ROBIS is the first large multicenter study performed in Russia. The Objective of the study was to compare the efficiency, safely, and impact of two treatment policies (the application of an algorithm to the stepwise use of 4 classes of antihypertensive agents in an intensive care group and random antihypertensive therapy in a routine treatment group) on the incidence of cardiovascular events in patients with arterial hypertension. Design: This is a national multicenter open consecutive prospective study. The patients meeting the criteria of inclusion were randomly divided into two equal groups, one of them (an intensive care group) received therapy with a nifedipine retard in Fixed dose for 4 weeks. In patients who failed to achieve the target level of blood pressure (BP), the therapy was supplemented by enalapril, 20 mg, hydrochlorothiazide, 25 mg, and metoprolol, 50 mg, at a 4-week interval. After achieving the target BP level, the patients continued the treatment with which the level had been attained. If the antihypertensive effect of therapy was found to disappear, the above drugs were successively supplemented. The other group (a routine treatment group) continued to be treated with the antihypertensive drugs prescribed in the polyclinic (Fig. 1). BP and heart rate were monitored and the patients' complaints and adverse reactions were recorded on repeated visits 4, 8, 12, 16, 24, 52, 64, 70, 88, and 104 weeks after the initiation of therapy. Control blood and urine analyses and ECG studies were made 12, 16, 52, and 104 weeks after therapy.

In the metabolic syndrome, the main cause of death is cardiovascular events due to the high rate of damage to target organs, lb treat patients with the metabolic syndrome, it is necessary to more thoroughly choose drugs or their combination to prevent adverse metabolic effects and at the same time to adequately monitor blood pressure. It has been long considered that β-blockers exert a negative effect on lipid and carbohydrate metabolism and they arc able to deteriorate brain perfusion in patients with arterial hypertension. This study was undertaken to evaluate the effects of bisoprolol on the daily BP profile, lipid and carbohydrate metabolism and brain perfusion in patients with the metabolic syndrome and hypertension.

The antihypertensive effect of diovan in the medical correction of arterial hypertension (AH) was tested in fertile-age women. The specific features of the agent were studied in relation to the gene polymorphism of angiotensin-converting enzyme (ACE) and antagonists of type 1 receptors to angiolensin-ll receptor blockers (ATR₁). The use of diovan, 80 mg daily, to correct AH in fertile-age females was found to promote the normalization of the daily blood pressure profile, the improvement of the lipid spectrum, and cardioprotection. There was an association of the efficacy of diovan and the structural status of ACE and ATR₁ genes. The maximum efficacy of the drug may be expected in patients with DD genotype (ACE gene) and AC genotype (ATP₁ gene).

The aim of this study was to evaluate the effect of the thiazide-like diuretic indapamid retard on cardiovascular remodeling processes in patients with arterial hypertension. The study included 20 previously untreated patients (mean age 51,7 ± 2,7 years) with Stages I - П arterial hypertension and a disease history of 2 to 6 years. The duration of indapamid retard therapy was 2 to 6 months. In patients with arterial hypertension, indapamid retard therapy leads to a decrease in left ventricular myocardial weight and to a larger number of more patients with arterial hypertension with the normal geometry of the left ventricle. There was a significant decrease in the rale of pulse wave primarily in the arteries of elastic type. By having a high antihypertensive efficacy, excellent tolerance, metabolic neutrality, indapamid retard produced a significant effect on remodeling processes of the heart, large and middle arteries in patients with arterial hypertension.

The effects of the conventional antihypertensive agents atenolol and nifedipine retard on the functional status of cerebral circulation were studied in patients with first- and second-degree arterial hypertension (AH) in relation to its risk factors. In smoking patients, atenolol was shown to increase the pulsation index, which can affect arterial elasticity. In AH patients having risk factors (familial history, smoking, and hypercholesterolemia), the antihypertensive effect of nifedipine retard did not increase the cerebrovascular responsiveness index, which is indicative of the decreased compensatory capacities of cerebral arteries.

Seventy five patients with lacunar infarcts (LI) in the presence of arterial hypertension (AH), 40 patients with AH without signs of lacunar syndromes, and 25 apparently healthy individuals were examined to study the functional status of cerebral circulation in LI and AH. The site and sixes of ischemic foci were specified by the results of brain computed tomography. The functional status of cerebral circulation was evaluated by Doppler transcranial evidence, by using the compression test. There was a reduction in the linear blood flow velocity (LBFV) in the middle cerebral arteries (MCA) and an increase in the pulsation index in the group of patients with LI as compared with the controls. The autoregulation reserve estimated by the overshoot coefficient was preserved in all the examinees. The greatest differences between groups were found in estimating the reserves of col lateral circulation (CC). The signs of decompensated CC were considered to be a less than 23,4 cm/sec decrease in LBFV in the MCA during compression of the common carotid artery (V₂). a greater than 10,8 sec increase in the recovery time of the baseline LBFV after compression (T), discriminant equation values more than 0,728 at D = 0.186 x T — 0,102 x V₂ + 1,116. The decompensated type of CC was revealed in 67.556 of the patients with LI versus 17,5 % of those with AH and 8 % in the control group. It is suggested that decompensated CC detected by the compression serves as a marker of the parallel development of angiopathy of connective and perforating arteries and as the background for LI development.

The paper presents the results of a representative survey of the population in the Republic of Sakha (Yakutia), by examining households in 8 districts (towns). A total of 1554 households or 5011 individuals (the response rate was 92,5 %) were examined. The results of the population above 15 years of age (1371 males and 1751 females) were analyzed. The mean age was 40,6 ± 0,3 years. The prevalence of arterial hypertension (AH) in the Republic of Sakha (Yakutia) averaged 30,3 ± 0,8 %. The highest prevalence rate of AH among males was noted in the Promyshlennyi (Industrial) district, the least in the Vilyuisk one (38,4 and 15,4 %, respectively, p < 0.05). The high prevalence rates were also recorded in Yakutsk where more than a third of the adult population had elevated blood pressure (BP). There is a noticeable increase in the prevalence of AH with age. Among the natives of Yakutia, the incidence of AH is slightly less than in comers (22,9 and 27,7 %, respectively). However, the prevalence of AH drastically increases up to 29,3 % or more in the natives from the sixth decade of life. 49,9 % of the males and 66,4 %- of the females are awareness of the presence of the disease. 14,0 % of the males and 28,8 % of the females are effectively treated.

Fifty-six peri- and postmenopausal women with arterial hypertension (AH) who had no history of cerebrovascular disorders were examined. Cerebral blood flow was studied by Doppler ultrasound study of extra- and intracranial arteries. The patients were divided into 2 groups: Group 1 received lisinopril and Group 2 had metoprolol. The studies performed before therapy, at the peak of drug tests, and 1 month after the initiation of therapy. In patients with first- and second-degree AH, cerebral hemodynamic disorders were found to occur at the extra- and intracranial level, which appeared as changes in the velocity characteristics of blood flow and in the indices characterizing cerebrovascular resistance. In addition to blood pressure lowering, lisinopril therapy for AH brought about changes in cerebral blood flow in the extra- and intracranial arteries. The most important changes appeared as a normalized intracranial arterial responsiveness and a diminished peripheral vascular resistance. Metoprolol therapy caused a reduction in the velocity of blood flow, without substantially changing the responsiveness and resistance of cerebral vessels.