The paper reviews the main tasks of the psychological intervention in patients with arterial hypertension (HTN) and prehypertension. It presents an analysis of the studies, involving the assessment of psychological intervention efficiency in HTN prevention, lowering blood pressure (BP) and promoting adherence to treatment in HTN patients as well as prevention and correction of psychopathological complications of HTN. According to the results of well-planned studies, the psychological methods, used in the HTN prevention and treatment, do not achieve a satisfactory level of evidence-based efficiency. The findings in favor of the psychological intervention for HTN prevention are the weakest. At the same time, there is evidence of the efficiency of some psychological methods in reducing BP and promoting adherence to treatment. The efficiency of psychological intervention in preventing and slowing progression of vascular cognitive dysfunction is well documented, although the BP is not taken into account in most relevant studies. The authors suggest possible explanations of the limited efficiency of psychological interventions in HTN prevention and treatment according to up-to-date meta-analytic studies and outline future directions of research.

Increased stress reactivity of blood pressure is one of the central pathogenesis theories, as well as one of the most important precursors of the clinical symptoms of cardiovascular diseases. Recent studies have shown that different exercise tests in healthy and hypertensive people provide important additional information about the functional status and reserve capabilities of the cardiovascular system, as well as help to estimate the prognosis and morbidity risks. The article reviews the literature data and long-term own observations on the relationship between increased stress reactivity and risk factors, the state of the vascular wall, and the cardiovascular prognosis. These data increase our understanding of the pathogenetic effects of stress reactivity and in the future can enable to define an individual cardiovascular prognosis and development of effective preventive measures.

Objective. The objective was to study the relationship of mental and emotional stress, metabolic characteristics, structural and functional parameters of the heart and blood vessels in men with hypertension (HTN). Design and methods. We included 120 men, among them 70 subjects had HTN I–II stage (mean age 21,4 ± 2,3 years, mean ± SD) and 50 healthy individuals (mean age 21,5 ± 1,4 years, mean ± SD). All patient study of hormonal, lipid, fasting venous blood immunological parameters, ultrasound of the heart and blood vessels, blood pressure measurement according to standard procedure, 24‑hour blood pressure monitoring, and psychological questionnaires were performed. Results. Young men with HTN showed higher levels of cortisol, interleukin‑6, low density lipoprotein cholesterol, atherogenic index. Psychological features of hypertensive subjects were characterized by a predominance of personal anxiety, certain coping-strategies (distancing, self-control, acceptance of responsibility). The identified associations of psychological, structural and functional parameters of the heart can be useful for planning programs for early prevention of cardiovascular remodeling in HTN patients. Conclusions. Understanding the relationship of mental and somatic factors, we can find out the mechanisms of pathology development and to implement new methods of preventive medicine at the individual and population level, strategy of interaction between psychiatrists, medical psychologists and physicians.

Objective. The study aim was to evaluate the role of psychological, somatic factors in the development of left ventricular hypertrophy (LVH) in the cohort of persons without hypertension (HTN) and to define their effect on LVH. Design and methods. We included 107 otherwise healthy middle-aged people from an organized population, including 46 men (mean age of 43,7 ± 11,5 years, mean ± SD) and 61 women (mean age 43,1 ± 10,1 years, mean ± SD). All the subjects underwent blood pressure measurement according to the standard procedure, questionnaire survey using validated psychological questionnaires, echocardiography, and fasting blood tests (hormonal, immunological, biochemical). Results. Individuals with LVH were characterized by a significantly higher level of depression, accumulated stress, social frustration, decreased self-evaluation of health state and vitality. In the LVH group, the avoidance strategy is used more often; meanwhile strategies for solving out the problem and finding social support are more rarely applied. There were positive correlations between the left ventricular myocardial massindex and height (r = 0,56); body surface (r = 0,54); the ratio waist circumference/hip circumference (r = 0,62); concentration of triglycerides (r = 0,58); cholesterol of very low density lipoproteins (r = 0,58) (n = 41; p ≤ 0,001). The left ventricular mass index in otherwise healthy non-HTN individuals is determined by 4 factors: the level of apolipoproteins-B, the ratio waist circumference/hip circumference, the concentration of the products of free radical lipid oxidation, and smoking duration. Conclusions. Personal response, which cause an increased susceptibility to stressful influences, also determine the nature and intensity of stress-reactions, their metabolic and hormonal support. LVH in non-HTN subjects is associated with personality characteristics that determine the nature of a multilevel response (somatic, hormonal, biochemical).

Background and objective. The strategy aimed at overall cardiovascular risk reduction involves the assessment of patient’s personality and motivating him/her to change his/her lifestyle. Poor medication adherence and coping behavior of smokers with hypertension (HTN) indicate the need for improvements in therapeutic training and including into the training program both information on stress and the information related to stress coping behavior. The purpose of the study was the assessment of the efficacy of an optimized therapeutic training during the correction of modifiable risk factors among HTN smokers. Design and methods. We surveyed 102 male smokers with HTN; among them 52 male smokers with HTN (mean age 48,5 ± 1,05 years, disease duration of 7,9 ± 0,52 years and smoking history of 18,0 ± 1,16 years) attended an optimized program of the School for Patients with HTN, and 50 male smokers with HTN (mean age 49,7 ± 1,04 years, disease duration of 7,6 ± 0,47 years and smoking history of 19,2 ± 0,85 years) attended a standard structured program of the School for Patients with HTN. The enhancement of the training program of the School for Patients with HTN consisted in perfoming a person-oriented training at this School and introducing a modified stress coping skills training course. Results. The efficacy of the optimized therapeutic training of male smokers with HTN was determined. We found a number of advantages of the enhanced therapeutic training over the standard structured training with respect to the correction of modifiable risk factors among smokers with HTN. The optimized therapeutic training helps to maintain target blood pressure level, to reduce smoking intensity, to reduce the levels of nicotine dependence and triglyceride concentrations, as well as to extend the range of coping behavior strategies. Conclusions. The introduction of a modified stress coping skills training course and a person-centred model of therapeutic training in the program of the therapeutic training of smokers with HTN improves the efficiency of the correction of modifiable risk factors.

Objective. To determine the effect of family and job stress on hazard ratio risk (HR) of hypertension (HTN) in female population aged 25–64 years over 16 years. Design and methods. Within the framework of the WHO “MONICA-psychosocial”, in 1994, we examined a random representative sample of women aged 25–64 years (n = 870, mean age 45,0 ± 0,4 years) who were residents of one of the districts in Novosibirsk. Response was 72,5%. Job-related stress was assessed using the Karasek scale, family-related stress was evaluated by the scale “Awareness and attitude towards the health”. Altogether 560 women were included in analysis. Those with diagnosed cardiovascular disease (HTN, ischemic heart disease, stroke) and diabetes mellitus were excluded. Over the 16‑years (1994–2010 years) all cases of new-onset HTN were registered in the cohort. Cox-proportional regression model (Cox-regression) was used for the assessment of incidence HR based on a different time slot. Results. The prevalence of family- and job-related stress levels in female population aged 25–64 years were 20,9% and 31,6%, respectively. High stress levels are associated with low self-rated health, with a high frequency of complaints, lack of awareness about prevention methods. Despite higher prevalence of job-related stress the HR of HTN was 1,39‑fold higher in women with family-related stress over 16 years. The job-related stress led to a significant 1,28‑time fold increase in HR of HTN. The incidence of HTN was higher in married women experiencing stress in the family and at work, with higher levels of education, in category “executives” and “physical labor”. Conclusions. There is a high prevalence of family- and job-related stress levels in female population aged 25–64 years, and job-related stress is predominant. At the same time the HR of HTN is higher in women with family-related stress compared to those with job-related stress.

Objective. The aim of this study was to determine the age- and gender-stratified prevalence and structure of high blood pressure (BP) among school-age children (7–17 years) in St Petersburg based on the electronic protocols of the regular preventive medical examination in 2009–2013 years. Design and methods. We collected the data from the regular preventive medical examination electronic protocols of 4618 children aged from 7 to 17 years old for the period from 2009 to 2013. The mean age of males (52,2%) was 12,81 ± 0,05 years; Me = 13,2 years, the age of females (47,8%) was 12,95 ± 0,05; Me = 13,3 years. Data entry and assessment of height, BP percentiles were carried out using mathematical software. Gradations of systolic BP (SBP) and diastolic BP (DBP) were the following: high normal BP, stage 1 hypertension (HTN) and stage 2 HTN. Results. High normal BP was detected in 10,3% of school-age children, 8,7% had stage 1 HTN, 1% had stage 2 HTN. No significant differences in the HTN distribution were found between males and females. The proportion of males with higher BP increased significantly with increasing age of children. There was no significant relationship between age and BP gradation in females. The prevalence of elevated SBP was 12,7%. High normal SBP was found in 6,1% children, stage 1 HTN by SBP — in 5,9%, stage 2 HTN by SBP — in 0,7%. The rate of higher SBP was greater in the total sample, and in both boys and girls. The systolic hypertension was found only in older boys. The prevalence of increased DBP was 12,4% (high normal DBP was found in 7,5%, stage 1 HTN by DBP — in 4,5%, stage 2 HTN by DBP — in 0,4%). The DBP gradations did not correlate with the children’s age. Conclusions. The elevated BP was detected in 20% of school-age children (among males — in 19,4%, in females — 20,6%). The understanding of trends in the HTN prevalence in children will allow optimization of medical and organization approaches to treatment and prevention.

Background. Hypertension (HTN) associated with metabolic syndrome is an important issue of preventive medicine. The modulation of biochemical activity of immune cells might be a solution, as immune cells play crucial role in atherosclerosis progression and vascular inflammation. Among factors regulating molecular processes, e. g. activity of signaling pathways and cell proinflammatory sensitivity, low-intensity microwave (1GHz) therapy attracts attention. The purpose of this study was the assessment of the low-intensity microwave therapy in the management of hypertensive patientsin order to influence the biochemical components of metabolic syndrome. Design and methods. In a randomized double-blinded controlled study, we included 60 patients with hypertension (HTN) aged 45–55 years old. The patients of the comparison group (n = 30) received medication therapy according to the current guidelines, while patients from the study group (n = 30) additionally underwent physiotherapy with the use of microwave therapy (frequency 1 GHz, device “Aquaton”). Control group included 15 otherwise healthy subjects. Serum insulin, glucagon, apoA1 and apoB100 were measured by immuneenzyme assay. Hugh-sensitive C‑reactive potein (hsCRP) was assessed to evaluate the inflammatory response. Results. HTN patients compared to the healthy group demonstrated higher levels of insulin by 23,0% (p = 0,051), apoВ100 by 35,1% (p = 0,001), hsCRP by 43,4% (p = 0,05), and lower levels of glucagon by 5,0% (p = 0,8) and apoА1 by 32,8% (p = 0,000002). Patients of the comparison group who received only medication therapy showed an increase in glucagon level by 2,2% (p = 0,018), apoА1 by 0,96% (p = 0,063), insulin by 3,5% (p = 0,11) with the decrease in apoВ100 by 2,7% (p = 0,083) and hCRP by 2,4% (p = 0,18). Those who additionally underwent the low-intensity microwave therapy showed an increase in glucagon by 1,3% (p = 0,028), apoА1 by 11,1% (p = 0,028), while insulin level decreased by 5,1% (p = 0,06), apoВ100 by 5,4% (p = 0,015) and hsCRP by 5,3% (p = 0,05). There was no significant impact of microwave therapy on the central hemodynamics. Conclusions. The patients who received low-intensity microwave therapy demonstrate higher apoА1 level and lower levels of insulin, apoВ100 and hsCRP. The number of patients to be treated for the planned effect achievement was the following: for the change in the levels of apoА1 — 2,0 patients, change in insulin level — 3,7, change in апоВ100 level — 5,5, change in hsCRP — 5,8. Therefore, low-intensity microwave therapy positively affects metabolism in HTN patients without significant impact in central hemodynamics.

The article summarizes and presents data on the historical experience of medical leeches, numbering more than 30 centuries. The paper reviews the historical and empirical basis of hirudotherapy in the clinical practice worldwide. The peculiarities of hirudotherapy in different countries (USA, Europe, Russia) have been studied at the present time. The therapeutic effects of hirudotherapy in clinical practice are due to the well-investigated saliva content of the medical leech, as well as the local and systemic reflex action on the body in response to the bloodsucking and hemorrhage. We analyze pathogenesis mechanisms of hirudotherapy. Hirudotherapy can reduce ischemia, hypoxia and normalize microcirculation. Hirudotherapy is effective in different groups of patients with cerebrovascular diseases. A number of studies confirm the effectiveness of hirudotherapy in the treatment of patients with essential hypertension, chronic impairment of cerebral circulation, acute stage of ischemic stroke, as well as in post-stroke rehabilitation. There is sufficient evidence for the use of hirudotherapy in cases of cerebrovascular disease for complementary method in the complex treatment and for the prevention of acute cerebrovascular events.

Objective. The aim of the present study was to compare conventional and novel, potentially earlier biomarkers of kidney injury in patients with different severity and duration of arterial hypertension (HTN) and healthy controls. Design and methods. Urine levels of neutrophil gelatinase-associated lipocalin (NGAL), kidney injury molecule‑1 (KIM‑1), liver fatty-acid binding protein (L‑FABP), albuminuria and serum levels of cystatin C and creatinine were measured in 92 hypertensive patients (46 male, mean age 50,7 ± 12,2 years) and 34 healthy control subjects (16 male, mean age 49,9 ± 11,4 years). Hypertensive patients were divided into four age- and sex-matched groups according to HTN severity: 1st grade (n = 24), 2nd grade (n = 26), 3rd grade (n = 17) and resistant hypertension (n = 25). Glomerular filtration rate (GFR) was estimated by the level of serum creatinine and cystatin C by MDRD and CKD-EPI formulas. Instrumental examination included measuring office blood pressure (BP), 24‑hour ambulatory BP monitoring (ABPM, SpaceLabs 90207), applanation tonometry (SphygmoCor, Artcor Medical) with the calculation of central aortic pressure. Results. As compared to healthy control subjects, hypertensive patients were characterized by higher creatinine and albuminuria levels, and lower GFR, however, creatinine levels remained within the normal range despite the increase in the severity of HTN. Levels of albuminuria increased only in patients with severe HTN. Also as compared to healthy controls, HTN patients had significantly higher levels of cystatin C, which already was found in patients with 1st and 2nd stages of HTN, which occurs more often than an increase of creatinine and albuminuria levels. Patients with HTN had significantly lower sCys-estimated GFR and creatinine-sCys-estimated GFR. In HTN patients these biomarkers were associated with office systolic BP (SBP), central aortic systolic and diastolic (CAP) and mean 24‑hour BP level. There were no differencesin NGAL, KIM‑1 levels between the groups, however, KIM‑1 levels were associated with office SBP, mean daily 24‑hour of diastolic BP (DBP) and systolic and diastolic CAP in patients with severe HTN. At the same time, as compared with healthy controls, patients with initial HTN were characterized by higher levels of urine L‑FABP and its concentration increased in patients with severe HTN. In addition, L‑FABP levels were associated with office SBP and DBP, mean 24‑hour BP and systolic and diastolic CAP. Conclusions. The simultaneous assessment of creatinine and cystatin C levels, and the calculation of GFR using the formula CKD-EPI seems to be more accurate method for CKD stage classification in general and, in particular, in hypertensive patients; in hypertensive patients L‑FABP appears to be earlier biomarker of kidney injury, reflecting the progression of tubulointerstitial injury.

Objective. To assess the antihypertensive efficiency of perindopril arginine and indapamide retard in patients with nocturnal hypertension (HTN). Design and methods. In the regional program “Chronos” of the open, multicenter, observational, non-controlled study, we included 196 patients with nocturnal hypertension (2nd degree — 59,4%; 3rd degree — 40,6%). Upon inclusion, instead of the previous therapy the patients received 10 mg perindopril arginine at night and 1,5 mg indapamide retard in the morning. The follow-up was 3 months, the efficiency and tolerability were assessed in 2 weeks, 1 and 3 months of therapy. Blood pressure (BP) was measured by Korotkoff method. Statistical analysis was performed with the use of the programs Microsoft Excel 2012, Statsoft Statistica 10.0. Results. At baseline, daytime median systolic BP was 165,5 (160; 180) mmHg, diastolic BP was 100 (90; 100) mmHg. After 2 weeks of treatment by perindopril arginine and indapamide retard, both daytime and nocturnal BP decreased (p < 0,05). The positive changes maintained for the whole follow-up period. Seven patients did not achieve target BP 1 month later. In these cases, additional therapy (other drug class medications) was prescribed. Conclusion. All patients demonstrated both daytime and nighttime BP decrease. In 73% patients there was no morning BP rise anymore. In 60% BP was normalized in patients who had been considered resistant. The combination therapy was well-tolerated.

The review discusses the role of blood pressure variability as a novel risk factor and its prognostic value in hypertension associated with the coronary artery disease. We discuss the modern approaches to calculation of blood pressure variability, its classification. The choice of antihypertensive drugs based on the blood pressure variability is discussed considering hypertension associated with coronary artery disease. We pay special attention to angiotensin enzyme converting inhibitors and calcium channel blockers, as well as their combinations. We present the evidence of the effects of perindopril and amlodipine and their fixed combination on the blood pressure variability and the decrease in cardiovascular risk in hypertension associated with coronary artery disease.