Fifty-seven patients with grade 1 essential hypertension concurrent with chronic obstructive bronchitis or bronchial asthma were examined. They were found to have characteristics of the daily blood pressure profile, such as a high load due to pressure and its inadequate nocturnal lowering. The concentric type of left ventricular hypertrophy (LVH) is typical of the vast majority of persons of this category. The patients with a high LVH concentricity have more significant imbalance of autonomic cardiac rhythm regulation with the preponderance of myocardial sympathetic impact while those with low LVH concentricity showed higher aldosterone secretion.

The structural and functional features of the microcirculatory heel (MCB) were studied in patients with arterial hypertension (AH) in relation to the presence or absence of type 1 diabetes mellitus (DM). Two hundred and twelve patients were examined. These included 110 patients with grades 1 and 2 arterial hypertension (AH) and type 2 DM, 82 patients with AH without type 2 DM, and 20 apparently healthy individuals. Laser Doppler flowmetry (LDF) was used to estimate basal blood flow, the loading test parameters characterizing the structural and functional status of MCB, and the incidence of hemodynamic types of microcirculation. Patients with AH concurrent with type 1 DM were found to have the following microcirculatory features: an increase in perfusion blood flow (microcirculation index, 8,8±1,8 perf. units versus 4,9±0,8 perf, units in patients with AH without DM and 6,7±0,9 perf. units in the control group), a drastic reduction in myogenic activity to 13,2±5,7 % versus 16,7±6,8 and 25,2±6,4 %, respectively, a decrease in vascular resistance, impairment of autoregulation, and low reserve capacities (reserve capillary blood flow was 197,8±31,6 % versus 429,9±82,01 % in the group of AH without DM and 302,8±50,1 % in the control group), a predominance of the hyperemic hemodynamic type (58,8 % in patients with AH and DM, 20,9 % in those with AH without DM, and 20,0 % in the controls). The specific features of the altered microcirculatory bed in patients with AH concurrent with type 2 DM were ascertained. These included the predominance of hyperemic microcirculation, impaired autoregulation. diminished microvascular resistance, and the low reserve capacities of the microcirculatory bed.

The purpose of the present investigation was ю evaluate the effects of the representatives of two classes of antihypertensive drills central acting agents and those affecting the rennin-angiotensin system on blood pressure (BP) variability in awake rats. Experiments were carried out on normotensive male Wistar rats, spontaneously-hypertensive rats (SHR), and non-inbred albino rats with induced renal hypertension. In the experiments. HI' and intersystolic interval were recorded and arterial baroreceptor reflex was tested. Mean BP variability appeared as undulating fluctuations with a variable amplitude (from 5 to 15 mm Hg) and a duration of 5 to several tens of cardiac cycles. The observed BP fluctuations had no well-defined periodic shape. They did not affect mean BP and stable-unstable BP transition was not attended by mean pressure changes. In hypertensive rats, BP and its variability were higher and the baroreceptor reflex was less than in normotensive rats. Captopril and aprovel in used doses produced an antihypertensive effect; they did not affect HP variability. In hypertensive animals, captopril-induced reductions in BP were followed by a decrease in its variability whereas approve was responsible lor an increase in BP variability. Clonidine and rilmenidine lowered mean BP and its variability in all experiments.

In patients with left ventricular hypertrophv (LVH), coronary hemodynamics was studied by¹³N-ammonium positron emission tomography (PET). We examined 38 patients aged 53,22±9,57 years, who had LVH in the presence of hypertensive disease. A control group comprised 15 individuals without a history of cardiovascular diseases The structural and functional parameters on the left ventricle were determined by echocadiography. Myocardial blood flow (МBР) was evaluated at rest and during a dipyridamole test, by using PET. The coronагу reserve (CR) and resistanсe were calculated. In the patients with LVH and in the controls, the mean resting values of MBF did not differ significantly (73,3±12,8 versus 73,4±16,6 ml/min per 100 g of tissue, the differences wen insignificant). During the dipyridamole test, the values of MBF and CR were significantly lower in the patients with LVH (140,4±35,1 versus 219,86±69,2 ml/min per 100 g of tissue (p<0,5) and (1,94±0,62 versus 2,95±0,41 (p<0,05), respectively). In the presence of vasodilatation, coronary resistance was substantially less in the control group (0,54±0,16 versus 0,89±0,24; p<0,05). There was no correlation between the coronary hemodynamic parameters and the left ventricular myocardial mass index. CR was substantially less in the concentric type of LVH than that in the eccentric type (1,77±0,44 versus 2,11±0,51; p<0,05). All patients with concentric LVH showed impaired left ventricular diastolic function (LVDF) whereas the latter was observed only in case in the eccentric type. In LVH, resting МBF did not virtually differ from the normal values; however, the coronary bed responded to dipyridamole-induced vasodilatation to a substantially lesser degree. The decrease in CR was largely marked in concentric hypertrophy and associated with LVDF.

The study was undertaken to evaluate the antihypertensive and antiischemic effects .mil safety of combined therapy with calcium blockers (CB) of the dihydropyridine and non-dihydropyridine series, and its impact on the structural and functional status of the heart. Forty-eight patients with stages II-II hypertensive disease and grade 2 (according to the All-Russian Cardiology Research Society classification, 2001) were examined. Of them, 31 patients were observed to have exercise induced anginal attacks. The data of 24-hour blood pressure (HP) monitoring, electrocardiography, and Doppler echocardiography were assessed The patients received combined therapy with amlodipine and isoptin SR for 24 weeks. With the therapy, its complete (BP < 140/90 mm Hg) and partial (a 10 mm Hg decrease in diastolic HP) antihypertensive effects were noted in 72,2 and 20,8 % of patients, respectively. The left ventricular myocardial index reduced by on average of 24,9±2,3 g/m² (p<0,01) and diastolic function improved: the E/A ratio increased 10,3 % (p<0,05); isovolumic relaxation time decreased by 13,6 % (p<0,01). There were also reductions in the depth of the maximum ST-segment depression (from 2,3±0,2 to l,5±0,1 mm) and in the duration and incidence of silent myocardial ischemia The rate of adverse reactions caused by combined therapy was 1,5-4 times less than that due to monotherapy. A combination of different classes of CB has rather high antihypertensive and cardioprotective effects and it is well tolerated.

The purpose of the study was to estimate the intensity of the proarrhythmic indices in patients with hypertensive disease and to evaluate the effect of the angiotensin-converting enzyme inhibitor perindopril on proarrhythmic factors. Out of 42 patients with stages I-II hypertensive disease, 28 (66.6 %) were observed to have cardiac arrhythmia. Patients with the signs of left ventricular hypertrophy were significantly more frequently found to have ventricular arrhythmias, including high-grade ones and decreased cardiac rhythm variability A significant decrease in both systolic and diastolic blood pressures was recorded alter therapy with perindopril in a dose of 4-8 mg for 6-10 months. At the same time, there was a significant reduction in the average daily number of premature ventricular beats and in the left ventricular myocardial mass index, and an increase in CRV. Evaluation of the effectiveness and tolerance of perindopril revealed that as main as6 patients had side effects that were not a reason for discontinuing the drug.

Remodeling of large arteries and endothelial dysfunction, as left ventricular hypertrophy, is associated with the development of severe cardiovascular events and worse prognosis in patients with hypertensive disease. The impact of genetic determinants on the development of such lesions to target organs in this group of patients was the subject of wide speculation. We determined the genotype of endothelial NO-synthase (the polymorphisms 4a/4b and Glu298Asp) in 51 patients (28 males and 23 females; mean age |48,0±6,3 years) with hypertensive disease and left ventricular hypertrophy; the profile of blood pressure (BP) was assessed by its 24-hour monitoring data; the thickness of an intima-media complex was measured during ultrasound study. Endothelial function was determined by the increase in the diameter of the brachial artery during a reactive hyperemia test. The remodeling of large arteries in the examinees was found to be associated with both the average BP levels and age. There was no relationship of the gene polymorphism of endothelial NO-synthase to the daily BP profile and the remodeling of the large arteries alike. Endothelial dysfunction in t lie examinees was associated with the carriage of the mutant allele T of the gene of endothelial NO-synthase.

The purpose of the study was to evaluate the hypolipidemic effectiveness and safety of use of Tulip, a novel atorvastatin generic agent, registered by LEK, Slovenia, in Russia. Materials and methods. The open prospective uncontrolled study covered in hyperlipidemic patients aged 57,3±1,2 years. Of the 40 patients included into the present study, 19 (47.5 %) achieved the target level of low-density lipoprotein (LDL) cholesterol just by week 4 of therapy when 10 mg of Tulip was used and 7 (17,5 %) patients did by week 8 when 20 mg of the drug was given. As a whole, 65 % of patients achieved the target level of DLD cholesterol in the Tulip group. By treatment week 8, there were35,6; 44,6; 39,8 and 40,9 % decreases in the serum content of total cholesterol, very low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, and triglycerides, respectively. The serum level of LDL cholesterol tended to increase. The pronounced hypolipidemic effect of Tulip was not attended by increases in transaminases (aspartate aminotransferase and alanine aminotranferase) and creatinine phosphokinase. Conclusions. The marked hypolipidemic effect of Tulip, which is comparable with that of the original drug atorvastatin, is unquestionable to he attractable for practical use in Russia due to its inexpensive cost. Tulip has demonstrated to be safe and well tolerated.