Pathogenetic role of aldosterone in resistant hypertension phenomenon and its possible correction are discussed.
Key words: aldosterone, aldosteronism, resistant hypertension, aldosterone antagonists.

Primary aldosteronism is one of the most prevalent reasons of secondary hypertension. Mineralocorticoid excess is on independent powerful pathogenic factor of left ventricular hypertrophy and its diastolic dysfunction. The degree of participation of aldosterone precursors in left ventricular remodeling is unknown. Two case reports concerning the peculiarities of different mineralocorticoid influence on left ventricle structure and function are described in the paper.

Several endogenous digitalis-like cardiotonic steroids (CTS) have been identified in humans, including endogenous ouabain, a cardenolide, and marinobufagenin which belongs to a class of bufadienolides. The main function of CTS is maintenance of sodium homeostasis and regulation of natriuretic function. Endogenous cardiotonic steroids bind to the Na/K-ATPase and exhibit two kinds of effects, inhibition of transmembrane transport of monovalent cations, and induction of a complex cascade of cell signaling. In Dahl salt-sensitive rats with NaCl-induced hypertension, endogenous ouabain, acting as a neurohormone stimulates adrenocortical marinobufagenin, which raises blood pressure via inhibition of vascular Na/K-ATPase. In a subgroup of hypertensive subjects, which possess a polymorphism of alpha-adducin gene, elevated levels of endogenous ouabain activate renotubular Na/K-ATPase and induce renal sodium retention. Elevated levels of CTS also contribute to pathogenesis of congestive heart failure, preeclampsia, and diabetes mellitus. The approaches to pharmacological antagonism of the effects of CTS include blockade of CTS receptor site on the Na/K-ATPase, immunoneutralization, and interactions at the levels of Na/K-ATPase phosphorylation/dephosphorylation by protein kinases С and G.

The review addresses modern concept of calcium antagonist pharmacological properties which allow to use them in patients with hypertension and concomitant coronary artery disease. The antihypertensive, antiischemic and antiatherosclerotic effects of calcium channel blockers are discussed as well as influence on arterial elasticity and safety reasons.

The study documented blood pressure lowering effect according to ABMP data in 50 hypertensive patients receiving antibodies to C-end fragment to AT1 receptors for 3 months. (Cardos). The drug was well-tolerated and showeed 24-hour significant decrease of blood pressure at day-time as well as at night-time.

We studied relationship between renin-angiotensin system (RAS) gene polymorphisms and parameters of endothelial function in males with history of myocardial infarction in young age. We found endothelial dysfunction in these patients. There were no correlations between certain polymorphic genes and risk of myocardial infarction. At the same time, insertion/deletion polymorphism of the angiotensin-converting enzyme gene was associated with more prominent endothelial dysfunction in males with history of myocardial infarction in young age. These data may confirm influence of RAS gene polymorphism on the endothelial dysfunction.

Aim of the paper was to study the influence of stress, muscle relaxation and their combination on endothelium-dependent vasodilation (EDV) in hypertensive patients.
We investigated 22 hypertensive patients of I stage (age 41,8+1,8 years) and healthy persons (n= 16) as control group comparable by sex and age. The central hemodynamic parameters and forearm blood flow estimated before and during the reactive hyperemia test (RHT) at initial condition, during the mental stress, muscle relaxation and their combination.
Results: the mental stress caused in healthy people increased heart rate and systolic blood pressure, but did not influence on forearm EDV. In hypertensive patients increase of heart rate and blood pressure at mental stress was accompanied by decrease of EDV (up to 5,15±0,75%). The muscle relaxation condition in healthy individuals resulted in more expressed EVD (on 10,76±1,77%). In hypertensive patients heart rate and blood pressure reduction was even more expressed, thus, EDV was comparable with basal. The combination of stress and muscle relaxation unequally influenced on EVD in groups: if in the control disappearance of additional vasodilator reaction (EVD was 7,98+1,0%) has taken place, in the hypertensive group the stress with condition of muscle relaxation had no similar effect (EVD was 8,71 ±2,3%).
Thus, we revealed dependence of EDV on both stress and stress-limiting influences. It can be used in primary and secondary prevention of arterial hypertension.

Correction of sleep disorders in hypertensive patients with obstructive sleep apnea (OSA) may improve response to treatment and facilitate achievement of target blood pressure (BP). Due to the absence of guidelines and insufficient number of studies in this patient population we decided to conduct a study in order to investigate efficacy of standard antihypertensive treatment in combination with CPAP therapy in hypertensive OSA patients.
Population: The study enrolled 60 ambulatory or in-hospital hypertensive patients, which were assigned to 3 treatment groups: OSA patients on standard antihypertensive therapy in combination with CPAP; OSA patients on standard antihypertensive therapy alone; non-OSA patients on standard antihypertensive therapy.
Results: After 3 months of treatment, 17 patients in the first group, 12 patients in the second group and 18 patients in the third group achieved target BP.
Conclusion: Combination of standard antihypertensive treatment and CPAP in hypertensive OSA patients results in increase of proportion of patients on target and decrease of time to achievement of target BP. Due to effective OSA treatment, addition of CPAP therapy results in higher efficacy of antihypertensive therapy with decrease of the number/ dosages of antihypertensive drugs.

The study addresses antihypertensive therapy in 60 hypothyroid patients with hypertension of different degrees. It is documented that 70% of hypertensive in patients with sub compensation of hypothyroidism have stage 3 hypertension. The efficacy of perindopril in these patients is 87,5%. The time necessary for blood pressure reduction is longer in patients with older age, severe hypertensions and lower thyroid status.