Arterial hypertension (HTN) is frequently associated with comorbid diseases. Hypertensive patients commonly have one or several co-existent pathologies. The most frequent ones include diabetes mellitus, metabolic syndrome, chronic kidney disease, chronic obstructive pulmonary disease, cerebrovascular disease and others. The comorbidities have mutual impact on each other, character and severity of complications. They often lead to complications, influence the choice of antihypertensive drugs. The guidelines of the European Society of Cardiologists and the European Society on Hypertension, the American Association of Heart and the American Association of Strokes, the Russian Cardiologic Society and Scientific Association of Nephrologists of Russia, the Russian Medical Society on Arterial Hypertension give recommendations based on the available evidence. Comorbidities influence both the choice of antihypertensive drugs and target blood pressure level. Recently the current concepts were updated by the novel results and meta-analyses. Hypertensive patients with coexistent pathologies require individual approach, complex diagnostics and treatment dependent on the type of comorbidity.

The second part of review discusses the choice of antihyperglycemic agents, including thiazolidinediones, dipeptidyl peptidase‑4 inhibitors, selective inhibitors of the sodium glucose co-transporter‑2, glucagon-like peptide‑1 receptor agonists, in high-risk patients with type 2 diabetes mellitus. Randomized clinical studies, metaanalyses considering cardiovascular safety of antihyperglycemic agents showed that in high-risk patients with type 2 diabetes mellitus selective inhibitors of the sodium glucose co-transporter‑2 (empagliflozin), glucagon-like peptide‑1 receptor agonists (liraglutide) are the first line treatment (monotherapy or combined, depending on baseline glycosilated hemoglobin level) due to their ability to decrease cardiovascular risk. Glucagon-like peptide‑1 receptor agonists (lixisenatide), dipeptidyl peptidase‑4 inhibitors (alogliptin) were shown to have favourable safety profile. Meta-analyses demonstrated a higher risk of heart failure in patients treated by saxagliptin and sitagliptin. In addition, we present an algorithm for the choice of the initiation antihyperglycemic treatment in patients with diabetes mellitus type 2 and very high cardiovascular risk depending on baseline glycosilated hemoglobin level.

Objective. To study the effect of chronic emotional stress and physical activity on endothelial function in patients with arterial hypertension (HTN) and obesity.

Design and methods. We enrolled 76 male patients with HTN stage I and II. Group 1 consisted of 36 patients with HTN and obesity, group 2–40 hypertensive patients without obesity. Ultrasound of the brachial artery was performed to assess endothelial function after reactive hyperemia (flow-mediated dilation) and nitrate administration (nitrate-mediated dilation). Serum cortisol level was determined by enzyme-linked immunosorbent assay. PSM‑25 scale was used to access psycho-emotional stress. The level of reactive and personal anxiety was measured by the Spielberger and Khanin’s questionnaire. Brief international physical activity questionnaire was used (IPAQ) for physical activity evaluation.

Results. In patients with HTN and obesity a more significant deterioration of the flow-mediated and nitrate-mediated dilation (FMD and NMD) was found compared to hypertensive patients without obesity, and to healthy individuals. In both groups physically inactive patients showed a significant decrease in endothelial function compared to physically active patients. In group 1, an inverse correlation between FMD with the level of reactive anxiety and trait anxiety (r = –0,54; r = –0,46, respectively; p < 0,05) and a direct correlation with the level of physical activity (r = 0,42; p = 0,01) was found. In group 2, FMD and NMD inversely correlated with psycho-emotional stress (r = –0,42; r = –0,33, respectively; p < 0,05) and directly correlated with the level of physical activity (r = 0,46; r = 0,33, respectively; p < 0,05). In both groups, there were direct correlations between cortisol levels with personal and reactive anxiety scores. Furthermore, there was an inverse association between FMD and cortisol levels in group 1 (r = –0,36; p = 0,05) and group 2 (r = –0,41; p = 0,02).

Conclusions. Our findings suggest a strong connection between chronic emotional stress and physical inactivity with endothelial dysfunction in hypertensive patients.

Objective. To assess changes of elastic properties of the aortic wall in patients with aorta coarctation and aortic arch hypoplasia after reverse left subclavian flap aortoplasty and extended end-to-end anastomosis compared to the control group of children without cardiovascular pathology.

Design and methods. A two-center prospective cohort study was designed to assess elastic properties of the aorta in 54 patients, who underwent surgical treatment of aorta coarctation by reverse left subclavian flap aortoplasty (I group, 27 patients) and extended end-to-end anastomosis technique (II group, 27 patients) in infancy. The control group included 27 children without any congenital heart pathology.

Results. Two patients in the I group (7,7 %) and 8 patients in the II group (30,7 %) had blood pressure above 95th percentile, while in the control group none of the patients had blood pressure higher than 95th percentile (p < 0,01). Elastic properties of precoarctation area significantly differed in both groups throughout the follow-up period, while the elasticity of the descending aortic wall differed between groups only 6 months after surgery.

Conclusions. Elastic properties of the aortic wall in patients with aorta coarctation remain impaired, even after early neonatal surgical treatment. Due to the decrease in the elasticity of ascending and descending aorta, we consider a systemic genesis of vascular damage following the remodeling of aortic arches. However, this hypothesis requires further prospective studies.

Background. Atrial fibrillation (AF) is associated with the increase in mortality from cardiovascular causes, systemic thromboembolism, congestive heart failure, high rate of hospitalization and deterioration of quality of life. Hypertension (HTN) is the most common cause of AF. Beta-blockers are the therapy of choice for AF prevention. To predict the therapy efficiency, one should assess the regulatory and adaptive status (RAS).

The aim of our study was to compare bisoprolol vs sotalol in patients with HTn and paroxysmal AF taking into account quantitative indices of the regulatory adaptive status (RAS).

Design and methods. We included 50 patients with HTN stages II–III and paroxysmal AF and randomized them into two groups for treatment with bisoprolol (6,4 ± 1,8 mg/day, n = 25) or sotalol (157,0 ± 38,3 mg/day, n = 25). As part of combination therapy, lisinopril (14,2 ± 3,8 and 14,0 ± 4,8 mg/day), atorvastatin (17,1 ± 3,7 mg/day, n = 11 and 16,0 ± 5,1 mg/day, n = 11), acetylsalicylic acid were prescribed (90,0 ± 14,6 mg/day, n = 12 and 92,1 ± 16,8 mg/day, n = 12), respectively. At baseline and 6 months after therapy, quantitative assessment of RAS (by cardio-respiratory synchronism test), echocardiography, triplex scanning of brachiocephalic arteries, treadmill test, six-minute walk test, 24‑hour blood pressure and electrocardiogram monitoring, subjective assessment of quality of life.

Results. Both schemes comparably improved structural and functional parameters of the heart, increased exercise tolerance, controlled arterial hypertension, effectively suppressed AF paroxysms, improved quality of life. At the same time, sotalol led to the decrease of RAS to a lesser degree than bisoprolol.

Conclusions. In patients with HTN stages II–III and paroxysmal AF sotalol as a component of the combination therapy may be preferable to bisoprolol due to its lower impact on the RAS.

Background. Today preeclampsia remains one of the most serious complications of pregnancy, taking third place in the structure of maternal and perinatal mortality. The basis of the pathogenesis of preeclampsia is endothelial dysfunction. The underlying causes are widely discussed in the scientific literature.

Objective. To evaluate levels of vascular endothelial growth factor, placental growth factor, a soluble receptor‑1 of a vascular endothelial growth factor in pregnancy complicated by preeclampsia.

Design and methods. We enrolled 105 pregnant women at gestation 32–34 weeks. The main group consisted of 17 (16,2 %) women with moderate preeclampsia. Control group included 88 (83,8 %) pregnant women with uncomplicated pregnancy. VEGF was defined by the enzyme-linked immunosorbent assay, PlGF and sVEGF-R1 — by the electro-chemiluminescence immunoassay.

Results. PlGF level was 942,4 ± 241,3 pg/ml in the control group, and 134,9 ± 73,18 pg/ml in the main group (p < 0,01). VEGF level was significantly higher in study group compared the control group: 5,3 ± 1,3 vs. 2,1 ± 0,8 pg/ml, respectively (p < 0,05). sVEGF‑1 in the control group was 2068,3 ± 323,5 pg/ml, in the main group — 9314,3 ± 1381,0 pg/ml (p < 0,001). Normal pregnancy was characterized by the predominance of angiogenic over antiangiogenic factors. In pregnancy complicated by preeclampsia, there was a significant increase in antiangiogenic factors and decrease in angiogenic factors.

Conclusions. The serum levels of angiogenic and antiangiogenic factors differ in pregnant women with and without preeclampsia at 32–34 weeks gestation. Predominance of angiogenic over antiangiogenic factors is found in normal pregnancy, while women with preeclampsia demonstrate significant increase in antiangiogenic factors and decrease in angiogenic factors. Further investigation of biologically active substances in early pregnancy is required in order to find an early predictor of preeclampsia.

Objective. The purpose of this work is evaluation of the occurrence of arterial hypertension (HTN) in patients with ankylosing spondylitis (AS) and psoriatic arthritis (PsA).

Design and methods. We enrolled 159 patients with AS and 85 with PsA in a cross-sectional study. Another aim was the analysis of the results of a 10‑year prospective study with evaluation of new- onset HTN in patients with AS (n = 278) and PsA (n = 109). Control group was formed by 150 healthy volunteers. All the results were adjusted by cardiovascular risk factors.

Results. HTN occurred in 48,7 % of AS and 67,5 % PsA patients, respectively (p = 0.03). The relative risk (RR) of HTN occurrence in patients with AS compared with healthy individuals was 2.22 (95 % CI 1.59–3.1), the odds ratio (OR) was 3.34 (95 % CI 2.1–5.3). The HTN risk in patients with PsA compared to individuals without spondyloarthritis (RR) was 3.08 (95 % CI 2.19–4.03). HTN occurrence differed significantly in PsA and AS patients (p < 0.0001).

Conclusions. The risk of new onset HTN in patients with AS and PsA is higher compared to the healthy individuals. The HTN incidence in PsA patients is higher than in the AS group. The number of new cases of HTN increases with time, and 10 years after diagnosis was verified, half of AS/PsA patients without cardiovascular disease are at risk of HTN.

Objective. To evaluate the effectiveness of combination treatment with antihypertensive drugs and antidepressant in patients with uncontrolled hypertension (UHTN) and depressive disorders (DD).

Design and methods. The study involved 160 patients with UHTN and DD and prescribed a combination therapy including an angiotensin-converting enzyme (ACE) inhibitor (perindopril 10 mg/day) and a thiazide-like diuretic (indapamide SR, 1,5 mg/day). Patients were randomized into 2 groups: 1st group recieved antihypertensive treatment with an antidepressant (selective serotonin reuptake inhibitors, escitalopram 10 mg/day); 2nd group received calcium channel blocker (CCBs, amlodipine 5–10 mg/day). At baseline and after 24 weeks all patients underwent clinical examination, ambulatory blood pressure monitoring (ABPM) (“Petr Telegin”, BPLab Vasotens, Russia) with 25‑minute intervals between the measurements during the day and 50‑minute intervals at night. We assessed the average 24‑hour, daytime and nighttime systolic blood pressure (SBP), diastolic blood pressure (DBP), variability of blood pressure (BP), hypertension time index, the size and speed of morning rise in BP, daily index, pulse pressure. In addition, we evaluated arterial stiffness: the propagation time of the reflected wave (RWTT, ms), the estimated PWV in the aorta (PWVao, m/s) adjusted to systolic BP 100 mm Hg and heart rate 60 beats/min (RWTT ms, PWVao m/s), augmentation index. We also assessed central aortic pressure: systolic aortic pressure, aortic diastolic pressure, mean pressure in the aorta, aortic augmentation index. All the patients filled in the Hospital Anxiety and Depression Scale (HADS), Tsung depression scale, Spielberger’s scale of the anxiety, Wayne questionnaire and the SF‑36 questionnaire for the assessment of quality of life.

Results. Combined antihypertensive therapy with escitalopram provided the target BP achievement in half of patients after 4 weeks, while in the control group an increase in the amlodipine dose to 10 mg per day was required to achieve target BP in 75.6 % of patients. After 24 weeks, group 1 showed better ABPM parameters compared to the control group. In addition, daily BP profile was normalized in a larger number of patients than in control group. Antidepressants led to a comparable to the calcium antagonist therapy regression of the indicators of arterial stiffness and the central aortic pressure. After 24 weeks, a positive change in DD was registered in the group treated with escitalopram, while in the group 2 depression indicators remained at a high level. The use of antidepressant resulted in a significant decrease in anxiety disorders and autonomic disturbances, whereas in patients treated with “traditional” antihypertensive therapy, an increase of anxiety level and baseline autonomic dysfunction remained unchanged. Also, the group of antidepressant showed greater improvement of the quality of life assessed by the SF‑36 questionnaire.

Conclusions. The use of escitalopram in combination therapy provided a rapid achievement of target BP and more significant improvement in the main ABPM indicators, normalization of daily BP profile, a significant improvement in the emotional status and autonomic function, reduction of the depression and anxiety symptoms, improvement in quality of life compared to the treatment without antidepressant.

The review presents the results of clinical studies on the prognostic role of albuminuria A2 (microalbuminuria), mild renal dysfunction (estimated glomerular filtration rate — 60–74 ml/min/1,73 m 2), biomarkers of proximal tubular damage in hypertensive patients. Moreover, we discuss the data on the nephroprotective effects antihypertensive drugs, including calcium channel antagonist 3rd generation lercanidipine and β-blocker 3rd generation carvedilol.