The review of literature presents evidence of the relevance of the wider application of angiotensin II receptor antagonists in the treatment of cardiovascular diseases. The advantages of this class of antihypertensive drugs on the effect on blood pressure and regression of target organ damage in patients with hypertension. The data on nephroprotective, neuroprotective, antiarrhythmic effects of angiotensin II receptor antagonists, as well as the opportunity of effective correction of the metabolic abnormalities are presented.

Objective. To assess the safety of transcatheter radiofrequency denervation (TRFD) of renal arteries (RA) in patients with resistant hypertension (RH) by ultrasound of the kidneys.

Design and methods. We assessed estimated glomerular filtration rate (eGFR) and performed ultrasound examination of the kidneys and RA at 1, 24 and 48 weeks after TRFD in 35 patients (mean age — 52 +- 10 years) with blood pressure (BP) > 160/100 mmHg despite 3 full-dose antihypertensive drugs as a part of the single-center prospective safety/efficacy study (NCT01499810).

 Results. Office BP decreased by 34,9/18,2 mmHg (p < 0,001/0,001) and -42,7/-21,7 mmHg (p < 0,01/0,01) at 24 and 48 weeks after TRFD, respectively. No significant changes of eGFR and renal blood flow were found, however, the resistive index (RI) decreased significantly in segmental RA: from 0,62 Ѓ} 0,05 initially till 0,58 +-0,06 and 0,59 +- 0,06, respectively, at follow-up points (p = 0,003; p = 0,049 and p =0,063).

Conclusions. TRFD of RA has no adverse effect on either renal function or blood flow in the trunk and segmental branches of the RA. On the contrary, the decrease of resistive index in segmental RA after the intervention indicates improvement of renal blood flow. 

Objective. To assess population mean blood pressure (BP), prevalence, treatment, and control of arterial hypertension from 1975 to 2001 depending on the socio-demographic indicators

Design and methods. Seven independent cross-sectional population surveys were conducted in 1975–2001 with randomly selected men (10094) and women (3527) aged 25–64 years old,Moscow residents, with response > 70 %. We have combined data from studies performed in Soviet period, «the period of perestroika» and post-Soviet period.

Results. Systolic BP (SBP) has increased from «Soviet period» to «the period of perestroika» in men by 2,5 mmHg (р < 0,05), and in women by 5 mmHg (р < 0,001). Diastolic BP (DBP) has increased among men (from 87,0 to 87,8 mmHg, р < 0,02), and among women (from 81,5 to 87,2 mmHg, р < 0,001). In the late 90’s SBP has decreased (in women from 137,5 to 130,1 mmHg, р < 0,02), DBP has decreased (in men — to 85,1 mmHg, р < 0,02, and in women — to 81,3 mmHg, р < 0,005). There was a statistically signifi cant increase in the prevalence of arterial hypertension from «Soviet period» to «the period of perestroika» (from 46,5 to 49,2 % in men; from 38,7 to 50,3 % in women, р < 0,001). In the post-Soviet period it has decreased among men to 39,8 % and among women to 32,7 % (р < 0,04). The rate of adherence to antihypertensive medications has increased (in men from 6,2 to 19,4 %, р < 0,001; and in women from 15,5 to 26,6 %, р < 0,001). The proportion of effectively treated hypertension has decreased (in men from 35,7 to 23,4 %, and in women from 36,9 to 31,7 %). Control of hypertension improved signifi cantly from 3,6 to 5,8 % (р < 0,01).

Conclusion. The prevalence of arterial hypertension remains high. The main objective of physicians is to increase the number of effectively treated patients and to achieve target levels of blood pressure.

Objective. To evaluate the incidence and causes of atrial fi brillation in hospitalized patients of therapeutic profi le and to compare the dynamics of these parameters over past 25 years.

Design and methods. We analyzed 14595 medical histories of the faculty therapy clinic of Pavlov St Petersburg State Medical University for the periods from 1985 to 1990 years and from 2005 to 2010 years.

Results. The incidence of atrial fi brillation increased by 1,7 times over the past 25 years. There is a signifi cant increase in the number of patients with atrial fi brillation in combination with co-morbidities: obesity — 1,9 times, essential hypertension — 1,8 times, and type 2 diabetes mellitus — 3-fold increase. The incidence of valvular heart diseases in patients with atrial fi brillation decreased by 1,9 times from 1985 to 2010 year. Statistical signifi cance of differences was assessed by Fisher’s exact test (p < 0,0001).

Conclusion. The number of hospitalized patients with atrial fi brillation signifi cantly increased over the past 25 years. The number of patients with nonvalvular atrial fi brillation signifi cantly increased from 1985 to 2010 year and the number of patients with rheumatic valvular heart disease with atrial fi brillation decreased.

Objective. To study the effect of the 8-week treatment with atorvastatin on the quality of life (QOL) of hypertensive patients with metabolic syndrome.

Design and methods. An 8-week open prospective study included 35 patients with essential hypertension (stage II), associated with metabolic syndrome. Along with the complete clinical, laboratory and instrumental examination, taken in a specialized cardiology clinic, MOS SF-36® questionnaire was used to study the QOL during atorvastatin treatment.

Results and conclusions. The 8-week atorvastatin treatment (20 to 40 mg/day titrated individually) both contributes to statistically signifi cant reduction of atherogenic fractions of cholesterol and provides a positive dynamics of subjective evaluation of QOL by SF-36® scales in hypertensive patients with metabolic syndrome. 

Objective. Vascular remodeling in patients with pulmonary artery hypertension (PAH) may be assessed by measurement of contrast magnetic-resonance imaging (CMRI) derived pulmonary artery distensibility (PAD) index. The objective of our study was to investigate whether PAD index could be used as a marker for the evaluation of PAH severity.

Design and methods. Forty four patients with PAH (mean age — 42,8 ± 14,5 years, males:females = 11:33) were enrolled: 29 patients with idiopathic pulmonary arterial hypertension, 4 subjects with corrected congenital heart disease, 3 subjects with scleroderma PAH and 8 patients with inoperable chronic thromboembolic pulmonary hypertension. All patients underwent 6-minute walk test, right heart catheterization (RHC), heart ultrasound (ECHO), CMRI, cardiopulmonary exercise testing, and serum N-terminal-pro-brain natriuretic peptide (NT-proBNP) level was defined.

Results. PAD index was decreased in PAH patients 11,9 % (9,3-19,7). Patients with decreased PAD index < 20 % had higher NT-proBNP level, lower tricuspid annular systolic velocity and right ventricle/left ventricle ratio by ECHO. Patients with PAD index < 20 % had higher pulmonary artery systolic blood pressure (96,5 ± 22,4 versus 77,9 ± 19,4 mmHg; p < 0,05), and reduced cardiac output which were determined by RHC (3,98 ± 1,1 versus 4,95 ± 1,21 l/min; p < 0,05). Decreased VO2peak was found in patients with PAD index < 20 % (14,8 versus 18,8 ml/min/kg; p = 0,05).

Conclusions. PA distensibility index may be used for noninvasive assessment of PAH severity and progression.

Objective. Despite the high frequency — 0,2 % (1:500) population, hypertrophic cardiomyopathy (HCM) is still considered one of the most mysterious and misunderstood diseases of myocardium. Insidious pathology has neither specific anatomical and morphological, nor clinical features which makes it a delayed-action bomb: nobody is capable to predict when and what clinical symptoms develop. The clinical phenotype of HCM varies from latent course when the symptoms are absent till rapid progress of heart failure syndrome and sudden cardiac death due to severe arrhythmia. The review covers modern view on genetics, morphology and pathogenesis of HCM.

Objective. Despite the high frequency — 0,2 % (1:500) population, hypertrophic cardiomyopathy (HCM) is still considered one of the most mysterious and misunderstood diseases of myocardium. Insidious pathology has neither specific anatomical and morphological, nor clinical features which makes it a delayed-action bomb: nobody is capable to predict when and what clinical symptoms develop. The clinical phenotype of HCM varies from latent course when the symptoms are absent till rapid progress of heart failure syndrome and sudden cardiac death due to severe arrhythmia. The review covers modern view on genetics, morphology and pathogenesis of HCM.

Objective. To evaluate the quality of life by questionnaire SF-36 in young men of military age.

Design and methods. The MOS SF-36 was used in 148 young men of military age (aged from 18 to 27 years old) for quality of life assessment.

Results and conclusion. Quality of life in hypertensive subjects was worse than in healthy ones. Quality of life signifi cantly increased in most subjects after 24 weeks of antihypertensive therapy.

Objective. To study the relationship between diastolic left ventricular dysfunction and the circadian blood

pressure prof le in patients with chronic prostatitis.

Design and methods. Eighty-two patients with chronic prostatitis underwent ambulatory blood pressure monitoring and echocardiography.

Results and conclusion. The disturbances of circadian blood pressure profile in patients with chronic prostatitis include the abnormal nocturnal decrease in systolic and/or diastolic blood pressure, instable nocturnal systolic hypertension and an abnormality of the morning blood pressure surge. In patients with abnormal circadian blood pressure profile left ventricular diastolic dysfunction with increased myocardial mass and thickness of the posterior wall of the left ventricle was more prevalent.

and their relationship to nitric oxide production by endothelium.

Design and methods. The study involved 141 patients with hypertension, including isolated hypertension, and associated with coronary heart disease and type 2 diabetes mellitus. Methods of investigation included the evaluation of clinical and conventional instrumentation and laboratory parameters with the additional study of heart rate variability. To assess endothelial function we determined the level of the final stable metabolites of nitric oxide: nitrite and nitrate anions (NO2 - and NO3 -) in blood plasma.

 Results and conclusions. According to the analysis of heart rate variability we found apparent disturbances of heart rhythm regulation in hypertensive patients: decreased overall heart rate variability, decreased amplitude of parasympathetic, sympathetic and humoral waves, reduced proportion of sympathetic, parasympathetic waves and increase of humoral waves. Co-existing diabetes mellitus led to more apparent disturbances of autonomic regulation of heart rhythm. High heart rate and low heart rate variability in hypertensive patients are associated with an increase of the final metabolites of nitric oxide in the blood plasma.

Elevated levels of homocysteine (Hcy) in tissues cause cytotoxic effects. Increase in the overall conсentration of the various Hcy chemical forms above 12 μM is called hyperhomocysteinemia. The term «total homocysteine» of plasma (tHcy) is the sum of concentrations of aminothiol in reduced (-SH) and oxidized (-SS-) forms. It was suggested that the S- and, partially, N-homocysteinylation of proteins plays a major role in the toxic effects of Hcy. The rate of tHcy in plasma is not closely related to pathological process with remodeling of the vascular wall and not entirely suitable for prospective evaluation of the pathologic process. The paper presents the method of evaluation of the tHcy and its fraction after ultrafiltration, allowing cut off proteins with mass above 300 kDa. Proteins in this fraction which can form a mixing disulfides of Hcy include apoB protein and activated alpha-2-macroglobulin. The proposed Hcy estimation in plasma preparations prior and after ultrafiltration may be performed in any laboratory with kits for tHcy evaluation in plasma. Evaluation of Hcy fraction associated with > 300 kDa plasma proteins by means of centrifugal device Vivaspin 300 000 MWCO PES «Sartorius» provides information about Hcy transport by an additional way in macrophages, endothelial cells, smooth muscle cells and others in vascular wall by receptorial endocytosis. 

Objective. To assess efficiency of angiotensin II converting enzyme inhibitor Perindopril versus angiotensin II receptor blocker Telmisartan in hypertensive patients with obstructive sleep apnea syndrome (OSAS).

Design and methods. Sixty hypertensive patients with OSAS (non-CPAP-users) were enrolled in a randomized controlled open study: 48 males and 12 females; mean age — 56,2 ± 9,5 years; hypertension duration — 12,5 ± 7,4 years; body mass index — 32,0 ± 5,9 kg/m2, apnea-hypopnea index (AHI) — 35,4 ± 24,2 episodes per hour of sleep. All patients were divided into 2 groups: patients (n = 30) from the 1st group got Telmisartan 40 mg daily (titrated up to 80 mg daily if necessary), and Perindopril 4 mg daily (titrated up to 8 mg daily) was prescribed to 2nd group (n = 30). The treatment lasted for 12 weeks.

 Results. Twenty three patients in Telmisartan group and 24 patients in Perindopril group achieved goal blood pressure (< 140/90 mmHg) (χ2 = 1,23; p > 0,05), all patients got maximal doses of medications. The reduction of offi ce and 24-hour blood pressure was comparable in both groups. Circadian blood pressure profi le was normalized in 17 patients from Telmisartan group and in 9 patients from Perindopril group (χ2 = 6,21; p < 0,05). At the same time AHI decreased by 19 episodes per hour of sleep in Telmisartan group, while it increased by 10,1 episodes per hour of sleep in Perindopril group (p < 0,01).

Conclusion. Telmisartan treatment is beneficial in hypertensive obese patients with OSAS compared to Perindopril due to the reduction of OSAS severity (assessed by AHI) leading to the normalization of circadian blood pressure profile.