-time and were not related with BMI, BP or type of night BP decline. The analysis of echocardiography revealed that in «non-dippers» (n = 18) left ventricular myocardial mass index (LVMMI) was higher (94,3 ± 16,6 g/m2) than in «over-dippers» (n = 15; 77,8 ± 10,3 g/m2, р < 0,001). In daytime «non-dippers» had lower HRV (total power spectrum and power in all three groups) and power spectrum of VLF and LF spectrum at night. The frequency of repolarization instability (transient T-wave inversion) and early repolarization syndrome was higher in «over-dippers» (66,7 %, р < 0,01). Circadian index of HR was also higher (150 %) in «over-dippers». The number of sleep apnea in «non-dippers» and «dippers» was higher (39,7 ± 29,7 and 37,1 ± 18,1 episodes per hour of sleep) than in «over-dippers» (22,3 ± 12,0 episodes per hour of sleep, р < 0,05), but the last group had more hypopneas.

Conclusion. Breathing disturbances were a frequent, and, probably, physiological, fi  nding at polyfunctional 24-hour Holter monitoring in young overweight men with pre- or mild hypertension. There is a relationship between LVMMI and nocturnal BP dipping even in young men. Young «non-dippers» demonstrate the same clinical pattern as the older ones. «Over-dipper» type is characterized predominantly by lower HR at night and ECG repolarization abnormalities. 

Objective. To study the effects of stress at home and at work on the 14-year risk of hypertension in men aged 25–64 years.

Design and methods. In the framework of the WHO program «MONICA — PSYCHOSOCIAL» a screening study was performed in 1994, and 657 males aged 25–64 years (mean age — 44,3 ± 0,4 years), the citizens of Novosibirsk were included.

Results. The greatest risk of hypertension was observed during the 10-year period in men experiencing stress at home (5-fold increase) and at work (6,8 times higher). Those most at risk of hypertension were the divorced and widowed men, and those with physical labor.