Objective. To assess the features of the cardiovascular system and hormonal regulation of acromegaly in patients with arterial hypertension (HTN). design and methods. The study involved 66 patients with acromegaly. We assessed the interrelations between hormonal and cardiovascular parameters in acromegaly and HTN. Results. The main cardiovascular disorders in patients with acromegaly and HTN include concentric hypertrophy and left ventricular diastolic dysfunction, dilatation of the left atrium, and abnormal daily blood pressure (BP) profile. conclusions. The increased serum levels of growth hormone and insulin-like growth factor 1, duration of acromegaly and functional activity of a pituitary-adrenal axis are associated with the abnormal daily BP variability, contractile dysfunction of the longitudinal fibers of the left ventricular myocardium, reduced velocity of active relaxation of the left atrium, and left ventricular hypertrophy.

This review includes the results of the original prospective studies and meta-analyses focusing on the relationship between vitamin D deficiency and arterial hypertension (HTN). We discuss potential mechanisms of HTN development in vitamin D deficiency subjects and the associations between high blood pressure and VDR gene polymorphisms. The vitamin D treatment impact on blood pressure was demonstrated. The data provided could widen the knowledge related to different pathogenetic mechanisms of HTN and would be of interest to different specialists.

Parathyroid hormone (PTH) controls regulation of phosphorus-calcium metabolism and affects the cardiovascular system. PTH receptors have been found in the myocardium, smooth muscle cells of the vessels and the glomerular zone of the adrenal cortex. Cardiovascular diseases are the most common cause of high mortality among patients with primary hyperparathyroidism (PHPT). Moreover, asymptomatic patients also demonstrate cardiovascular involvement due to the direct effects of PTH. The most common are arterial hypertension, left ventricular myocardial hypertrophy and diastolic dysfunction, as well as intima-media complex pathology, vascular stiffness and endothelial dysfunction, calcifications and conduction disorders. Nevertheless, the causeeffect relationship and the impact on cardiovascular and overall mortality in asymptomatic PHPT are unknown. The reversibility of the abnormal changes and reduction in mortality after surgical treatment in asymptomatic PHPT are not well investigated. Regarding the high prevalence of asymptomatic PHPT (often without absolute indications for surgical treatment), cardiovascular complications, their impact on cardiovascular and general mortality, and reversibility after surgical treatment are highly important.

Objective. To evaluate the effect of insulin resistance on arterial hypertension and target organ damage  in patients with normal body weight. design and methods. The study involved 95 patients with arterial hypertension 1–2 degree (essential hypertension stage I–II) with normal body weight (body mass index 18,5– 24,9 kg/m 2) aged 30–50 years. The examination included fasting blood glucose, immunoreactive insulin, the index of insulin resistance — QUICKI factor, as well as lipids, serum uric acid and microalbuminuria. In addition, patients underwent ambulatory blood pressure monitoring, duplex scanning of neck vessels, echocardiography, endothelial function assessment. Results. The rate of insulin resistance-hyperinsulinaemia syndrome was 36 % in the studied group of hypertensive patients with normal body weight. Hypertensive patients with insulin resistance had higher average daily systolic blood pressure, higher rate and more severe target organ damage (left ventricular hypertrophy, endothelial dysfunction, intima media thickness). Among metabolic disorders, dyslipidemia was predominant, in particular, hypertriglyceridemia, as well as increased total cholesterol and LDL-cholesterol, and decrease in HDL-cholesterol. conclusions. Insulin resistance and hyperinsulinaemia syndrome is registered  in 36 % of hypertensive patients with normal body weight. They are characterized by high rate of hypertension and more severe target organ damage, and metabolic disorders (mainly hypertriglyceridemia).

Objective. To assess the changes in NAP-22 messenger ribonucleic acid (mRNA) expression level as well as NAP-22 protein content in hippocampus and in parietal cortex of spontaneously-hypertensive rats after longterm dietary salt load (nutritional factor of the arterial hypertension, HTN). design and methods. We examined SHR and WKY male rats before and after 1 % NaCl consumption instead of drinking water. NAP-22 mRNA level was estimated using real time PCR, and the content of NAP-22 protein and its isoforms was evaluated by electerophoresis with subsequent immunoblotting. Results. In spontaneously-hypertensive rats, NAP-22 mRNA expression in parietal cortex significantly decreased after the salt load, the decrease was more profound in parietal cortex than in hippocampus and even more expressed in the normotensive control. After the salt load, NAP-22 protein level in parietal cortex decreased more in SHR rats than in the normotensive rats. conclusions. Although both salt load and dietary calcium deficiency induce similar changes in blood pressure, intracellular mechanisms of developing HTN are different. Intracellular signaling cascades involved in the salt load model need further investigation.

Objective. To assess features of circadian blood pressure profile in ambulatory female patients with knee osteoarthritis (OA). design and methods. In case control study 60 postmenopausal female out-patients were recruited from those undergoing ambulatory blood pressure monitoring (ABPM). All patients signed the informed consent. All women had arterial hypertension (HTN) with no antihypertensive treatment reported by the inclusion date. Main group (30 women, median age 58 years; 25–75 %: 55,0–61,0) had HTN and OA. Control group (30 women, median age 56 years; 25–75 %: 52,0–60,0) had HTN and no OA criteria. Results. Office blood pressure (BP) did not differ between the groups. However, ABPM showed higher average BP in the group with OA. Higher time index for both systolic BP (SBP) and diastolic BP (DBP) during daytime and nighttime, SBP and DBP higher variability, as well as insufficient nighttime PB decrease were found in OA patients. conclusions. Our findings provide additional explanation of the target organ involvement in hypertensive postmenopausal women and confirm the need to perform ABPM in hypertensive OA patients.

Objective. To assess the efficacy of physical exercise program in hypertensive patients with the use of physical exercise tolerance test and post-test heart rate restoration. design ant methods. We examined 57 patients [median aged 63 (56, 67) years old] with the II–III stage hypertension and achieved target blood pressure. All of them were included in the regular physical exercises program for 1 academic year (9 months). Bicycle ergometry was performed before the beginning of the training and in the end of the academic year, the heart rate restoration during 5 minutes after the physical load was assessed. It was determined as difference between the threshold of heart rate restoration and heart rate restoration in the end of each minute. At baseline, all patients were divided into 2 subgroups: group with “rapid” (1st group) and “slow” (2nd group) restoration after bicycle ergometry. Results. Discriminative analysis provided the formula for predicting the efficacy of standard programs of rehabilitation in hypertensive patients. conclusions. Follow-up examination (at the end of rehabilitation course) demonstrated significant improvement in patients with initial high heart rate restoration after the bicycle ergometry. Among those with low heart rate restoration after bicycle ergometry, no improvement was noted in 73 % cases. We believe that these patients require an individual approach and other types of exercise testing.

Background. Overweight and obesity in children are accompanied by a wide range of comorbidities. The role of overweight in the formation of cardiovascular diseases is unquestionable, however, the impact of overweight on cognitive functioning is less obvious. Obstructive sleep apnea is a potential factor which affects neurocognitive impairment in overweight children. objective. To assess the relationship between obstructive sleep apnea syndrome (OSA) and cognitive functions in obese and overweight adolescents. Methods. We examined 39 adolescents (26 boys) aged 12–18 years old. Among them 17 persons were overweight, and 22 children were obese. We assessed anthropometric parameters, cognitive functions, respiratory status (cardiorespiratory monitoring) and the main indices of carbohydrate and lipid metabolism. C-reactive protein level as a cardiovascular risk marker was evaluated. Results. More than half patients were found to have sleep-disordered breathing. The adolescents with OSA had higher levels of serum cholesterol, triglycerides and glucose. Abnormalities in main respiratory indices correlated with decreased volume of short-term auditory memory and slower reasoning process. At the same time the difference in neurocognitive characteristics between adolescents with and without OSA was more prominent in the younger age group (12–14 years old). conclusions. Thus, our study has shown that obstructive sleep-disordered breathing in overweight/obese adolescents is a risk factor for some neurocognitive problems.

Objective. To analyze the state of the cardiovascular system in middle-aged patients with severe obstructive sleep apnea syndrome (OSAS), before and 6 months after the use of CPAP therapy. design and methods. The study involved 35 hypertensive patients with verified severe OSAS. All patients underwent comprehensive cardiovascular assessment (blood pressure (BP) and electrocardiogram monitoring, echocardiography), CPAP therapy has been recommended as the primary treatment of obstructive sleep-disordered breathing. After 6 months, all patients underwent a complete re-examination. Patients were divided into 2 groups: the experimental group consisted of 17 people (16 men and 1 woman, mean age 49,6 ± 10,1 years) treated with CPAP therapy throughout the study period, the control group included 18 patients, who refused CPAP-therapy. Results. After 6 months of CPAP therapy, patients with severe OSAS demonstrated favourable changes in the cardiovascular system: reduction of office and average daily BP, reduced BP variability, normalization of BP circadian profile and velocity of morning BP rise. BP reduction in CPAP-users was associated with the decrease of myocardial afterload. As a result, we have witnessed a reverse myocardial remodeling, manifested by a decrease in size of both left and right heart, which also contributed to the increase in exercise tolerance and improvement of quality of life. In CPAP use was associated with the tendency to the decrease in cardiac arrhythmias. conclusions. Six-month CPAP therapy in highly compliant patients leads to the BP reduction and normalization of BP daily profile, reduction in the number of antihypertensive drugs, as well as — to a reverse myocardial remodeling.

The prognosis of patients in diabetes mellitus associated with hypertension can be improved if target blood pressure is achieved. Based on the results of the large-scale, multicenter trials, the target blood pressure levels have been modified in the recent guidelines on the management of hypertension, and in various countries different approaches have been reported. Lower target blood pressure might be reasonable provided with the optimal safety. A personalized approach is important for the choice of antihypertensive therapy.