The article is based on literature review and describes the implication of psycho-emotional factors in the development of arterial hypertension (HTN). HTN and its cardiovascular complications take a leading place among the causes of high mortality and disability in the adult population. High blood pressure (BP) is known to be a major modifiable risk factor for premature death, myocardial infarction, stroke and other cardiovascular diseases. The pathogenesis of HTN is complex and multifactorial with a significant variability of the involved mechanisms in individual patients. In this regard, the determination of specific pathogenic mechanisms underlying stable BP elevation would substantially individualize therapeutic approaches, and hence increase the effectiveness of treatment. The role of psycho-emotional stress has been recently reassessed and it is widely discussed as a factor contributing to the HTN formation. Global urbanization, sedentary lifestyle, daily work-related stress, lack of physical activity and social support lead to increased anxiety, uncertainty, and finally to chronic mental and emotional stress. This review analyzes the main physiological markers of chronic stress, neuroendocrine and immunological mechanisms underlying the development of HTN. The role of endothelial dysfunction as a binding link between chronic stress and high BP is also discussed.

This article reviews the history of blood pressure (BP) measurement by invasive and noninvasive methods. It also discusses the idea of considering arterial hypertension as independent disease. The common information for arterial BP levels in different division of vascular bed is described.

First studies in the field of physical activity and its role in chronic non-communicable diseases prevention were published more than 50 years ago. Initially, the goal of these investigations was to assess the risk of cardiovascular events during exercises. However, later the assessment of optimal intensity and duration of physical activity within preventive measures became the leading issue of research. Evolution of methodological approaches in physical activity assessment — from subjective methods based on the diaries and questionnaires to modern mobile devices — pedometers and accelerometers, required the changes in physical activity guidelines. Global recommendations on physical activity for health, published by WHO in 2010, leave many open questions due to the lack of an ideal method for physical activity evaluation.

Objective. Underlying the development of insulin resistance (IR), abdominal obesity (AO) to a large extent determines the occurrence of both type 2 diabetes mellitus (T2DM) and arterial hypertension (HTN). Consequently, obesity treatment has a pathogenetic significance. However, in T2DM there are certain associated difficulties. Feasible methods in this group are the intra-gastric balloon (IGB) implantation and glucagon-like peptide‑1 (aGLP‑1) receptor agonists.

The aim of the study was to compare the effects of IGB therapy and aGLP‑1 therapy on the various components of metabolic syndrome (including HTN) in T2DM patients.

Design and methods. The study involved 19 patients, aged from 18 to 65 years old, with obesity (BMI > 35 kg/m 2), T2DM, AO, and HTN. IGB (“MedSil”, Russia) was inserted in 10 patients, and subcutaneous injection of GLP‑1 (exenatid) was administered to 9 patients. At each visit (0, 2nd, 6th, 12th, and 24th week of research) anthropometric parameters, systolic (SBP) and diastolic blood pressure (DBP), as well as the required number and dosage of hypoglycemic and anti-hypertonic medication were assessed. At baseline and after 24 weeks of treatment, indicators of T2DM compensation were assessed, and HOMA index was calculated.

Results. After 24 weeks of treatment, there was a decrease in BMI by 5,1 [2,4; 8,1] kg/m 2 (p < 0,0001), HbA1c by 1,1 [0,5; 2,0] % (p = 0,04), SBP by 17 [7,8; 26,3] mm Hg (p = 0,003), DBP by 13,0 [6,5; 19,5] mm Hg (p = 0,000) in the IGB group, whereas in the aGLP‑1 group BMI decreased by 3,4 [2,7; 4,1] kg/m 2 (p = 0,000), HbA1‑by 1,0 [0,8; 1,9] % (p = 0,008), SBP — by 20 [4,0; 33,0] mm Hg (p = 0,009), DBP — by 12,0 [1,5; 16,5] mm Hg (p = 0,003). However, the differences between the groups were not significant (p > 0,05).

Conclusions. Both the insertion of IGB and aGLP‑1 therapy resulted in a comparable decrease in BMI, HB1C, and BP level in obese patients with T2DM.

Objective. Chronic heart failure (CHF) is the most common complication of cardiovascular system diseases associated with unfavorable prognosis. Vitamin D deficiency is an additional factor contributing to the development of cardiovascular pathology. Current evidence on the relationship between vitamin D and the state of the myocardium in patients with CHF is insufficient. The aim of the study was to assess the plasma level of vitamin D in CHF patients and to evaluate its impact on the morphological and functional state of the myocardium.

Design and methods. The study involved 124 patients with CHF I–II functional class and 16 control subjects without CHF. In all patients, vitamin D level was assessed (25(ОН)D total by ELISA) and echocardiography on the apparatus Logiq Р5 (USA) was performed.

Results. The average plasma level of 25 (OH)D in CHF patients was 16,6 (10,9; 23,7) ng/mL that was significantly lower (p = 0,01) than in the control group 42,1 (27,8; 49,6) ng/mL. All patients with CHF were divided by the plasma level of 25 (OH)D according to centile distribution into group I (LQ0–UQ25) with level of 25 (OH)D 10,9 ng/ml, group II (LQ25–UQ75) with level 25 (OH)D 10,9–23,7 ng/ml, and group III (LQ75–UQ100) with level of 25 (OH)D 23,7 ng/ml and above. Systolic blood pressure (SBP) was significantly higher in group I than in group III (p = 0,04), and in the control group this value was significantly lower than in all groups of CHF patients (p < 0,05). Dimensions of the aorta and its sections, left atrium, parameters of end-systolic volume, end-diastolic volume (EDV), thickness of the anterior and posterior left ventricle wall during systole were significantly higher in group I as compared to group II, III and the control group. There is a negative correlation between the plasma level of 25 (OH)D and EDV (R = –0,24; p = 0,03), systolic output (R = –0,28; p = 0,01), dimensions of the aorta at aortal valve (AV) (R = –0,39; p = 0,0002), ascending aorta (R = –0,31; p = 0,02) and aortic arch (R = –0,41; p = 0,002), parameters of anterior (R = –0,36; p = 0,004) and posterior left ventricular wall thickness during systole (R = –0,27; p = 0,01) in all patients with CHF. Also, there is a positive correlation between SBP and aorta dimensions at the AV level (R = 0,44; р = 0,00003) and ascending aorta (R = 0,36; р = 0,006).

Conclusions. Found association of vitamin D plasma levels with structural and functional state of the myocardium indicates the negative impact of vitamin D deficiency on myocardial contractile function, dimensions of the aorta and anterior and posterior walls of the left ventricle.

Objective. To find the parameters of the ambulatory blood pressure monitoring (ABPM), which play a significant role for the development of the structural and functional changes of left ventricle (LV) in hypertensive patients.

Design and methods. We included 94 hypertensive patients (55 males, 39 females), mean age — 51 ± 6 years. ABPM and echocardiography were performed in all patients.

Results. There was a significant relation between mean hemodynamic blood pressure (BP) and a relative wall thickness and LV myocardial mass index. Pulse BP significantly correlated with the early LV diastolic dysfunction.

Conclusions. As an indicator of LV postload, mean hemodynamic BP might be used to determine the target organ (heart) damage.

Background. Bronchial asthma (BA) is a serious medical problem. The number of patients with the first manifestations at age older than 40–50 years has increased. The frequency of arterial hypertension (HTN) in BA patients was found to be about 30 %.

Objective. To reveal the characteristics of cardiac remodeling at different severity degrees of BA in hypertensive patients.

Design and methods. Altogether 91 patients were enrolled in the study in 2008–2015 years, they presented with controlled BA of varying severity associated with 1–2 degree HTN. Of these, 26 patients (29 %) had mild BA, 34 (37 %) — moderate BA severity, 31 (34 %) — severe BA. All examined subjects were outpatients and received adequately chosen basic BA therapy by inhaled corticosteroids. On demand, they used a β2‑agonists of short action. A group of patients with 1–2 degree HTN (n = 30), and a group of patients with different severity of controlled BA (n = 32) served as controls. All patients underwent echocardioscopy (Acuson 128XP/10c, USA).

Results and conclusions. Left ventricular hypertrophy and diastolic dysfunction were found in all groups, but their number was greater in the group with comorbidities. The number of patients with hypertrophy and diastolic dysfunction was greater with the higher severity of bronchial obstruction in groups with 1–2 degree HTN. Systolic dysfunction was registered in none of the groups.

Objective. To determine predictors of atrial fibrillation (AF) recurrence in patients with persistent AF and arterial hypertension (HTN) after sinus rhythm (SR) restoration by electrical cardioversion (ECV) using data on the dynamics of structural and functional changes in the heart during prolonged preventive antiarrhythmic therapy (AART).

Design and methods. The study involved 127 patients with HTN and non-valvular form of persistent AF who underwent ECV leading to the restoration of sinus rhythm. All patients underwent Holter monitoring (HM) and echocardiography, and were randomized into groups for certain anti-arrhythmic drug (propafenone, sotalol, amiodarone).

Results and conclusions. There is a strong negative correlation between the duration of sinus rhythm after ECV with the prolonged antiarrhythmic therapy and the value of anteroposterior size of the left atrium referred to the body surface area. There was no change in the structural parameters of the left heart one year after ECV when SR was maintained in patients receiving AART (propafenone, sotalol, amiodarone). Amiodarone is more effective for the prevention of AF recurrence after ECV than sotalol or propafenone; and is associated with a decrease in left ventricular isovolumic relaxation time and deceleration time of mitral flow.

Objective. The purpose of the study was the comparative analysis of the vasoprotective effects of a fixed combination of perindopril and indapamide (Noliprel A‑Bi-Forte, Servier) and the combination of enalapril and hydrochlorothiazide (Co-Renitec, MSD) on various sites of the arterial bed in hypertensive patients.

Design and methods. Depending on the mode of antihypertensive therapy (AHT) the patients were randomized into 2 groups: patients of the 1st group (41 persons) received a fixed combination of perindopril A (10,0 mg) and indapamide (2,5 mg), and those from the 2nd group (34 persons) received a fixed combination of enalapril maleate (20,0) mg and hydrochlorothiazide (12,5 mg). The aorta and major arteries were assessed with the use of the device VaSera‑1000 («Fukuda Denshi», Japan), and the following parameters were evaluated: velocity of propagation of pulse wave in the aorta, cardio-ankle vascular index and biological age of the arteries. The peripheral arteries were estimated using the device Pulse Trace PCA, and stiffness index, reflection index and vascular age were measured. All assessments were performed at baseline and at 1-, 3‑and 6‑months and at 1‑year follow-up.

Results. Both combinations resulted in a significant decrease of vascular wall stiffness of the aorta and major arteries, but in the 1st group of patients the changes were observed earlier (after 3 to 6 months), and were more expressed. At the same time vasoprotective effects in peripheral arteries were observed only in 1st group of patients who received perindopril and indapamide.

Conclusions. Leading to a significant reduction of the vascular wall rigidity both in aorta, major and peripheral arteries, a combination of perindopril and indapamide provides the most effective vasoprotection.

Background. A phase III multicenter open-label randomized comparative trial on antihypertensive efficacy and safety of fimasartan and losartan in parallel groups for adult outpatients with arterial hypertension (AH) 1–2 grade during 12 weeks of therapy was performed in 13 investigational sites of Russia.

Design and methods. The study included patients with mean systolic blood pressure (SBP) in the sitting position ≥ 140 mm Hg and ≤ 179 mm Hg, previously treated patients underwent a «wash-out» period. The starting therapy was fimasartan 60 mg per day or losartan 50 mg per day, in case blood pressure was maintained at the level SBP ≥ 140 mm Hg and/or diastolic blood pressure (DBP) ≥ 90 mm Hg at 4 and 8 weeks of therapy the doses were increased up
to 100 and 120 mg, respectively. Primary end-point was change from baseline in “office” sitting SBP at week 12 that was intended to show a “non-inferior” fimasartan efficiency (non-significant difference was set at 5,5 mm Hg).

Results. Altogether 179 patients were randomized either to fimasartan (n = 89) or losartan (n = 90) groups. There were no differences between groups by demographic data and the characteristics of hypertension. After 12 weeks of treatment, mean SBP was 127,7 ± 8,0 mm Hg (–25,2 ± 8,6 mm Hg compared with baseline) in group fimasartan and 127,6 ± 5,6 mm Hg (–24,3 ± 7,8 mm Hg compared with baseline) in losartan group. The mean change in SBP was –0,18 ± 1,00 mm Hg (p = 0,390), the upper limit of the 95 % confidence interval was equal to 1,47 mm Hg that confirms the primary criterion of effectiveness. “Non-inferior” fimasartan efficiency was confirmed by the secondary criteria — the change in SBP and DBP at follow-up visits and the response rate. Safety profiles of fimasartan and losartan were comparable.

Conclusions. Fimasartan is well tolerated, safe and provides similar to losartan BP lowering effect in outpatient population.