Forty patients with stages I-II arterial hypertension (AH) were examined. After a two-week control period, the patients were given Noliprel (a small-dose combination of perindopril and the diuretic indapamidе) in a dose of 1 tablet in the morning to correct elevated blood pressure (BP). The course of therapy lasted 3 months. No additional therapy was performed. The level of CB lowering, the proportion of the patients in whom BP became normal, as well as the clinical and biological tolerance of the therapy were estimated. The small-dose combination of perindopril and indapamidе showed its high antihypertensive efficacy (significant reductions in systolic, diastolic, and mean arterial BP; BP was normalized in 80 % of the patients within 3 months, in most patients within the first month of treatment). Noliprel proved to be well clinically and biologically tolerated.

The paper analyzes the currently available data on the spread of arterial hypertension as the present-day means of effective control of blood pressure (BP) values, defines a place of combined therapy in the treatment of elevated BR There is evidence for I he choice of effective drug combinations for the treatment of patients with elevated BP.

The paper shows a certain regularity in the development of cardiac structucal and functional disorders in relation to the stage of diabetic nephropathy in patients with type 1 diabetes mellitus. Cardiac functional changes are detected in normoalbuminurua. A concomitance of diabetic nephropathy enhances these changes: the disorders are minimal in the microalbuminuric sphase of diabetic nephropathy and maximal when proteinuria appears. In diabetic nephropathy, arterial hypertension determines the pattern of left ventricular remodeling in patients with type 1 diabetes mellitus to a greater extent than does hyperglycemia.

Background. The values of ventricular repolarization variability are higher in patients with hypertensive left ventricular hypertrophy (LVii) and (hey correlate with the left ventricular myocardial mass index (LVMMl). Objective. To develop diagnostic criteria for LVH, which are based on the analysis of the values of ventricular repolarization heterogeneity, the indices of the variability of a T-wave amplitude. Subjects and methods. The study included 69 patients with arterial hypertension and 20 patients without cardiovascular diseases who were divided, on the basis of echocardiography determination of LVMMI into groups with or without LVH. The par of the variability of repolarization parameters were analyzed. These included dispersion (Disp), normalized dispersion (Dispnorm), root mean square deviation (RMSD) of T-wave amplitude, as well as total repolarization integrals (TRI, a product of JT_end interval, and the T-wave amplitude), early repolarization integrals (ERI, a product of the JT_apex interval, and the T-wave amplitude,) late repolarization integrals (LRI, a product of the T_apex - T_end interval, and the T-wave amplitude.) of EGG leads 12 and V₁-V₆. Results. An analysis of V₁-V₆ leads has indicated that as compared to male patients with normal l.VMMI. the males with I.VII had higher values of T-wave amplitude variability and increased values of the variability of total and early repolarization integrals (of Disp, Dispnorm and RMSD), which correlated with LVMMI. A regression analysis has shown that LVMMI was an independent predictor of the dispersion of T-wave amplitudes and that of the variability of Disp, Dispnorm, of TRI, the relative thickness of the walls of the left ventricle is an independent predictor of Dispnorm and RMSD of T-wave amplitudes, as well RMSDo f TRI and ERI variability. The best diagnostic characteristics were demonstrated by RMSD of T_amp of ≥ 37 ms (39 % sensitivity, 91 % specificity, 86 % positive predictive value, and 51 % negative predictive value) and Dispnorm of TRI of ≥ 300 mV x msec (45 % sensitivity, 91 % specificity, 88 % positive predictive value, and 54 % negative predictive value). These characteristics were comparable with those for the Cornell criteria, but they were less than those for the Sokolov-Lyons criteria in sensitivity. In females with LVH, the values of the variability of T-wave amplitudes and repolarization integrals did not differ from those with normal LVMMI. The correlation of LVMMI and the values of the variability of T-wave amplitudes and repolarization integrals was insignificant. Conclusion. The values of the amplitude heterogeneity of ventricular repolarization and variability of repolarization integrals may be used as independent criteria of LVH in males with arterial hypertension.

The increased duration and dispersion of the QT-interval and the depressed variability of cardiac rhythm have been recently considered to be predictors of life-threatening ventricular arrhythmias and sudden death. However. the prognostic value of these indices in patients with arterial hypertension (AH) is little studied. Three representative samples from the total population of 2167 males aged 25-64 years were examined by conventional epidemiological methods within the framework of the WHO "MONICA" project. In a group of patients with AH (n = 415), fatal cardiovascular events were studied for 9,5 years. Resting ECG was blindly evaluated according lo the Minnesota code and the duration of the QT and QTc intervals, their dispersion were manually determined on the basis of 12 standard leads (DQT and DQTc), heart rate, and its variability (SDNN). The prognostic value of threshold indices (QTc ≥ 440 msec_1/2 DQT ≥ 60 msec, DQTc ≥ 60 msec_1/2 and SDNN ≤ 20 msec) was studied by the survival methods: the Cox model, the Log-rant-test, and the Kaplan-Meier curves. In the total male population. AH is associated with the relative increase in the duration and dispersion of QT interval, with accelerated sinus rhythm, and its decreased variability. In the group of males with AH, these electrophysiological changes identify individuals at high risk for cardiovascular death irrespective of age, body mass index, blood pressure, smoking, alcohol abuse, blood lipid levels, the presence of coronary heart disease and left ventricular hypertension.

The impact of therapy on the activity of erythrocytic Ca²⁺ -dependenl K⁺-channels was evaluated In 19 patients with primary pulmonary hypertension (PPH). All the patients received either monotherapy with calcium antagonists or a combined therapy with calcium antagonists and β-blockers. The activity of the channels was determined by pH-metry using a calcium ionophore (A23187). The combined therapy with calcium antagonists and β-blockers for PPH was shown to inhibit vasoconstriction and to improve vasorelaxation, which plays a positive role in the treatment of this disease.

The wide spread of obesity in the populate in, and the increased risk of cardiovascular events, and type 2 diabetes mellitus (DM) in this group of patients served as the basis of the ECO study. Therapeutic approaches to treating arterial hypertension (AH) in patients with metabolic syndrome and type 2 DM have their peculiarities. Properly chosen antihypertensive therapy may also contribute to not only its good antihypertensive effect, but to better carbohydrate and lipid metabolic parameters. A decrease in weight may lead to the lowering of blood pressure and to the normalization of metabolic disorders. Obesity is pathogenetically related to AH, and it is apparent that the use of the newest and effective antihypertensive drugs will not be rather effective without concurrent treatment of obesity. But the main task of the study was to provide an opportunity to physician to be, from his/her own experience, convinced of the effectiveness of nondrug measures and their combination with antihypertensive therapy with the drug of choice (the angiotensin-converting enzyme inhibitor quinapril) in treating this group of patients. With this study, the authors would like to pay the attention of physicians and patients to the problem of obesity and All and to the hazard presented by these diseases.

The effects of nitric oxide and its metabolites on vascular tone were studied in patients with hypertensive disease (HD) during isometric exercise and reactive hyperemia tests. During the static loading tests, blood pressure increases were followed by the development of vasospastic reactions, by the higher activity of the sympathetic part of the autonomic nervous system, by a reduction in parasympathetic effects, by a decrease in the activity of superoxide dismutase and in the concentrations of nitrites/nitrates in the plasma, by the activation of lipid peroxidation, and by an increase in the levels of S-nitrosothiols. The reactive hyperemia test showed a higher production of nitric oxide and developed vasodilator reactions. The activation of lipid peroxidation is common to these stress tests. However, the formation of peroxynitrites and S-nitrosothiols aggravates nitric oxide deficiency and potentiates the development of vasoconstrictive reactions in patients with HD under decreased SOD-like activity.

Diabetes mellitus and arterial hypertension are major risk factors of cardiovascular complications. Diabetic nephropathy is the most common cause of end-stage chronic renal failure in the world; next is hypertensive nephropathy. Microalbuminuria is the earliest clinical marker of renal dysfunction. The basic clinical significance of microalbuminuria is that it is an independent risk factor of both end-stage chronic renal failure and cardiovascular complications. Controlling blood pressure with antihypertensive agents in patients with diabetes mellitus ensures diminished microalbuminuria and retards the development of chronic renal failure. Angiotensin II receptor blockers and angiotensin-converting enzyme (ACE) inhibitors are essential drugs for the treatment of patients with diabetes mellitus and nephropathy. A combination of these two classes of drugs offers new prospects for nephroprotection in this group of patients.

The paper presents the latest data on the clinical efficacy and safety of OSMO adalate (Nifedepine GITS), a lomg-acting drug from a group of slow calcium channel blockers. In addition to its pronounced and steady-state antihypertensive effect during monotherapy, OSMO adalate, when long used, causes a significant reduction in the incidence of cardiovascular complications, including fatal events in particular, and in patients with prior myocardial infarction. The antihypertensive effect of this drug is not inferior to that of the routine diuretic therapy. However, OSMO adalate more favorably affects the metabolism of carbohydrates, lipids, and uric acid and less frequently induced peripheral arterial oclusions, gout, and diabetes mellitus. The use of this drug has been found to prevent an increase in the thickness of carotid intimomedial layers, as well as progression of coronary arterial calcinosis (the use of a diuretics does not). Moreover, the ENCOR study has revealed that OSMO adalate therapy also prevents spastic reactions in the coronary arteries due to their better endothelial function.