Despite adequate lipid-lowering therapy the rate of cardiovascular complications is still high. One of the main factors influencing the residual risk in patients with atherogenic dyslipidemia, along with elevated triglycerides and reduced cholesterol of high density lipoproteins is lipoprotein (a). The paper reviews the current conception of the impact of lipoprotein (a) on the development and progression of atherosclerosis, as well as the main methods of treatment, including lipid apheresis.

Objective. To study the intensity of cardiovascular behavioral and other risk factors of masked arterial hypertension (MHTN) and stable arterial hypertension (SHTN) in young subjects (students of medical university).

Design and methods. A full-design screening study included 423 young men and women aged 20–27, mean age 22, 59 % were women and 41 % — men. All subjects underwent clinical examination: physical examination — height, weight, body mass index (BMI), waist and hip circumferences, questionnaires to assess behavioral risk factors and history of the complaints; laboratory and instrumental screening: fasting serum creatinine, lipid profile (total cholesterol, triglycerides, high density lipoproteins, low density lipoproteins), 30‑second breath-hold test, standard 12‑lead electrocardiography (ECG); echocardiography and 24‑hour blood pressure monitoring in HTN subjects (with MHTN and SHTN).

Results. MHTN was detected in 12,3 % subjects, SHTN — in 9 %; 78,7 % were normotensives. Subjects with SHTN were overweight — BMI 28,4 (27,4; 29,7) kg/m 2. In MHTN subjects, waist and circumferences tended to increase: 77,2 (65,1; 82) and 98 (93,2; 104) cm, respectively. MHTN patients demonstrated higher office systolic blood pressure as compared to normotensives: 120 (110; 130) versus 108,5 (100; 118) mm Hg. However, they had lower BP compared to subjects with SHTN — 139 (132,3; 140) mm Hg. Family history of early cardiovascular diseases was detected in all MHTN patients (100 %), as well as in 50 % SHTN individuals and in 56 % normotensives. The highest prevalence of behavioral risk factors was found in a group of subjects with MHTN, as compared to those with SHTN and normotensives.

Conclusions. Subjects with MHTN and SHTN have prevalent indicators of behavioral and other risk factors for HTN, which form its phenotype. The development of MHTN and SHTN in young subjects is associated with the severity of clinical, genetic and behavioral risk factors.

Objective. To determine the polygenic association of polymorphisms of M235T angiotensinogen (AGT) gene, I/D angiotensin-converting enzyme (ACE) gene, C3123A of angiotensin II type 2 receptor gene (AGTR2), C344T aldosterone synthase gene (CYP11B2) with essential arterial hypertension (HTN).

Design and methods. A total of 532 subjects are examined, representing the Belarussian ethnic homogeneous group (356 hypertensive patients and 176 normotensives). Clinical and molecular genetic examinations of the renin-angiotensinaldosterone system (RAAS) polymorphisms were performed. The search and analysis of polygenic associations are implemented using APSampler software.

Results. We found an association of the combined polymorphisms of T allele of gene AGT (M235T) and T allele of gene CYP11B2 (C344T) with essential HTN in women under 45 years (odds ratio, OR = 4,15, 95 % confidence interval, CI = 1,90–9,07; р = 0,004). Polygenic associations among normotensives included: I allele (I/D) ACE gene and CC genotype (C3123A) AGTR2 gene (OR = 0,58; 95 % CI = 0,49–0,68; р = 0,03); I allele (I/D) ACE genes and ММ genotype (М235 Т) of AGT gene in women under 45 years (OR = 0,09; 95 % CI = 0,01–0,63; р = 0,005); М allele (М235 Т) of AGT gene and CC genotype (C3123A) of AGTR2 gene in all subjects over 45 years (OR = 0,55; 95 % CI = 0,47–0,64; р = 0,03).

Conclusions. There was no difference in distribution of the studied alleles and genotypes of RAAS genes in patients with HTN and healthy subjects. At the same time the polygenic combinations of RAAS genetic polymorphisms significantly differ between hypertensive and normotensive subjects. This indicates the advantages of studying the effect of combinations of genotypes and/or alleles of different polymorphic loci on the risk of essential HTN before analyzing the impact of each single locus.

Objective. To study the association between N‑terminal pro B‑type natriuretic peptide (NT-proBNP) and diurnal blood pressure (BP) profile in middle-aged men with arterial hypertension (HTN) and chronic heart failure (CHF).

Design and methods. We surveyed 550 men from 40 to 50 years, 420 subjects were included in the study and were divided into groups: 1st group — patients with HTN without CHF (n = 180); 2nd group — patients with HTN and CHF (n = 86); 3rd group — patients with CHF without HTN (n = 74). The control group consisted of healthy men with normal BP without CHF (n = 80). NT-proBNP (fmol/ml) and 24‑hour BP monitoring were performed in all patients.

Results. NT-proBNP was lower in patients with HTN 2 and 3 degree in comparison with patients with HTN 1 degree without CHF (group 1). It was not found in hypertensive patients with CHF (group 2). NT-proBNP was higher in patients with HTN 1 degree in the 1st group in comparison with patients with HTN 1 degree in the second group and lower in patients with HTN 2 and 3 degree in the first group, in comparison with patients with HTN 2 and 3 degree in the 2nd group. There was an inverse correlation between NT-proBNP and HTN degree in the 1st group (r = –0,624; p = 0,023).

Conclusions. The decrease in plasma level of NT-proBNP in hypertensive patients is associated with the increase in BP. Natriuretic peptides are involved in the circadian rhythm of BP, and their level is associated with the HTN degree and «load pressure». NT-proBNP was the highest in «non-dippers» and «night-peakers» and differed significantly from «over-dippers» and patients with unchanged circadian BP profile.

The aim of the research was to study the peculiarities of cardiac and pulmonary hemodynamics, the mechanisms of formation of endothelial dysfunction, as well as their correction with angiotensin converting enzyme inhibitor, Ramipril and angiotensin-II receptor blocker, Irbesartan, in patients with arterial hypertension (HTN) combined with bronchial asthma (BA).

Design and methods. Altogether 80 patients with BA of moderate severity combined with HTN of 1, 2 degrees were enrolled in the study. The average age of the patients was 52,9 ± 4,2 years. The eligible patients were randomized for treatment with either Ramipril 5 mg/day or Irbesartan 150 mg/day in combination with bronchodilator inhalation and anti-inflammatory medications for BA (Formoterol/Budesonide 160/4,5 mcg 2 inhalations twice, Ipratropium bromide and Ambroxol through nebulizer devices). The program of instrumental examination included echocardiography (Aloka 1700, Japan; LOGIQ 500, Germany) with ultrasonic sensors of 3,5 MHz. The plasma level of endothelin 1 (ET‑1) was estimated by immune-enzyme assay (Biomedica set, category № 442–0052, Arkray, Japan).

Results. Two-month monotherapy with Irbesartan allows to achieve the target blood pressure (BP), leads to the regression of cardiac remodeling and has a positive effect on endothelial function and bronchial patency.

Conclusions. Irbesartan is able to provide a stable and reliable control of BP, and delays the progression of pathological cardiovascular changes; it has a favorable impact on the respiratory function, is well tolerated, easy to use, and may be considered as the best antihypertensive drug in patients with co-morbid HTN and BA.

Background. The population studies demonstrated the direct relationship between blood pressure (BP) level and risk of cardiovascular complications. The BP elevation (even within high normal values) in the young adults is associated with early involvement of target organs. Moreover, the initial myocardial structural and functional changes associated with BP increase are not studied completely. Modern ultrasound diagnostic opportunities (development of high frequency broadband transthoracic transducer, implementation of Tissue harmonic imaging and development of “speckle tracking” echocardiography method — STE) allow to assess the coronary blood flow status and to reveal the earliest signs of left ventricle (LV) myocardial dysfunction.

The aim of our study is to assess the LV longitudinal deformation and coronary blood flow at the level of left anterior descending (LAD) artery and perforant arteries (PA) in young patients with high normal BP (HNBP).

Design and methods. The study involved 43 men aged 18–27 years old, who were divided into 2 groups depending on office BP level. The first group consists of the subjects with HNBP, the second group included persons with optimal and normal BP values. The standard physical examination was performed in all patients. Heart condition was assessed by transthoracic EchoCG data. The registration of blood flow spectrum in LAD and in apical PAs was performed by impulse Doppler regimen. LV functional status was assessed by STE with global longitudinal strain analysis.

Results. The traditional parameters of systolic and diastolic LV function were comparable in patients with HNBP and in healthy subjects. In patients with prehypertension a significant decrease of global strain rate was registered; they negatively correlate with systolic BP. In patients with HNBP the significant decrease of maximal diastolic blood flow rate in PA was registered.

Conclusions. The earliest preclinical sign of myocardial contractile dysfunction in the subjects with HNBP is the decrease of global longitudinal strain. In patients with prehypertension the decrease of maximal diastolic blood flow rate in performant arteries is found.

Objective. To study the efficiency of cortexin in the treatment of hypertensive patients with circulatory encephalopathy (CE) exposed to ionizing radiation in anamnesis.

Design and methods. There were 165 liquidators of the Chernobyl accident (liquidators) with hypertension (HTN) 1–2 degree and CE stage I and II. The liquidators were divided into groups: group 1a received one course of cortexin (10 mg for 10 days), group 1b — two courses for 10 days (every 6 months), 2a — one course for 20 days, 2b — two courses for 20 days (with an interval of 6 months), the 3rd group was not treated with cortexin. We studied the dynamics of blood pressure (BP) and cognitive functions assessed by the neuropsychological tests.

Results. Administration of cortexin in hypertensive patients with CE was associated with the decrease in BP, it was more evident at higher doses both during the first and the second courses of treatment (after 6 months).

Conclusions. The administration of cortexin improves cognitive functions and reduces BP in the liquidators with HTN and CE. More effective and long-lasting results (up to 12 months) were found when the two-step approach was applied (cortexin 200 mg per course).

Objective. To assess incidence rates for arterial hypertension (HTN) in the cohort of workers exposed occupationally to prolonged radiation.

Design and methods. Incidence of HTN was studied in the cohort of 22,377 workers of the first nuclear enterprise in the former USSR, the Mayak Production Association, for the entire follow-up period (1948–2008). “Crude” and standardized incidence rates were calculated. To standardize incidence rates indirect method was applied.

Results. As of 31.12.2008, 8,047 cases of HTN were registered in the study cohort (5,463 in males and 2,584 in females). Standardized incidence rates for HTN among workers of the study cohort were significantly associated with sex, attained age and body mass index. No relation was found between standardized incidence rates of HTN to occupational prolonged external gamma- ray-radiation.

Conclusions. Incidence of HTN in the cohort of nuclear workers was related to non-radiation factors, but had no association with occupational prolonged exposure.

Objective. Fimasartan, a novel potent angiotensin II receptor blocker, was evaluated in various preclinical and clinical studies in Korea. Considering that Korean population were studied in pivotal clinical trials, determination of Fimasartan pharmacokinetics in Russian patients was performed.

Design and methods. Open-label study on fimasartan pharmacokinetics after single use of fimasartan 60 mg included 15 patients with established arterial hypertension (HTN) 1–2 grade. Drug concentration was evaluated by protein precipitation for sample extraction followed by liquid chromatograph mass spectrometry.

Results. Fimasartan 60 mg was quickly absorbed after oral uptake, and maximal product concentrations in plasma were observed after 1,0 hour (tmax median), individual range of tmax values was from 0,50 to 4,00 hours after product uptake. After Сmax was achieved fimasartan concentration biphasic reduction started, and elimination phase began 2,5–8 hours after medication uptake in all patients. Fimasartan plasma concentration was identifiable until last timepoint of sampling 24 hours after drug uptake in the range of 1,33 to 11,2 ng/ml. Apparent terminal half-life period (t1/2) was 5.8 hours, individual data was in the range of 4,40 to 7,93 hours.

Conclusions. Pharmacokinetics of fimasartan in HTN patients in Russian population correlates well to the data obtained in Korean patients with HTN as well as in healthy volunteers.

Objective. The aim of our study was to compare the reproducibility of signal-averaged and conventional electrocardiogram (ECG).

Design and methods. The study group included 20 young healthy volunteers (10 men and 10 women, aged 18–25 years) examined twice with one-week interval. Twelve-lead and Frank’s orthogonal system ECG recordings were acquired during 5 minutes using computerized ECG device at each examination; conventional and averaged ECG analyses were performed. Mathematical processing to get averaged ECG in each lead was performed using original program «HR ECG». The sum of P wave, PQ interval, and QRS durations and the sum of P, Q, R, S, T waves amplitudes (amplitudes) in lead I of 12‑lead ECG and in lead Y in Frank’s lead system and left ventricular hypertrophy (LVH) indices (Sokolow-Lyon, Cornell voltage, Cornell product) were used for the evaluation of reproducibility.

Results. Variation coefficients of durations between two evaluations of conventional and signal-averaged ECG were 13,1 % versus 4,8 % (p < 0,01) for lead I and 16 % versus 4,8 % (p < 0,01) for lead Y, respectively. Variation coefficients of amplitudes between two examinations of conventional and signal-averaged ECG were 12,2 % versus 7,2 % (p < 0,01) for lead I and 10,3 % versus 6,7 % for lead Y (p < 0,05), respectively. Variation coefficients of Sokolow-Lyon index, Cornell voltage and Cornell product were 12,3; 16,9 и 12,8 % versus 8,0; 14,2 и 10,1 %, respectively (p < 0,05 for all variables).

Conclusions. The reproducibility of the signalaveraged ECG is significantly higher than the conventional one for interval duration, wave amplitude, as well as for LVH indices. The use of this method in clinical practice will increase the reliability of individual evaluation of myocardial changes at single examination and during follow-up. In studies with ECG control it may contribute to the decrease in study duration or group size required to reach statistically significant differences.