Background. Arterial hypertension (HTN) plays a major role (42 %) for cardiovascular disease incidence, meanwhile routine early HTN detection remains low. Different measures are implemented in order to solve the problem of early HTN detection, as well as other chronic diseases leading to disability and the decrease in life expectancy. These measures include medical prevention based on the regular check-up and follow-up. objective. To evaluate the quality of the check-ups regarding the diagnostics of blood pressure (BP) elevation and associated risk factors, and to evaluate the regional characteristics in the adult population.

Design and methods. We analysed general data obtained in 2015 year during the check-ups in the country and regions. In this analysis, we present the data regarding HTN rates, including cases of preliminary diagnosis and elevated BP as a risk factor.

Results. In 2015, 21,7 million people underwent health check-up. HTN incidence was 33,6 %, including 16,5 % of verified HTN, 3,6 % cases of preliminary diagnosis, in 13,5 % cases increased BP was considered as a risk factor. We found significant regional differences. In regions with a lower active HTN detection the overall HTN morbidity is lower, but primary HTN morbidity and CVD-related mortality are higher. In addition, in these regions active follow-up of patients with verified HTN is performed less frequently. In regions with high mortality associated with cerebrovascular diseases, the diagnosis of the diseases characterized by BP elevation is lower.

Conclusions. We found a positive correlation between diagnosed HTN and nutrition-associated risk factors that confirms the importance of multi-factor prevention and control of HTN in primary health care. We suggest to use the ratio between the newly diagnosed cases of elevated BP of all cases with such diagnoses for rapid assessment of the quality of the health check-up for HTN detection at the regional level.

Arterial hypertension (HTN) is the leading factor associated with myocardial infarction, stroke and premature death in the most countries. Annual prophylactic examinations in the organized populations aim at the HTN detection and related complications including the hypertensive heart disease (HHD). The isolated elevated blood pressure (BP) during work time (HTN at workplace, work-related HTN) is associated with the risk of HHD and other complications.

The aim of our study was the assessment of work-related HTN prevalence and echocardiography (EchoCG) measures in the employees of the big industrial enterprise who were not treated with antihypertensive medications.

Design and methods. This paper presents the results obtained from examination of workers not treated by the antihypertensive drugs (AHD) (n = 40). All subjects underwent physical examination, EchoCG, and 24-hour ambulatory BP monitoring (ABPM) Criteria of the work-related HTN were the combination of normal office BP level (< 140/90 mm Hg) and high BP (≥ 135 and/or 85 mm Hg) during the working hours (based on ABPM data within the period from 8 am till 5 pm).

Results. Among 477 employees of the industrial enterprise, who underwent ABPM and EchoCG within the annual prophylactic examination, only 185 (39 %) had normal office BP levels. Among them only 40 persons (21,6 %) did not take AHD, and met other inclusion/exclusion criteria. Based on ABPM data, only 20 employees (50 %) had normal office and ambulatory BP levels. EchoCG showed a high rate (60 %) of the concentric left ventricular hypertrophy (LVH), other forms of heart remodeling (HHD) were rare, eccentric hypertrophy was found in 5 %, and concentric remodeling — in 15 %. The prevalence of left ventricular remodeling types was comparable to that in stable HTN.

Conclusions. We believe that workrelated HTN is worth noting, in particular its early diagnosis and prevention is of great importance. ABPM at work place along with EchoCG for the detection of target organ damage should be included in the annual prophylactic examinations and will encourage the early diagnosis and timely cardiovascular prevention.

Due to the significant financial costs associated with the management of arterial hypertension (HTN), the optimization of health care resource distribution is required.

Objective. To study the resource maintenance treatment of HTN in outpatient clinics. design and methods. The study included two stages. Firstly, we selected a sample of primary HTN patients based on the screening of primary medical records (n = 1766). Secondly, we performed a telephone survey 6 months after the inclusion (n = 1419).

Results. Outpatients are characterized by a high frequency of visits to the doctor: 2,9 physician’s counseling, 2,6 cardiologist’s counseling, 0.21 cases of medical emergencies, 0.08 hospitalizations per 1 patient for 6 months on average. Significant use of health care resources was found in the following groups: patients aged 60 years and older, who periodically or regularly measure blood pressure (BP), regularly take antihypertensive therapy (AHT), those who have drug incentives, do not use fixed combinations, with uncontrolled BP, coronary heart disease (СHD), who take 3 or more antihypertensive drugs, who changed or withdrew the recommended AHT. Although achieving target BP is associated with a reduced likelihood of medical emergency calls and outpatient physician’s counseling, there was not difference in the number of hospitalizations between the groups with achieved target BP and the group with uncontrolled HTN. Total direct costs for 6 months composed 9 283,13 rubles per one study participant. Factors associated with a higher total direct costs included age 60 years or older, a high level of self-monitoring of BP, regular intake of AHT, the opportunity of drug incentives, the presence of СHD, uncontrolled HTN, multiple combination antihypertensive therapy (3 drugs and more), no use of fixed combinations, changes or withdrawal of recommended AHT.

Conclusions. Our analysis of resource provision and cost-effectiveness of HTN treatment allowed to identify the groups of patients with inappropriate resource expenses. These data demonstrate the need for targeted interventions in order to reduce the economic burden of HTN.

Objective. To study chronophysiological alterations in blood pressure (BP) rhythms in normotensive patients and define their prognostic value in development of arterial hypertension (HTN) in shift workers at the Arctic Polar region in a prospective (one-year) observation.

Design and methods. We examined 173 men with normal BP and without HTN (mean age: 40,2 ± 4,1 years; mean northern shift-work experience: 16,5 ± 6,8 years; mean length of service: 11,2 ± 3,8 years and mean office systolic/diastolic BP 123,4 ± 7,5 / 80,5 ± 5,5 mmHg) within one-year prospective study during shift work in the Arctic region (monthly roundabouts to Arctic region and back to home cities). All patients underwent ambulatory BP monitoring (ABPM) with consequent chronobiologic data analyses once every 3 months.

Results. One-year prospective study of chronobiological parameters showed a high prevalence of distinct atypical types of BP diurnal rhythms/variability disorders in normotensive persons staying in the Far North. Moreover, preexisting BP variability/rhythm disorders have high prognostic value and are associated with high risk of HTN development within one year. Also, atypical normotensive BP variants were characterized by more evident structural cardiovascular changes. Moreover, chronobiological approach showed higher diagnostic sensitivity, specificity and efficiency in comparison with conventional analysis of ABPM.

Conclusions. Logistic regression showed prognostic significance of normotensive atypical rhythm/variability disorders compared to the conventional risk factors (smoking, low physical activity, body mass index, dyslipidemia, age, duration of stay in the North and camp experience, the mode and type of shift schedule). By multivariate analysis we developed a model for the risk prediction of HTN development during the year in normotensive people working as shiftworkers in the Far North. 

Objective. To detect the frequency of “white coat” hypertension (WCH) in 40–49-year old men and its association with the indicators of cardiovascular remodeling and cardiovascular risk factors. design and methods. In a single-step study, we assessed cardiovascular risk in 350 men (40–49 years old) with different levels of blood pressure (BP) based on the 24-hour ambulatory BP monitoring (ABPM).

Results. Prevalence of left ventricular hypertrophy (LVH) was 8 % in patients with WCH, and 26 % in patients with high BP (χ ² = 4,9, p < 0,05). The rate of increased intima-media thickness more than 0.9 mm was 11 % in WCH group, compared to 28 % among patients with verified arterial hypertension (HTN) (χ ² = 3,9; p < 0,05). Compared with healthy cohort, left ventricular myocardial mass index and carotid artery wall thicknesses were significantly higher in patients with LVH.

Objective. To determine clinical, laboratory and instrumental predictors of subclinical isolated and combined atherosclerotic lesions in middle-aged men and its association with metabolic syndrome. design and methods. We examined 194 middle-aged men (44–60 years, WHO, 2009) with subclinical atherosclerotic arterial lesions: coronary artery (CA), extracranial artery (ECA) and peripheral artery (PA). The 1st subgroup included 40 men with isolated lesion in one arterial region (mean age — 53,6 ± 4,7 years): 17 subjects had CA lesion, 9 had ECA involvement, and 14 patients had PA lesion. The 2nd subgroup included 154 patients with combined lesions of 2 or more vascular pools (mean age — 52,1 ± 4,1 years). Both groups were comparable by age. Past acute myocardial infarction and stroke were exclusion criteria. All subjects underwent general clinical examination (medical history, physical examination, blood pressure (BP) and body mass index assessment), blood tests (lipids, coagulogram, inflammatory markers), ultrasonography (duplex scanning, power and color Doppler and spectral analysis of blood flow), stress-testing (stress-echocardiography, treadmill-test) and angiographic methods. The following parameters were analyzed in a logistic regression model as predictors of subclinical atherosclerosis: systolic and diastolic BP, total cholesterol, high-density lipoprotein cholesterol, triglycerides, basal and postprandial glucose level, homocysteine, fibrinogen, C-reactive protein (CRP), smoking and cardiovascular (CV) heredity factors, intima-media (IMT) thickness, total duration of exercise test and oxygen intake (MET) at stressechocardiography, and change of the ankle-brachial index (ABI) at treadmill-test.

Results. The most significant predictors of isolated CA atherosclerosis are the following: cardiovascular disease in close relatives, increased CRP and IMT, decreased exercise tolerance and increment of ejection fraction during stress-echocardiography, ECA — family CV history, increased CRP and IMT, for PA — hyperglycemia and reduction in ABI increase at the peak exercise. Combined subclinical atherosclerotic lesions were associated with family CV history, hyperhomocysteinemia, increased CRP, decrease of the total duration of stress-test, oxygen intake and increment of ejection fraction during stress-echocardiography, as well as decreased ABI elevation at the treadmill test. Combined subclinical atherosclerosis is also associated with traditional and additional components of metabolic syndrome (hyperhomocysteinemia and increased CRP).

Conclusions. Besides to the known association with arterial hypertension, dyslipidemia, vascular wall thickening, the following predictors of isolated arterial lesions were found: for CA — with family CV history, increased CRP, decreased exercise tolerance, and increment of ejection fraction at stress-echocardiography, for ECA — family CV history, increased CRP, for PA — hyperglycemia and decreased ABI elevation at the peak exercise. Subclinical multifocal atherosclerosis is closely associated with hyperhomocysteinemia, increased CRP and reduced exercise tolerance at stress-tests.

The paper discusses the clinical and prognostic role of multifocal atherosclerosis, namely co-existent atherosclerotic lesions of several arteries. In addition, the issues of the diagnosis of subclinical multifocal atherosclerosis are reviewed.

Objective.  Bronchial asthma (BA) is a serious problem. The rate of arterial hypertension (HTN) in BA patients is about 30 %. The objective of our study was the assessment of efficacy of diltiazem-retard and ivabradine on myocardial structural and functional changes and HR in hypertensive patients with BA.

Design and methods. Outpatients (n = 91) with BA with HTN 1, 2 degree with high or very high cardiovascular risk by SCORE. All participants used inhaled corticosteroids and β2-agonists. All patients underwent Holter electrocardiogram monitoring (HM-ECG, GE SEER MC Marquette Medical System, USA). Based on HMECG data myocardial ischemia was found in 18 patients. Altogether 67 patients were included in the further analysis. They were divided into 2 groups: 1st group (n = 35, age 58,5 ± 8,34 years) received diltiazem-retard, 2nd  group (n = 32, age 55,2 ± 9,21 years) took ivabradine. Duration of follow-up was 12 weeks.

Results. In hypertensive patients with BA, both ivabradine and diltiazem decrease the frequency of ventricular premature beats and HR (р < 0,05), and supraventricular premature beats. Compared to ivabradine, diltiazem showed comparable efficiency regarding the decrease in HR, ventricular and supraventricular premature beats (р > 0,05). After 12-week therapy ivabradine led to a more significant decrease in ventricular premature beats compared to diltiazem in hypertensive patients with BA.

Conclusions. Ivabradine and diltiazem demonstrate comparable efficiency regarding decrease of HR and ventricular premature beats in hypertensive patients with BA.