Pheochromocytoma and primary hyperaldosteronism are the most common causes of secondary hypertension. In a group of patients with primary hyperaldosteronism the prevalence of somatic mutation has been established in patients with aldosterone-producing adenomas (APA), genetic mutations have been identified in patients with family
types of the disease. The authors declare that aldosterone-producing cellular clusters, which derived from zona glomerulosa, appear as a result of somatic mutations and might be a precursor of APA. Development of bilateral adrenal hyperplasia and APA might be explained by an existence of autoantibodies and their chronic stimulation of zona glomerulosa. The assessment of somatic and germline mutations in patients with pheochromocytoma and paraganglioma facilitates early diagnostics other tumors within syndromic neoplasia. Implementation of new genetic test in practice would improve early diagnosis of adrenal pathology in hypertensive patients.

Despite the recent advancesin diagnosis and surgical treatment of hormonally active adrenal tumors (GAAT), the awareness of medical practitioners about the disease remains insufficient. The results of examination and treatment of 758 GAAT patients prove that long existing symptomatic (secondary) arterial hypertension (SHTN) is malignant characterized by the development of vascular complications involving cardiac and/or cerebral arteries, and drug-resistance and requires pre-surgery correction of metabolic and endocrine disorders. In GAAT, adrenalectomy is the main method of SHTN treatment. The reasons for maintaining or recurrence of arterial hypertension (HTN) after surgery in 35,7% of patients are not associated with surgery itself, but are due to the long duration of high blood pressure due to a 5,37 ± 3,30 years before the manifestation of the tumor in adult patients (older 44,75 ± 3,89 s), and co-existent endocrine, metabolic and cardiovascular disorders. The predominance of the pressor hormones over depressor ones leads to the cardiovascular remodeling, causes the development of left ventricular diastolic dysfunction due to impaired relaxation and the increased role of atrial systole in its filling. If these factors are identified, the selection and follow-up of the patients after surgery, and the choice of antihypertensive therapy are required. Early diagnosis of GAAT, adequate preoperative drug therapy, and implementation of timely surgical treatment contribute to the elimination of adrenal-related SHTN, provide good treatment results and better quality of life in GAAT patients. 

Objective. To estimate and compare the endothelial function in patients with essential arterial hypertension (HTN) and primary hyperaldosteronism (PHA). Design and methods. Eighty-two patients were examined. Among them, PHA was verified in 19 patients, while 36 patients had essential HTN stage II (blood pressure (BP) elevation of 1st or 2nd degree), and 27 age-matching healthy people formed control group. The HTN duration in PHA patients was 1,95 ± 0,24 years, and in patients with essential HTN — 5,5 ± 0,5 years. Both patients and healthy peoples were examined within the hospital, in compliance with the hospital regime and diet. Endothelial function was assessed by several methods: the number of circulating desquamated endothelial cells (the method by Hladovec J.), reactive hyperemia test and evaluation of endothelium-dependent vasodilation (as a percentage of the brachial artery diameter increase), total blood nitrates and nitrites level (Griss-reaction method), nitric oxide excretion in urine. Results. Endothelial dysfunction (ED) was found in all patients with high BP. We found more profound ED in PHA patients compared to patients with essential HTN, which resulted in a significantly higher number of circulating endothelial desquamated cells, lower percentage of vasodilation response in reactive hyperemia test, decreased blood levels of total nitrites/nitrates and elevated nitric oxide urine excretion. Discriminant analysis was applied to range the severity of ED. Patients with essential HTN had moderate ED, while patients with PHA had severe ED. Conclusions. The proposed classification approach can be successfully applied for monitoring changesin ED and the effectiveness of treatment in patients with various diseases associated with BP elevation. 

Objective. Primary aldosteronism (PA) is a common reason of secondary arterial hypertension (HTN) and is associated with an increased risk of cardiovascular complications, chronic kidney disease and mortality. The aim of this study was to compare the prevalence of cardiovascular complications in patients with PA and HTN and show the peculiarities of cardiovascular system involvement in hyperaldosteronism. Design and methods. We included 191 (77,0  %) females and 57 (23,0  %) males with suspected PA aged from 19 to 86 years old. Other reasons for secondary HTN were excluded. Diagnosis of PA was based on Endocrine Society recommendations (2009). Results. PA diagnosis was confirmed in 41 (16,5  %) subjects. Systolic blood pressure was higherin patients with PA than in patients with essential hypertension, but diastolic blood pressure did not differ. Microalbuminuria was found in 61,0  % of patients with PA and only in 41,6  % of hypertensive subjects (р < 0,05). Study showed that prevalence of stroke, angina pectoris, myocardial infarction as well as arrhythmia were the same in both patients’ group. On the other hand, 29,3  % with PA had chronic heart disease compared to only 12,0  % among patients with essential HTN (p < 0,05). Conclusions. We showed that HTN associated with autonomic aldosterone production leads to more frequent cardiovascular complications. Hence, early PA diagnosis and treatment is an important approach of modern medicine.

Objective. To provide a method of differential diagnosis of the main forms of primary hyperaldosteronism (PHA) based on the high effective liquid chromatography (HELC). Design and methods. We evaluated 98 patients with PHA and with essential hypertension (EHTN). Aldosterone and plasma renin activity were measured by radioimmunoassay, renin levels by immunoassay. The blood levels of cortisol (F), cortisone (E), corticosterone (B), 11‑deoxycorticosterone (DOC), 11‑dehydrocortitocosterone (A), 11‑deoxycortisol (S), 18‑hydroxycorticosterone (18‑OH-B), the urinary excretion of free cortisol (UFF), free cortisone (UFE), 18‑hydroxycorticosterone (U18‑OH-B) were measured by HELC. Dexamethasone test, saline infusion test, postural test, computed tomography of adrenal glands were performed. All PHA patients underwent adrenal vein sampling (AVS). Results. PHA patients had higher blood levels of B, DOC, 18‑OH-B and urinary excretion of U18‑OH-B than EHTN patients. Moreover, patients with aldosteroma had combined excess of blood B, DOC, 18‑OH-B and urinary excretion of U18‑OH-B, patients with idiopathic hyperaldosteronism (IHA) showed a reduction of F/E and B/А blood ratios and UFF/UFE urine ratio. The blood levels of B, DOC, 18‑OH-B and urinary excretion of U18‑OH-B showed the highest sensitivity and specificity for the diagnosis of PHA. Patients with aldosteroma showed higher levels of B and 18‑OH-B, higher ratios B/А, B/F and 18‑OHB/F in the adrenal vein blood at the tumor side as compared with those in patients with IHA. Conclusions. B, DOC, 18‑OH-B blood levels and U18‑OH-B urinary excretion determined by HELC are informative and reliable indicators for early diagnosis of PHA. The use of HELC method in a complex examination of PHA patients is necessary in case of aldosterone-renin ratio between 30 and 50 ng/dl per ng/(ml per hour) and in case of borderline values of lateralization coefficient at AVS.

The objective of our work was to assess the prevalence of prehypertension (PHT) and the relationship with cardiovascular risk factors in the population sample of the inhabitants of the Russian Federation. Design and methods. The ESSE-RF study was carried out in 12 regions of the Russian Federation (Volgograd, Vologda, Voronezh, Vladivostok, Ivanovo, Kemerovo, Krasnoyarsk, Orenburg, Tomsk, Tyumen, St Petersburg, and North Ossetia (Alania)) with different climatic, geographic, economic and demographic characteristics. A stratified random sample was formed in each region. In total, 20652 inhabitants of the Russian Federation aged 25–65 years were examined. All participants signed informed consent and completed approved questionnaires regarding behavioral risk factors, socioeconomic status and concomitant diseases/therapy. Anthropometry, fasting blood sampling, measurement of blood pressure (BP) were performed. BP was measured by the OMRON device (Japan) twice on the right arm in the sitting position with calculation of the mean BP. The optimal blood pressure corresponds to the BP level < 120/80 mm Hg. The normal BP is 120–129/80–84 mm Hg. High normal BP is 130–139/85–89 mm Hg. PHT is diagnosed in case of BP 120–139/80–89 mm Hg. Hypertension is diagnosed case of BP ≥ 140/90 mm Hg or antihypertensive therapy. PHT includes groups of normal and high normal blood pressure. The statistical analysis was carried out using SPSS Statistics 20. Results. Data of 20607 participants were analyzed, among them 7806 men (37,9  %) and 12801 women (62,1  %). The optimal BP was registered in 3848 (23,4  %), normal BP in 3551 (20,1  %), high normal BP in 2861 (14,9  %), PHT — in 6412 (35,0  %), hypertension — in 10347 (41,6  %). The prevalence is standardized according to the age structure of the World Health Organization (2000). Among men, compared with women, PHT was significantly more frequent (41,2  % and 30,1  %, respectively). The probability of PHT, adjusted for sex, age and obesity is associated with hypercholesterolemia > 4,9 mmol / l (OR 1,27 [1,15, 1,39]), increased HDL > 3,0 mmol / l (1,25 [1,14, 1,37]), triglycerides > 1,7 mmol / l (OR 1,39 [1,23, 1,58]), hyperglycemia ≥ 5,6 mmol / l (OR 1,46 [1,28, 1,67], p < 0,05). The presence of higher education reduced the likelihood of PHT, behavioral risk factors were not significant predictors. Conclusions. The results demonstrate the high prevalence of PHT and the association of metabolic abnormalities with the transformation of optimal blood pressure in PHT, which emphasizes the importance of timely diagnosis of PHT and correction of cardiometabolic risk factors in the Russian population. 

Objective. The aim of the study was to compare the antihypertensive efficacy of fixed combinations of perindopril and indapamide in patients with arterial hypertension (HTN) and high cardiovascular risk. Design and methods. We included 65 patients with 1–2 degree of HTN who had not taken the studied drugs before: either perindopril arginine / indapamide 10 mg + 2,5 mg, n = 35), or indapamide / perindopril erbumine K 2,5 mg + 8 mg, n = 30). Clinical efficacy of antihypertensive therapy was evaluated at three different time points. We assessed objective clinical status, blood biochemistry, office blood pressure (BP), and parameters of daily monitoring of BP (MBP). Results. Perindopril arginine plus indapamide vs indapamide plus perindopril erbumine K after 4 and after 12 weeks shows higher antihypertensive effect regarding office BP and provides significantly better control of the daily BP profile based on the MBP results. Therefore, MBP is required in HTN high-risk patients who take indapamide / perindopril erbuminе K in order to assess the reduction in nighttime BP, independently of achieving target office BP values. 

Objective. Primary hyperaldosteronism (PGA) (Conn’s syndrome) is a relatively rare phenomenon in therapeutic practice, occurring in 4,7–9%. In resistant hypertension (HTN) the rate of PGA achieves 10–20%. Often it results from the aldosterone-producing adrenal tumors and manifests by symptomatic HTN, neuromuscular, and renal symptoms. We present the cases of successful verification and surgical treatment of PGA. HTN patients and patients with rhabdomyolysis symptoms (increased creatine phosphokinase or lactate dehydrogenase) require further examination to exclude PGA. 

Among the rare causes of secondary hypertension pheochromocytoma is traditionally considered. It represents a chromaffin tumor of the adrenal glands. Paraganglioma is an extra-adrenal chromaffinoma. High blood pressure due to the neurohormonal excess accelerates target organ damage. Variable manifestations of pheochromocytoma/paragangliomaclinical make more difficult timely diagnosis and dictate the need of multidisciplinary approach. We present a clinical case of norepinephrine-secreting retroperitoneal paraganglioma in a middle-aged female. An integrated approach to the diagnosis and the assessment of target organ damage is suggested. The features of renin status are highlighted. The case also demonstrates appropriate dynamics of the cardiovascular parameters, neurohormonal regulation of blood circulation, and carbohydrate metabolism after successful surgical treatment of chromaffin tumor.