Objective. To compare efficiency of the chronotherapy based on spectral analysis of blood pressure (BP) with chronotherapy based on the results of 24-hour BP monitoring.

Design and methods. Ninety-three men, transpolar shift workers, with hypertension (HTN) II stage, 1–2 degree were divided into 2 subgroups: in the 1st group daily BP profile was assessed once («dipper», «non-dipper», «over-dipper», «night-peaker», «Standard treatment» group, n = 57), in the 2nd group BP chronotype was considered (group «Chrono», n = 36). Standard analysis and cosinor-analysis of 24‑hour BP monitoring were performed. Lisinopril (LP) 5 mg per day was prescribed for 2 weeks followed by second assessment.

Results. Chronotherapy based on the chronotype of daily BP and its spectral characteristics is more efficient and allows better BP control. It leads to a better compliance and achievement of the target BP level, normalization of daily dynamics of BP and heart rate.

Conclusions. In shift workers living in the Far North, chronotherapy of HTN is a promising method used due to the early change of daily BP dynamics. Individual chronotherapy is recommended as a rational approach to treat “northern” HTN and contributes to a better patients’ compliance.

Objective. To analyze peculiarities of heart rate autonomic regulation in patients with hypertension and obstructive sleep apnea (OSA) at rest and during active orthostatic test (AOT).

Design and methods. The study involved 65 patients, average age — 53,7 ± 10,1 years. The complex examination included anthropometric parameters measurement, cardiopulmonary monitoring (CPM), and analysis of heart rate variability (HRV) at rest and during the AOT.

Results. The group 1 included 26 people with mild-to-moderate OSA, the group 2 consisted of 39 patients with severe OSA. In group 1 sympathetic influences on the heart rate regulation were predominant, and very low frequency (VLF) waves made a significant contribution in the overall spectrum. Key indicators of the CPM had no effects on HRV in group 1. In group 2, the severity of respiratory disorders directly affected the heart rate: low frequency (LF) waves and the LF/HF index, while high frequency (HF) waves reduced along with the increase in OSA severity. In group 1, the total capacity of the spectrum increased due to a larger contribution of LF-waves and VLF-waves during the AOT. The LF/HF index increased during the AOT. In group 2, there was a paradoxical increase in HF-waves, and a decrease in LF/HF index.

Conclusions. The autonomic regulation of the heart rate is disturbed in hypertensive patients with OSA. Excessive sympathetic activation occurs as OSA severity increases, manifesting as the rise of VLF and LF-waves proportion and being the most profound in patients with severe OSA.

Background. Currently, risk factors of ischemic stroke remain the relevant research object, including gender-dependent arterial stiffness.

Objective. To study the gender-related differences in factors associated with pathological cardio-ankle vascular index (CAVI) in subjects with acute cerebrovascular accidents (CVA).

Design and methods. The presence of cardiovascular disease, previous cardiovascular events, types and subtypes of stroke were assessed in all subjects. Color-flow duplex scanning of brachiocephalic arteries and laboratory studies (lipid profile) were performed to assess the presence of atherosclerosis.

Results. There were no significant differences in intermediate and pathological CAVI valuesin men and women (р = 0,59 and р = 0,48, respectively). The factors associated with pathological CAVI differ depending on the gender. The independent predictors of pathological CAVI in men include obesity (р = 0,04), intima-media complex thickening (р = 0,03); while in women they include obesity (р = 0,03), atherogenic index (p = 0,02), history of acute cerebrovascular accident (р = 0,03), and coronary artery disease (p = 0,02).

Conclusions. Thus, the assessment of CAVI is recommended in patients with ischemic stroke in order to identify increased arterial wall stiffness and to apply preventive approaches in accordance with the gender-related differences.

Objective. The purpose of research was to study the indicators of daily monitoring of blood pressure (ABPM) in post-stroke patients with atrial fibrillation (AF) and their relationship to mortality.

Design and methods. We included 350 stroke survivors with non-valvular AF. The patients were divided into 3 groups according to the stroke severity assessed by NIHSS (National Institutes of Health Stroke Scale). All patients underwent ABPM at baseline, at 3‑and 6‑month follow-up.

Results. By the time of stroke onset, 72% of patients have already had AF, in 28% patient AF was newly verified. Systolic (SBP) and diastolic blood pressure (DBP) was significantly (p < 0,05) higher in patients with paroxysmal AF (n = 109), they had significantly (p < 0,05) lower degree of blood pressure (BP) decrease at baseline, 3 and 6 months. At 6 months, the group of patients with paroxysmal AF included 96 people, 13 patients (3,7%) died: 4 (2,6%) in group I; 3 (2,5%) — in group II, and 6 (7,7%) in group III. In the subgroup of died patients, there was a significant correlation (r = 0,56, p < 0,05) between insufficient nocturnal BP decline and the incidence of paroxysmal AF.

Conclusions. Our findings suggest an independent contribution of the abnormal daily BP profile to the increased frequency of night AF episodes and its association with high mortality in post-stroke patients.

Objective. Based on factor analysis, we identified the most clinically significant characteristics of subjects with high normal blood pressure (BP) depending on the values of carotid intima-media thickness (IMT).

Design and methods. Altogether 88 patients (60 men and 28 women) with high-normal BP (Russian Society of Cardiology, 2010) were examined (mean age — 34,1±2,7 years, duration of history of high-normal BP was 4,4±1,3 years). They were divided into 2 groups: 1st included 45 individuals with IMT < 0,9 mm, the 2nd group consisted of 43 subjects with IMT ≥ 0,9 mm. All subjects underwent clinical examination, clinical and biochemical blood tests, electrocardiography (ECG), echocardiography, veloergometry, ambulatory blood pressure monitoring (ABPM) with central BP and arterial stiffness assessment, ECG monitoring, duplex scan of carotid IMT. Blood plasma levels of some hormones were also assessed.

Results. Factor analysis showed that BP is not related to other traditional risk factors in the group 1, while it is the leading factor in the 2nd group. Cardio-renal relations are present even when IMT is within normal values. Group 2 is characterized by BP-associated vascular remodeling, and left ventricular remodeling. The structural and functional changes were independent from lipid levels. Vascular stiffness correlated with changes in BP circadian rhythm. Increased IMT is associated with «non-dipper» daily BP pattern.

Conclusions. IMT increase in individuals with high normal BP may identify the risk of the transition from functional to organic vascular changes, followed by hypertension occurrence.

Background. Inter-arm difference in blood pressure (BP) and orthostatic BP response are significant prognostic factors in hypertensive patients, especially in the elderly ones. However, data on their prevalence, predictors and clinical associations remain contradictory.

The aim of our study was to investigate inter-arm difference and orthostatic response and to establish their clinical associations in the very elderly hypertensive patients.

Design and methods. We enrolled 67 hypertensive subjects older than 80 years (mean age 84,1 ± 3,1 years, 25,5 % male, mean clinic brachial systolic BP (SBP) 134,8 ± 23,2 mm Hg) in a cross-sectional study. Simultaneous bilateral brachial BP measurements were performed using oscillometric validated cuffbased device in sitting position and then 2 minutes after standing up. Central pulse waveform characteristics and arterial stiffness parameters were estimated by BPLab Vasotens system (Petr Telegin, Russia).

Results. The median of inter-arm difference in SBP (IADSBP) was 4,00 (2,50, 9,00) mm Hg. IADSBP was ≥ 10 mm Hg in 25,4 % participants. Compared to others, those with IADSBP ≥ 10 mmHg had significantly higher body mass index (31,39 ± 5,73 vs 28,48 ± 4,1 kg/m2 , p < 0,05), waist circumference (116,3 ± 13,6 vs 107,7 ± 11,2 cm, p < 0,05) and pulse wave velocity in aorta (11,65 ± 1,46 vs 10,75 ± 1,71 m/s, p < 0,05). A positive correlation between IADSBP and augmentation index was revealed (r = 0,277, p < 0,05). Patients with asymptomatic orthostatic hypotension (22,4 % participants) had higher levels of brachial SBP and pulse pressure while central BP and markers of arterial stiffness did not differ from those without orthostatic hypotension. Conclusions. Significant IADSBP is associated with increased arterial stiffness and abdominal obesity in the very elderly hypertensive patients, whereas there is no evidence of interrelation between orthostatic response and arterial stiffness in these patients.

Objective. To determine the gender-related differences of depression impact on the risk (HR — hazard ratio) of hypertension (HTN) development in the general population of 25–64 years old in Russia/Siberia.

Design and methods. Within the III screening WHO program «MONICA-psychosocial», a random representative sample (both genders, aged 25–64 years old) of Novosibirsk citizens was formed in 1994 (men: n = 657, 44,3 ± 0,4 years, response — 82,1%; women: n = 689, 45,4 ± 0,4 years, response — 72,5%). The examination included registration of social and demographic data, diagnostics of depression. During 16‑year follow-up new-onset HTN was diagnosed in 229 women and in 46 men.

Results. In an open population of 25–64 years, depression rate was higher in women (54,5%) compared to men (29%). There were no gender differences in social gradient in depressive subjects divided by marital status: women with high levels of education prevailed over men; depressive men more frequently were leaders and workers of heavy physical labor, while women mostly were engineers and workers of light physical labor. Hazard ration of HTN at 5, 10, 16 years was higher in depressive men compared to women.

Conclusions. Depression is more common in women than in men, however, HR is significantly higher in men than in women.

Objective. To study prevalence of type D personality and examine the relationship with metabolic syndrome (MS) in general population of the Kemerovo region.

Design and methods. A randomized sample was selected from general population in Kemerovo region within the multicentre observational trial «Epidemiology of Cardiovascular Diseases in the Regions of Russian Federation — ESSE-RF», including 1 610 subjects (response was more than 80%). The mean age was 45,8 ± 11,9 years, gender distribution was the following: women — 918 (57%), men — 692 (43%). They were divided into two groups: patients with type D personality (n = 231) and patients without type D (n = 1379). Psychological status was assessed by the questionnaire DS‑14. MS was defined according to the recommendations of the experts of the Russian Scientific Society of Cardiology (2009).

Results. MS was detected in 406 (25,2%) patients. The presence of type D personality was associated with the more than twofold increase in the risk of MS and its components, such as obesity and hypertension.

Conclusions. Predisposition to the MS may be one of the factors explaining the association between type D personality and poorer cardiovascular prognosis.

Objective. The objective was to study the relationship between psychological and emotional features, hormonal changes and left ventricular hypertrophy (LVH) in subjects with normal blood pressure (BP).

Design and methods. The study included 107 practically healthy people of working age from an organized population, including 46 men (mean age 43,7 ± 11,5 years) and 61 women (mean age 43,1 ± 10,1 years). In all subjects, fasting blood samples for hormone level evaluation were taken, structural myocardial changes were assessed by echocardiography, BP measurement was performed according to the standard procedure, and validated psychological questionnaires were completed.

Results. Subjects with LVH showed a high level of accumulated stress according to the Holmes-Rahe scale and low vitality according to the visual analog scale. They were also characterized by significant changes in the ratio noradrenaline/adrenaline, and by the elevated cortisol levels. Biochemical parameters and structural and functional myocardial characteristics correlated with the psychological factors in a gender-dependent manner.

Conclusions. In psychoemotional stress, triggered stress reactions are accompanied by metabolic changes (involving neurotransmitter mechanisms, growth factors), and, as suggested, by structural myocardial changes. The investigation of stress reactions within the psychosomatic continuum is highly important in order to understand how the stress affects the development and the course of various diseases, as well as for the development of an integrated approach to prevent chronic non-communicable diseases.

Objective. We present the data of the retrospective clinical study in order to summarize the experience of the implementation of infrared radiation with terahertz modulation 0,086–7,5 μm (0,02 to 8 THz) in patients with acute ischemic stroke (AIS).

Design and methods. We followed up 61 patients with AIS (age from 18 to 86 years, mean age 59 ± 1 year), 24 women and 36 men, who were divided into two groups: group I (n = 30) and II (n = 31). Patients from the group II received standard pharmacotherapy in acute stroke unit and during hospitalization. Patients from the group I in addition to standard pharmacotherapy underwent procedures of transcranail application of infrared radiation. The radiator was established on parietal area in a projection of an acupuncture point Bai-Huey (VG‑20) independent of brain lesion localization.

Results. Patients from the group I demonstrated earlier recovery, earlier consciousness, a more rapid regression of neurological symptoms and earlier expansion of physical activities compared to the second group. For two years of dynamic supervision patients from the group I showed stable and even better indicators of Barthel index, Rankin scale and National Institutes of Health Stroke Scale (NIHHS) compared to the group II. This can be due to the better compliance of patients from the group I to treatment and a positive effect of the 6–10 procedures of the infrared radiation modulated by terahertz frequencies.

Conclusions. Infrared radiation modulated by terahertz frequencies can be recommended in acute ischemic stroke as a part of complex treatment. A prospective controlled randomized study involving patients with ischemic stroke is required in order to develop the precise approaches for infrared radiation application.

We present the data based on the Registry of hypertensive patients including the results of the expert assessment of the health care in 1539 hypertensive patients. The clinical indicators were evaluated in accordance with the National guidelines on the prevention, diagnosis and management of arterial hypertension.

Objective. To perform an expert assessment of out-patient medical care quality in hypertensive patients based on the automated information and analytical system “Registry of Hypertension”.

Design and methods. Medical data of 1539 hypertensive patients examined in 2004–2010 were analyzed. Special software (Web-based Registry of Hypertension) produced by Moscow Cardio logical, Scientific and Clinical Centre and Saratov Research Institute of Cardiology was used. It allows continuous data entry and analysis.

Results. There is a positive dynamics by improving the quality control of health care in 1539 patients with risk factors and arterial hypertension.

Conclusion. Technology “Registry of Hypertension” can be used in treatment and prevention measures in order to perform an expert assessment and improve the quality of health care in hypertensive patients.

One of the main approaches to develop health care system is to increase the quality of medical education in the country. Currently, there exists the legislative framework for the successful modernization of medical education and improving the quality of medical specialists. The pilot project «Professional and public accreditation of educational programs — a way to improve medical education» led by the Russian Society of Cardiology is considered a first step to introduce an independent professional and public accreditation of educational programsin the health care system.