Aneurysm of the thoracic aorta of any origin is traditionally considered a pathology for surgical correction. Traditionally the patients are referred for the surgery (prosthetics or endovascular treatment) when thoracic aorta diameter achieves 50–55 mm. However, the management strategy and conservative treatment in case of the smaller aorta dilations are not well elucidated in еру guidelines. The medication therapy aims at the decrease of the hemodynamic stress in the aortic wall, as well as at the correction of risk factors and accompanying diseases, including coronary heart disease, diabetes mellitus, hypertension, etc. Since drug therapy of this pathology is not sufficiently developed, its choice is difficult for physicians. The paper reviews the main groups of drugs and their effectiveness in patients with thoracic aorta aneurism resulted from different causes, including atherosclerosis, genetic pathology (Marfan syndrome, Loeys-Dietz syndrome, etc.). Currently, no drugs are considered as first line therapy. The evidence suggests the use of beta-blockers, angiotensin-converting enzyme inhibitors and angiotensin II receptor blockers only in genetic pathology.

Objective. To investigate the serum levels of galectin‑3 in patients with metabolic syndrome (MS) and in patients with combination of MS and left ventricular hypertrophy (LVH), as well as to define the role of this marker of fibrosis in MS.

Design and methods. The study included 43 patients with MS (33 patients had LVH), and 33 patients of comparable age without MS (LVH was diagnosed in 10). The level of serum galectin‑3 was determined by enzyme immunoassay kits Platinum ELISA.

Results. The average level of galectin‑3 in the MS group was significantly higher (1,89 ± 1,71 ng/ml), compared to the group without MS (1,03 ± 0,22 ng/ml, p = 0,006). The study showed a positive correlation between the level of galectin‑3 and LVH (r = 0,323, p = 0,004). The mean value of galectin‑3 in patients with no evidence of LVH was 1,2 ± 0,76 ng/ml, in patients with LVH — 2,1 ± 2,02 ng/ml.

Conclusions. In patients with MS the level of galectin‑3 was higher than in patients without MS, and in patients with MS and concomitant LVH it was higher than in patients without LVH. In patients with MS and LVH increased galectin‑3 levels may indicate the severity of myocardial fibrosis and help for prognosis evaluation. 

Objective. To determine the relationship between the thickness of epicardial adipose tissue (EAT) and the serum concentration of transforming growth factor beta1 (TGF-beta1) with the severity of left atrial myocardial fibrosis in patients with metabolic syndrome (MS) and to define the role of these factors in atrial fibrillation (AF) development.

Design and methods. The study included 258 patients: patients with MS without AF (n = 57), patients with MS and AF (n = 83), patients with AF without MS (n = 36), and otherwise healthy subjects without cardiovascular disease and metabolic disorders (n = 82). Serum level of TGF-beta1 was assessed by ELISA. Epicardial adipose tissue thickness (EAT) was measured by ultrasound on the Vivid 7 apparatus (General Electric, USA). To assess fibrosis we constructed anatomical and amplitude maps of the left atrium (LA) using the non-fluoroscopic electro-anatomical mapping system CARTO3 (Biosense Webster, USA)

Results. EAT in patients with MS and AF is higher than in patients with MS without AF (4,7 ± 1,9 and 4,2 ± 1,6 mm, respectively, p = 0,023), higher than in patients with AF without MS (4,7 ± 1,9 and 4,3 ± 1,7 mm, p = 0,01) and significantly higher than in healthy subjects (4,7 ± 1,9 and 2,3 ± 0,9 mm, respectively, p < 0,001). The EAT positively correlated with the percentage of fibrosis of LA estimated by the mapping method (r = 0,549, p < 0,0001). The serum concentration of TGF-beta1 in patients with AF and MS was 6700,2 [2588,4, 17500,3] pg/ml. It was 4,7 times higher than in healthy subjects (p < 0,0001), 2,6 times higher than in patients with MS without AF and higher than in patients with AF without MS. Positive correlations were found between TGF-beta1 and LA volume (r = 0,203, p = 0,03). Binomial regression analysis showed that the probability of AF presence in patients with MS was higher when traditional predictors of this arrhythmia were present — the volume of the LA (odds ratio (OR) = 1,092, 95% confidence interval (CI) 1,026–1,162, p = 0,005), systolic blood pressure (OR = 1,093, 95% CI 1,021–1,169, p = 0,01), as well as EAT (OR = 2,21, 95% CI 1,111–4,386, p = 0,024) and TGF-beta1 (OR = 1,01, 95% CI 1,006–1,015, p = 0,002).

Conclusions. Thickness of epicardial adipose tissue and transforming growth factor beta1 are associated with AF also in MS. Probably, epicardial fat and transforming growth factor beta1 stimulate atrial myocardial fibrosis which is the risk factor of AF. 

Recent studies demonstrated an important role of the junctional adhesion molecule-A (JAM-A) in the pathogenesis of essential hypertension. Our studies showed higher content of JAM-A in women with essential hypertension. Also hypertensive women have higher levels of very low–density lipoprotein (VLDL), higher atherogenic index and lower concentrations of estrogen, progesterone and prolactin, indicating an increased risk of atherosclerosis and premature aging. By the laser speckle showed that the hemodynamic indices considerably change in essential hypertension. The levels of JAM-A correlate with blood pressure, lipids and hemodynamic indices, both in healthy subjects and in women with essential hypertension. The data demonstrate the importance of JAM-A in the pathogenesis of essential hypertension.

The epidemiology, pathophysiology, clinical manifestations, treatment effects and outcomes of the majority of cardiovascular disease differ between men and women. These differences occur due to the various expression of sex chromosome genes resulting in the different levels of sex hormones. As a result, gender-related differencesin the functioning of cardiovascular system are well-known, including vascular regulation, heart remodeling, drug metabolism, etc. Gender differences related to the cultural and social factors (behaviour, nutrition, life style, coping-strategies, relation to the disease and its prevention, etc.) also affect the course of cardiovascular diseases including hypertension. The gender–related issues of the regulation of blood pressure and therapeutic approaches to the treatment of hypertension remain the subject of high interest and debate.

Objective. To evaluate the serum adipokines and the degree of expression of adiponectin type 1 receptors (AdipoR1) in the brachial arteries with small and medium diameter of the muscular tissue in young and middleaged patients with hypertension (HTN).

Design and methods. We included 50 patients with HTN 1–3 degree (18 to 60 years old), 30 underwent surgery due to trauma-related fractures on the shoulder. The control group included 20 otherwise healthy non-smoking volunteers, 10 underwent surgery due to trauma-related fractures of the shoulder. The serum levels of adiponectin and leptin were determined by the method of enzyme immunoassay. The biopsy of the muscle tissue were analyzed by the immunohistochemistry using primary polyclonal rabbit antibodies against AdipoR1 (Santa Cruze, sc‑99183, USA, 1:500). The data were processed using software Statistica 6.0. The Mann–Whitney criterion U, and Spearman’s correlation analysis were applied. Differences were considered statistically significant at p < 0,05.

Results. Young and middle-aged patients with HTN had higher body massindex (BMI), waist circumference (WC), cholesterol, low-density lipoprotein cholesterol than control group. The serum adiponectin level was 5.48 (4,11; 6,95) μg/ml in HTN patients (p > 0,05), the leptin — 3,0 (2,2; 3,5) μg/ml (p > 0,05). Women with HTN showed higher leptin level — 3,4 (2,7; 3,6) μg/ml (р < 0,05). Women had a positive relationship between leptin and BMI (r = 0,6; p = 0,001), WC (r = 0,5; p = 0,02). The control group demonstrated normal vascular wall structure. Patients with HTN had two types of muscle vessel remodeling. The elastofibrosis was found in small vessels, circular hypertrophy was found in medium diameter vessels. Expression of AdipoR1 was the highest in the area of hypertrophy, reaching 14,1% (12,22; 16,83). Expression of AdipoR1 in the muscular wall of the vessels of the control group was the lowest and constituted 1,09% (0,37; 1,41). The increase in AdipoR1 correlated with the glucose level (r = 0,5; p = 0,02) in women with HTN and AdipoR1/high density lipoprotein (HDL) (r = –0,6; p = 0,04) in men and women with HTN.

Conclusions. Women with HTN had increased serum leptin. Leptin directly correlated with BMI and WC. HTN patients demonstrate two types of vascular remodeling: arteriolosclerosis in small vessels and hypertrophic circular remodeling in vessels of medium diameter. There were 14% AdipoR1 labels in hypertrophic area. No significant relationship between serum adiponectin and AdipoR1 were found in the patient groups. Glucose level positively correlated with AdipoR1 in the arteries of medium diameter in hypertensive women, while serum HDL level negatively correlated with AdipoR1 in all patient groups. 

Objective. To study clinical and expert parameters, life limitations and aspects of rehabilitation using the International Classification of Functioning, Disability and Health (ICF) in patients with systemic hypertension (HTN) associated with metabolic syndrome (MS).

Design and methods. The study included 273 patients with HTN and MS, examined in the Bureau of Medical and Social Expertise of St Petersburg. All patients underwent complete examination when referred for medical and social expertise. The profile of patients’ functioning and rehabilitation effectiveness were studied using the ICF domains: b4200 — increased blood pressure; b4150 — arterial function; b4101 — heart rate; b4102 — myocardial contractility; b4550 — general physical endurance; b460 — cardiovascular sensations. The severity of the violations was coded using a quantitative assessment from their absence (0–4%) to absolute violations (96–100%).

Results. In HTN patients examined in the Bureau of Medical and Social Expertise of St Petersburg, the 3‑component MS (disorders of glucose metabolism, abdominal obesity, increased level of low-density lipoproteins) is the most common one. Persistent violations result from a high degree of HTN, severity of complications of type 2 diabetes mellitus, functional class of angina and chronic heart failure, severity of arrhythmias. Evaluation of cardiovascular dysfunction with ICF showed a wide range from absence of violations to absolute impairments in the same patient. The patients demonstrate 1–2 degree disability. After rehabilitation measures, some ICF domains changed.

Conclusions. Clinical and expert evaluation of HTN with MS is variable depending on the severity of MS components. Patients with HTN with MS, recognized as disabled, need a complex of rehabilitation measures, including all the main directions of an individual rehabilitation/habilitation program. ICF can be used to assess impaired functions in patients and their changes after rehabilitation measures.

Arterial hypertension (HTN) is the most common cardiovascular disorder around the world. High blood pressure is a manifestation of essential hypertension (EHTN) in the majority of cases. The exclusion of symptomatic HTN is crucial for correct diagnosis. We present a case of a very rare symptomatic HTN caused by nonspecific aortoarteritis (Takayasu disease). Morphological substrate of Takayasu disease is arteritis associated with the total wall damage of aortic brunches. The diagnosis is very difficult due to the chronic course, nonspecific signs and a variety of clinical masks. That often leads to late diagnosis and complications. Clinical features of Takayasu aortoarteritis include unilateral pulse weakening, blood pressure asymmetry on right and left arms, bruit on damaged artery, laboratory signs of inflammation: accelerated erythrocyte sedimentation rate (ESV), anemia, thrombocytosis, C‑reactive protein (CRP) elevation. Ultrasound vessel duplex scanning is important, but angiography of aorta and aortic branches are still the “gold standard”. We draw attention to clinical features, diagnostic methods and the course of the Takayasu disease in a young woman with high blood pressure.

Despite multiple risk factors of pulmonary hypertension (PH) are known, the true incidence of PH remains undefined in patients with severe bronchial obstruction. Objective. The aim of the study was to identify mechanisms of compensation of the increase in pulmonary artery pressure and to determine their prognostic role. Design and methods. The results of a complex clinical and radiological studies of 200 patients with COPD II (B), and 207 patients with COPD III (D), and COPD IV (D), (GOLD 2017) were analyzed. A comparative analysis of changesin pulmonary circulation in patients (n = 8) with primary PH was performed. Male subjects predominated among the examined patients with COPD (90,6  %), the average age of patients with COPD II was 54,0 ± 6,3 years, in patients with COPD III–IV stages — 63,9 ± 5,8 years. The average age of patients with primary PH was 38,7 ± 7,9 years. The following diagnostic methods were performed: single-photon emission computer tomography, multidetector computed tomography, external respiration function, echocardiography. Results. In patients with COPD II (B), both ventilation and perfusion disorders developed, the diffusion capacity of the lungs decreased and the intrapulmonary shunting of the blood occurred. Despite overall decrease in pulmonary perfusion, local zones of increased blood flow appeared in the unchanged pulmonary parenchyma. This compensation mechanism was observed in 54,6  % of patients and was accompanied by partial decrease of pressure in the pulmonary artery to values close to normal. In severe COPD, 44,4  % patients developed hyperperfusion zones, but without any compensatory effect. In such cases, pressure reduction in the pulmonary artery system was promoted by the development of blood bypass, which was observed only in 10  % cases. Conclusions. We can speculate that the mechanism of compensation of increased pressure in the pulmonary artery and reduction of PaO2 results from the development of local zones of increased blood flow in the unchanged pulmonary parenchyma, but in severe bronchial obstructive pathology it causes the formation of blood shunting.

Systemic hypertension (HTN) is the most prevalent non-communicable disease and the leading cause for major cardiovascular events, renal failure and cognitive decline. The World Health Organization showed that HTN is a key area of concern for healthcare and identified this condition as one of the primary targets for intervention to reduce global morbidity and mortality. The hard-hitting AHA/ACC Guidelines on management of High blood pressure in adults published in 2017 shocked medical community and enforced reconsidering overall significance HTN once again due to the large pool of newly diagnosed individuals and higher healthcare costs. Ensuing debates around Task Force committee opinions were fomenting at every scientific session related to cardiac diseases throughout first half-year 2018 and beyond the lecture halls as well. Thus all attendees at the 28th European Congress on Hypertension and Cardiovascular Protection held in Barcelona, Spain in June were captivated with the European expert’s presented preview of the new 2018 ESH/ESC joint clinical Guidelines on diagnosis and management of HTN. This short review highlights the bullet points presented before fulltext publication. The chapters on diagnosis, risk stratification, blood pressure treatment target ranges had undergone minor but crucial corrections. Key changes include medical treatment of uncomplicated HTN and drug therapy in special groups with major comorbidities, management of resistant HTN, device-based HTN therapy and adherence interventions. 

Taking into account the widespread use of generic drugs and insufficient rate of achieving the target blood pressure (BP), a regional program “DIFFERENCE” was initiated. The purpose of this study was to assess the chance of increasing the effectiveness of antihypertensive therapy (AHT) by replacing generic perindopril and receptor blockers to angiotensin II (BRA) by the original perindopril and generic indapamide by the original one.

Design and methods. The study included 330 hypertensive patients (47,3% males; the average age of men is 53,5 ± 8,5 years, women — 54,2 ± 10,2 years, p > 0,05). The mean systolic BP was 149,5 ± 5,3 mm Hg, average diastolic BP — 96,4 ± 4,9 mm Hg; 1st HTN degree was achieved in 49,1% patients, 2nd — in 41,2%; 3rd degree remained in 9,7%. Monotherapy of HTN was prescribed in 79,4% patients.

Results. After the transfer from the generic perindopril to the original drug (± transfer from the generic indapamide to the original one) within 4 weeks no other changes of AHT were introduced. During these 4 weeks, the average systolic BP decreased to 139,1 ± 5,1 mm Hg, diastolic blood pressure declined to 88,2 ± 5,8 mm Hg, which allowed to achieve the target BP in 37,0% patients (p < 0,01). On the Month 1 visit, taking into account indications, the frequency of combined AHT increased to 76,4%, on the Month 3 visit — to 88,2%, exceeding the original one by 4,3 times (p < 0,01). On the Month 3 visit the average systolic BP was 136,5 mm Hg, diastolic BP — 85,9 mm Hg, the target BP level was achieved in 53,9% cases (p < 0,01). By the study completion, the most often combination included perindopril with diuretic or calcium antagonist.

Conclusions. The study “DIFFERENCE” demonstrated the effectiveness of the replacement of generic perindopril and BRA by the original perindopril combined, if necessary, with the replacement of generic indapamide by the original one in patients wth uncontrolled HTN. To date, the combined AHT has not been assigned frequently enough, which is also the reason for the insufficient efficiency. The most common were the combinations of perindopril with diuretic or calcium antagonist. 

Metabolic syndrome is associated with the kidney damage, and microalbuminuria is listed as one of the key diagnostic criteria of metabolic syndrome. In metabolic syndrome the risk of chronic kidney diseases is significantly increased. Moreover, kidney damage is also more severe in metabolic syndrome than in patients without metabolic disorders, and the severity of kidney damage is directly related to the number of the components of metabolic syndrome. Chronic kidney disease is shown to be associated with all the components of metabolic syndrome, including obesity, insulin resistance, hypertension. This article discusses the issues of drug nephroprotection in patients with metabolic syndrome (MS), including patients with uncontrolled arterial hypertension, in particular, the effectiveness of a fixed combination of perindopril arginine + indapamide. The available evidence clearly shows the advantages of this combination: favorable effect on adipokines, the level of noninfectious inflammation, vascular stiffness, which makes it unique and useful at all stages of the renal continuum in patients with MS and chronic kidney disease. This is confirmed by the reduction of the risk of cardiovascular and kidney complications.