Pathogenesis of hypertension in overweight and obese patients is to be studied due to the great theoretical and practical importance. The additional mechanisms directly involved in the development of hypertension in subjects with abdominal obesity have been determined. Functional disorders of adipose tissue were shown to play an important role in the development of hypertension in obese patients, and in some cases adiposopathy can be the primary cause of hypertension. Renin-angiotensin-aldosterone system was shown to change signifi cantly in obesity. Understanding the causes and mechanisms of hypertension in patients with abdominal obesity is of particular interest because it allows more focused prevention and treatment of the disease.

The article reviews the up-to-date approaches to the secondary prevention of cardiovascular complications, and the clinical situations when the target drug doses or target parameter levels are important to achieve an effect. We discuss the role of available evidence in titrating doses of angiotensin-converting enzyme inhibitors, statins and beta-blockers.

Puberty is an important developmental milestone. It can be considered as a complex sequence of biological  events leading to progressive maturation of sexual characteristics ultimately leading to attainment of full  reproductive capacity. The decline in age at puberty in the general population has been paralleled by an increase  in the number of girls referred for evaluation of precocious puberty (PP). The recent pubertal trends have resulted in a concomitant lowering of the lower limit of normality of the pubertal onset. However, evidence suggests that  age at the gonadotropin and sex steroid surges have not changed. Thus, it looks as if an increasing proportion of  contemporary early pubertal girls may experience isolated gonadotropinindependent thelarche rather than central  PP, which may not be discernible on pubertal examination alone. Thus, the population-based limits of normality  srapid progressive PP as well as intracranial and other underlying pathology. The initiation of mammalian puberty  requires an increased pulsatile release of gonadotropin-releasing hormone (GnRH) from the hypothalamus. This  increase is brought about by changes in transsynaptic and glial-neuronal communication. Coordination of these  cellular interactions likely requires the participation of sets of genes hierarchically arranged within functionally  connected networks. The role of kisspeptins in the control of GnRH neurons and the transmission of the regulatory  actions of key signals, such as sex steroids, metabolic hormones and environmental cues, has been recently  studied, point out that the Kiss1 system is an indispensable player of the brain sexual differentiation during early  periods of maturation and the timing of puberty onset.

Background. Arterial wall stiffness is an independent predictor of cardiovascular mortality in different patient populations. Currently, there are several studies that show an increase of arterial wall stiffness in systemic sclerosis (SSc). The effect of immunosuppressive therapy on vascular wall stiffness in SSc patients is not investigated. The authors of this paper attempted to study the effect of rituximab and cyclophosphamide combination therapy on vascular stiffness in 5 patients with diffuse form of SSc.

Design and methods. We assessed arterial stiffness in 5 patients with diffuse form of SSc before and after 6 months after combined immunosuppressive therapy.

Conclusion. The parameters of arterial stiffness decreased in all patients with the moderate effect of the therapy.

Objective. To examine the mechanisms underlying the activation of the sympathetic nervous system and blood pressure elevation in vasorenal hypertension in the male Wistar rats weighing 250–300 g.

Design and methods. We observed the development of renovascular hypertension, beat-to-beat interval and heart rate variability in animals with intact renal nerves and denervated ischemic kidney for 8 weeks after renal artery clamping. Eight weeks later after renal artery clamping in hypertensive rats with denervated ischemic kidney, both-sided renal denervation was performed, and blood pressure was monitored for 6 weeks.

Results. Although the ischemic kidney denervation reduces the activity of the sympathetic nervous system, it does not prevent renovascular hypertension development. However, both-sided renal denervation leads to the normalization of blood pressure in the rats with stable renovascular hypertension.

Conclusion. We suggest that increased afferent fl ow from structural formations of the ischemic kidney plays an important role for the increased sympathetic nervous system activity.

Objective. We present the results of the study assessing the frequency and character of hypertension in thyrotoxicosis, and its impact on left ventricular remodeling and cardiovascular prognosis.

Results and conclusions. Our data demonstrated that hypertension, and predominantly systolic hypertension, is highly prevalent in thyrotoxicosis and affects left ventricular remodeling. All normotensive patients developed only eccentric left ventricular hypertrophy (LVH). The prevalence of LVH, and of its concentric forms increases with the elevation of blood pressure. Concentric LVH is associated with the high rate of atrial fi brillation and heart failure.

Objective. To compare aortic elasticity and vasomotor endothelial function in hypertensive and normotensive patients with decompensated primary hypothyroidism (PHT) and after medical compensation.

 Design and methods. 41 women with PHT were examined, 23 (56 %) subjects had concomitant hypertension. Elasticity of aorta was evaluated by compliance coefficient (CC) and pulse wave velocity (PWV), state of vasomotor endothelial function — by vasodilatation coefficient (VDC). Patients were examined twice: during decompensation and after medical compensation.

Results. Mean values of CC in patients with decompensated PHT were 2,27 (95 % confidence interval 1,53–3,01) and 2,23 (1,78–2,67) mm2/mm Hg in hypertensives and normotensive, respectively, PWV — 12,2 (10,4–13,9) and 12,9 (11,8–14,0) m/s, VDC — 4,51 (2,91–6,11) and 3,72 (2,06–5,37) CU, respectively (all p > 0,05). Compensation of PHT led to the CC increase up to 4,69 (4,13–5,24) and 4,66 (3,96–5,36) mm2/mm Hg, PWV patients till 8,85 (6,77–10,9) and 7,40 (6,68–8,11) m/s, VDC increase up to 10,7 (9,27–12,2) and 8,94 (7,81–10,1) CU (all p < 0,05).

Conclusion. Compensation of PHT is accompanied by improvement of aortic elasticity and vasomotor endothelial function. There are no differences in aortic elasticity and vasomotor endothelial function in hypertensive and normotensive patients during decompensation and after euthyroid state achievement. 

Objective. To compare aortic elasticity and vasomotor endothelial function in hypertensive and normotensive patients with decompensated primary hypothyroidism (PHT) and after medical compensation.

 Design and methods. 41 women with PHT were examined, 23 (56 %) subjects had concomitant hypertension. Elasticity of aorta was evaluated by compliance coefficient (CC) and pulse wave velocity (PWV), state of vasomotor endothelial function — by vasodilatation coefficient (VDC). Patients were examined twice: during decompensation and after medical compensation.

Results. Mean values of CC in patients with decompensated PHT were 2,27 (95 % confidence interval 1,53–3,01) and 2,23 (1,78–2,67) mm2/mm Hg in hypertensives and normotensive, respectively, PWV — 12,2 (10,4–13,9) and 12,9 (11,8–14,0) m/s, VDC — 4,51 (2,91–6,11) and 3,72 (2,06–5,37) CU, respectively (all p > 0,05). Compensation of PHT led to the CC increase up to 4,69 (4,13–5,24) and 4,66 (3,96–5,36) mm2/mm Hg, PWV patients till 8,85 (6,77–10,9) and 7,40 (6,68–8,11) m/s, VDC increase up to 10,7 (9,27–12,2) and 8,94 (7,81–10,1) CU (all p < 0,05).

Conclusion. Compensation of PHT is accompanied by improvement of aortic elasticity and vasomotor endothelial function. There are no differences in aortic elasticity and vasomotor endothelial function in hypertensive and normotensive patients during decompensation and after euthyroid state achievement. 

Objective. To study the parameters of 24-hour blood pressure monitoring in young men with normal and high normal blood pressure.

Design and methods. Initially 66 men (group 1 included 32 subjects with optimal and normal blood pressure, group 2 was formed by 34 subjects with high normal arterial pressure) underwent 24-hour blood pressure monitoring, and in 12 months examination was repeated in 53 participants: 26 subjects from group 1 and 27 males from group 2.

 Results. Within 12 months blood pressure load, variability and morning blood pressure surge increased in men with high normal blood pressure, while it remained unchanged in subjects with optimal and normal blood pressure.

Objective. To study the changes of 24-hour blood pressure parameters and brain structure at follow-up after transcatheter renal denervation in resistant hypertension.

Design and methods. We enrolled patients with verified resistant hypertension undergoing an intervention that included 4–8 applications of radiofrequency discharge in both renal arteries using a standard catheter5 F under the controlled temperature regimen (60 С0, 8 Watt, 2-minute application). The efficiency of the intervention was assessed by the office and 24-hour blood pressure decrease within 6 months after intervention. All subjects underwent magnetic resonance tomography («Magnetom-OPEN», «Siemens AG», Germany).

Results. By the time of statistical analysis 45 subjects underwent renal denervation, there was not a single case of renal artery damage. At six-month follow-up a significant reduction of office blood pressure (-34,8/-17,2 mmHg; p < 0,00001/0,00001), and mean 24-hour blood pressure (-11,1/-7,1 mmHg; p < 0,001/0,001) was found. No increase of encephalopathy signs by magnetic resonance tomography was found. At the same time there was a reduction of the linear size of lateral ventricles of the brain, subarachnoid space, III ventricle of the brain, liquor volume in the lateral ventricles of the brain.

Conclusions. Renal denervation is a safe method resulting in effective blood pressure reduction in resistant hypertension. It is associated with the positive changes of encephalopathy and liquor dynamics according to the magnetic resonance tomography. 

and arterial hypertension for the planning of timely and effective prevention.

 Design and methods. We enrolled 147 people: with optimal and normal BP — 81, with high normal BP — 30 men, and 36 controls. Ambulatory BP monitoring (ABPM) nas performed in the offi ce at the setting of ≪typical working day≫ or 24 +- 1,5 hours with 15 and 30 minute intervals between the measurements during the day and night, respectively.

Results. Young people with high normal BP differ from the subjects with normal and optimal BP by a variety of ABPM indices. However, the changes are lower, but similar to those observed in patients with evident hypertension, including increase of mean systolic and diastolic BP, time index of systolic and diastolic BP, and morning BP surge. Young men with high normal BP are also characterized by the family history of the early cardiovascular disease and the presence of cardiocerebral complaints with the frequency similar to that in hypertensive subjects.

Conclusions. Young subjects with high normal BP seem to be at higher risk, and should undergo early and effective preventive measures.

Objective. Evaluation of critical aspects of primary and secondary prevention in hypertensive patients using Web-based technology was performed.

Design and methods. Medical records of 1539 hypertensive patients for the period 2006–2010 were analyzed. Special software (Web-based Register of Arterial Hypertension) produced by Moscow Cardiological, Scientific and Clinical Centre and Saratov Research Institute of Cardiology permits to input the important data of medical care continuously.

Results. In analyzed group 99,6 % patients required medical therapy, and most of them needed combination therapy. Nevertheless, the target level of blood pressure was achieved in the small group of patients (36,7 %).