^aDepartment of Clinical Medicine and Prevention, University of Milano-Bicocca; Centra Interuniversitario di Fisiologia Clinica e Ipertensione, Milan and Department of Cardiology, S.Luca Hospital, Istituto Auxologico Italiano, Milan, Italy,^bHypertension Center, Third University Department of Medicine, Sotiria Hospital, Athens, Greece,^cL'lnstitut CardioVasculaire, Paris, France,^dDivision of General Internal Medicine, Department of Internal Medicine, University Hospital Maastricht, Maastricht, The Netherlands,^eDepartment of Clinical Pharmacology and Therapeutics, Tohoku University Graduate School of Pharmaceutical Sciences and Medicine, Sendai,^fDivision of Cardiovascular Medicine, Department of Internal Medicine, Jichi Medical University School of Medicine, Tochigi, Japan,^gPediatric Department, Consorcio Hospital General, University of Valencia, Valencia, Spain,^hFirst Department of Cardiology, Evagelismos General Hospital of Athens, Athens, Greece,ⁱDivision of Hypertension and Vascular Medicine, Department of Internal Medicine, University Clinic Bonn, Bonn, Germany,^jConway Institute of Biomolecular and Biomedical Research, University College Dublin, Ireland,^kDepartment of Planning for Drug Development, Tohoku University Graduate School of Pharmaceutical Sciences and Medicine, Sendai, Japan,^lDepartment of Medical Sciences, University of Edinburgh, Western General Hospital, Edinburgh, UK,^mClinica Medica 4, University of Padova, Padua, Italy,ⁿColumbia University Medical College, New York, New York, USA,^oHypertension Clinic, Internal-Medicine, Hospital Clinico, University of Valencia, Valencia,^pHypertension Unit, 12 de Octubre Hospital, Madrid, Spain,^qMaternal and Fetal Research Unit, Kings College London, Division of Reproduction and Endocrinology, St. Thomas Hospital, Westminster Bridge Road, London, UK,^rLaboratory of Hypertension, Campus Gasthuisberg, Leuven, Belgium,^s1st Department of Medicine, Semmelweis University, Budapest, Hungary,^tDivision de Physiopathologie Clinique MP14, Lausanne, Switzerland,^uCentro Interuniversitario di Fisiologia Clinica e Ipertensione and Istituto Auxologico Italiano, Milan, Italy and^vClinica Medica, Department of Clinical Medicine and Prevention, University of Milano-Bicocca; Centro Interuniversitario di Fisiologia Clinica e Ipertensione, Milan and Istituto Auxologico Italiano, Milan, Italy

Cardiovascular morbidity is widely spread in patients with type 2 diabetes mellitus. Cardiovascular mortality risk in patients with type 2 diabetes mellitus is twice to six times as high as in patients without diabetes. The incidence of macrovascular complications, such as strokes and peripheral arterial disease is very high, and the cardiovascular events associated with type 2 diabetes are the major cause of mortality in these patients. This article reviews the efficacy and safety of various antidiabetic drugs in patients with concomitant diseases, and regards diabetes management in elderly population. The available evidence on treatment of elder adults with type 2 diabetes and concomitant diseases is discussed, and a general approach to therapy is suggested.

Evidence for genetic polymophisms may contribute to the dependence on sex and age differences in biochemical phenotypes, clinical manifestation, severity and success in medical treatment of coronary artery disease (CAD) comes from a variety of studies. Two genetic polymorphisms, L55M and Q192R, in the human antioxidant system paraoxonase 1 gene (PON1) have been shown to be associated with increased risk of CAD. The aim of recent study was to investigate a possible association between polymorphic variants of PON1 and CAD in patients of different age and sex. The group of patients with CAD (323 men and 71 women) and the group of healthy (114 men and 84 women) randomly sampled from St Petersburg were investigated clinically, biochemically and genetically. We found out the genotype L55M and Q192R frequencies in the group of patients with CAD were different depending on sex and age (p = 0,057, p = 0,007). In women with CAD the frequency of 55MM genotype (ОR = 2,1311, 95 % CI 1,14-3,98) was significantly higher and the frequency of 192QR genotype (ОR = 0,59, 95 % CI 0,39-0,89) was significantly lower than in men with CAD who survived myocardial infarction (MI) under the age of 45. Our results suggest that both PON1 polymorphisms play the role in risk of CAD. Furthermore, PON1 polymorphisms act in various ways in patients of different age and sex.

Some approaches to estimation of disease risk by means of unfavorable attendant factors analysis are considered as one of initial preventive methods. Bayesian theorem, significance test and binary logistic regression are shortly described and compared. Calculation results concerning hypertension in children for various combinations of unfavorable factors are presented.

In clinical practice arterial hypertension (АH) and coronary heart disease (CHD) often occur together; therefore they should be considered in the context of cardiovascular continuum. This study addresses central hemodynamics and coronary blood flow in patients with AH and CHD as compared to their isolated forms, as well as the influence of AH on the course of CHD.
Subjects of the study included: 125 patients with CHD and AH; 215 patients with isolated CHD; 57 patients with isolated AH; 42 patients without coronary artery involvement formed a control normal group. The left ventriculography and coronary angiography were performed in order to evaluate parameters of central hemodynamics and coronary blood flow in patients of each group. It was shown that the increase of myocardial perfusion improves coronary blood flow in atherosclerotic coronary arteries with moderate stenosis. In hypertensive patients with severe atherosclerotic damage changes in central hemodynamics were accompanied by significant reduction in coronary blood flow, increase of right atrial and end-systolic left ventricular volumes, reduction in left ventricular ejection fraction. Central hemodynamic changes in patients with CHD accompanied by AH depend both on the degree of coronary artery involvement and the presence of AH. The AH, the left ventricular hypertrophy and the increase of ventricular capacity are the main factors, responsible for hemodynamic changes when AH and CHD exist together.

Central arterial pressure was evaluated in 250 hypertensive patients and in 174 healthy subjects by means of contour analysis of pulse wave (SphygmoCor, AtCor Medical, Australia). The difference between central and peripheral pressure and influence of augmentation and amplification on it was shown. The features of formation of systolo-diastolic hypertension and isolated systolic hypertension at different age is described.

Relevance. Influence of psychological stress on individuals can be assessed by heart rate variability (HRV) analysis. The syndrome of mental "burning out" often reflects psychological stress in physicians. Aim. The study addresses relation between HRV and the severity of professional stress among medical students with initial symptoms of arterial hypertension under dynamic physical exertion. Material and methods: 98 people took part in our research: 50 students of first years, 20 of which tended to have high blood pressure (BP), and 48 doctors-interns. Professional stress was diagnosed by V.V. Boyko's technique. BP by Korotkov's method and HRV analysis of the electrocardiogram (using Cardiotechnique-04) were taken while veloergometry at 100 Vt was performed. Results. 90 % of students are under I phase of stress strain that is accompanied by the increase of diastolic BP (р < 0,05). Out of studied hemodynamic parameters (systolic and diastolic BP, heart rate) only systolic BP was found to decrease till 124,6 ± 4,58 mmHg (p < 0,05) in 32,5 % of subjects under II phase of stress having got 5-minute rest after physical exertion. Sympathetic nervous system activity assessed by the decrease of HRV parameters and LF/HF-ratio increase was prevalent in the same group.

Aim. The research addresses gender-age features of cardiac electrophysiological changes in patients with arterial hypertension based on a standard electrocardiogram, high-frequency electrocardiogram and cardiointervalography data. Materials and methods. 171 patients with arterial hypertension (97 men and 74 women) aged between 30 -73 years were included. Standard 12- lead electrocardiogram, high-frequency electrocardiogram with the analysis of late potentials of atria (LPA) and ventricles (LPV), and cardiointervalography with an estimation of heart rate variability were performed in all patients. Results. It is stated, that in patients with arterial hypertension, processes of cardiac electrophysiological changes are gender-and-age dependent. In our study women showed a longer QT interval as compared to men, but QT interval prolongation did not depend on the stage of the disease. No essential sexual distinctions were found in QT interval dispersion. LPA were registered more often in male patients, while there was no significant difference in LPV registration. It is worth noting that discussed changes are observed in patients with arterial hypertension, while no significant difference was found in patients without cardiac pathology. Therefore, men show a higher sympathetic activity influencing heart rate in comparison with women. Increased QT interval duration and dispersion was found in older patients with arterial hypertension, while no distinctions in LPA and LPV registration were observed.

Aim. The study addresses antihypertensive and cerebroprotective effects of long acting metoprolol (Egiloc retard, Egis, Hungary). Materials and methods. 47 objects with I-II stages of hypertension without serious concomitant diseases (25 males and 22 females, average age 51,7 ± 10,6 years) were included. Long acting metoprolol was administered (Egiloc retard, Egis, Hungary) in a dose of 25-100 mg given 1-2 times per day. 24-hour ambulatory blood pressure monitoring (ABPM), magnetic resonance tomography and dynamic contrast-enhanced perfusion computer scan of the brain with brain blood flow estimation were performed in all patients initially and after 6-month-therapy. Results. Egiloc retard showed a significant antihypertensive effect according to office and ABPM blood pressure. Egiloc retard normalizes 24-hour blood pressure profile in over-dippers and night-peakers. Subjective amelioration and improvement of functional and structural changes were found in hypertensive patients after 6-month therapy by Egiloc retard. Good tolerance and no significant abnormal changes of glucose and lipid metabolism were observed in patients taking Egiloc retard. It is also shown that Egiloc retard has the cerebroprotective effects.