The article summarizes the data on antiplatelet therapy in patients with coronary artery disease (CAD) undergoing coronary artery bypass graft surgery. The results of both randomized and open efficiency and safety trials of acetylsalicylic acid (ASA) and clopidogrel in the perioperative period are discussed as well as our own study results on association of ASA postoperative therapy with CAD recurrence after surgical revascularization are presented.

Metoprolol treatment in cardiovascular diseases is discussed considering efficiency, safety and pharmacoeconomic aspects. The article reviews the main clinical trials of metoprolol and its different forms (Extended-Release and Immediate-Release metoprolol, tartrate and succinate).

The review summarizes the data on lipotoxicity and lipotoxic cardiomyopathy, analyzes some mechanisms of insulin resistance and main consequences of these metabolic changes. Also the main therapeutic approaches are presented.

Modern views on atherosclerosis pathogenesis are briefly summarized regarding the role of vascular cell adhesion molecule-1, homocysteine and asymmetric dimethylarginine as risk factors for endothelial dysfunction and atherosclerosis onset and progression. Rosuvastatin (Crestor, AstraZeneca, Great Britain) efficiency data according to multicenter clinical trials are presented as well as the results of the own study on Crestor impact on immunological factors of endothelial lesion in hypertensive patients with coronary heart disease.

Objective. To assess prospectively the short- and long-term effects of the calorie-reduced diet on anthropometric
parameters, such as body-mass index (BMI), waist circumference (WC), waist-to-hip ratio (WHR) and compliance to the diet
in men and women with metabolic syndrome (MS). Design and methods. 60 MS patients were enrolled according to IDF
criteria (36 men) (average age 48 13 years). BMI at baseline was 33,4 4,9 kg/m2 in both sexes; WCmen = 113,9 10,9 cm,
WCwomen = 108,8 10,1 cm; WHRmen = 1,01 0,05, WHRwomen = 0,99 0,07. All MS patients were insulin resistant
(mean HOMA-IR = 5,8 3,6). Hypertension was diagnosed in 88,3 % (n = 53) MS patients according to the current
guidelines. Mean blood pressure (BP) in men was 151,6 19,6/94,7 10,7 mmHg, BP in women was 161,4 22,4/96,0 10,3
mmHg. We compared anthropometric changes in two diet programs: short-term low-caloric diet in reduction of 500 kcal
per day during 3 weeks supervised by hospital physicians; after that diet was home-based and completed by the participants
on their own during 6 months period. Results. At 3 weeks, in supervised group there were signifi cant reductions in all
anthropometric parameters in both sexes (p < 0,0003); however, men have achieved larger reduction in WC and WHR
than women (baseline-3-weeks WCmen = 4,38 1,7 cm vs WCwomen = 3,7 2,0 cm; WHRmen = 0,03 0,01 vs
WHRwomen = 0,027 0,01). At 6 month unsupervised patients had less WC and WHR reductions as compared to 3-week
data (WCmen 112,1 10,7 cm vs 110,6 10,4 cm; WCwomen 103,0 6,9 cm vs 104,7 9,3 cm; WHRmen = 1,0 0,05
vs 0,99 0,05; WHRwomen = 0,96 0,05 vs 0,98 0,06). Compliance to the home-based diet was related to sex (women
better than men) and was associated with greater reduction in WC and WHR in women. At 6 months home-based diet men
had a signifi cant increase in abdominal obesity comparing to 3-week diet (difference 3-weeks-6-months WC = -1,44 2,9
cm in men, p = 0,02; difference WHR = -0,014 0,02, p = 0,003). Conclusion. In this prospective study supervised shortterm
low-caloric program is more effective than home-based 6-months diet. We demonstrated the predictive value of gender
in outcomes: men had greater reductions in WC and WHR in short-term supervised program, but due to the less compliance
to the long-term home-based diet in males, women had greater reduction in WC and WHR after 6-months period.

A multimodal diagnostic study of the brain was carried out in 22 patients with arterial hypertension (mean systolic blood pressure 152,8 ± 7,6 mm Hg, mean diastolic blood pressure 94,6 ± 5,2 mm Hg), without cardiovascular events in anamnesis. Magnetic resonance imaging (MRI) imaging and dynamic contrast-enhanced perfusion X-ray computer assisted tomography scan (DynCT) of the brain were performed at admission and after six months of antihypertensive treatment. Based on the MRI and DynCT visual data the extent of periventricular oedema, dimensions of liquor system and regional cerebral blood flow (as ml/min/100 g tissue) were quantified. The quantitative MRI and DynCT indices were analyzed regarding the decrease of blood pressure. Significant decrease of periventricular oedema and improvement in perfusion of basal ganglii area were observed in patients demonstrated decrease in systolic blood pressure for 12-28 mm Hg. The degree of the blood pressure decrease was not associated with the significant MRI and DynCT data improvement. Hencefore, we conclude that the brain MRI and perfusion DynCT data can be employed for evaluation of cerebroprotective effects of antihypertensive therapy.

1357 patients with stroke, admitted to the specialized neurology department, were analyzed. The women prevail in this population and in the subgroup over 60 years old, however, males are predominant among young patients with stroke, and there number of men and women among patient of 41-60 years old is equal. If a subgroup of patients with hemorrhage stroke is analyzed, females are prevalent in all age groups. Patients with an ischemic stroke were hospitalized in the summer time more often, while patients with hemorrhage stroke were more frequently admitted in the spring. Arrhythmia and diabetes mellitus were more often reported in females, while myocardial infarction was diagnosed more frequently in males and there was higher number of smokers among men. The incidence of hypertension, heart rhythm disturbances, myocardial infarction and diabetes mellitus was higher in the elderly population. Patients with recurrent stroke are more likely to have a heart disease and myocardial infarction.

Objective. To assess relation between central blood pressure and arterial stiffness with cardiovascular risk factors. Design and methods. 116 subjects considering themselves healthy were examined. 63 showed blood pressure elevation. Anthropometry was performed and fasting blood specimens were obtained from all patients. Plasma glucose and lipids levels were measured. Pulse wave velocity (PWV) and augmentation index (AI) were measured by Sphygmocor Px device (Australia). Results. Parameters of arterial stiffness were strongly associated with hypertension, increased waist circumference, age, cholesterol level, and metaboloc syndrome. Females had higher AI as compared to males. Conclusion. Central blood pressure and arterial stiffness are determined not only by age and peripheral blood pressure but by cholesterol level and anthropometric parameters as well.

Objective: to estimate common carotid arteries wall state in hypertensive patients with different types of left ventricle (LV) remodeling.
Materials and methods: 102 patients 30-65 years old with essential arterial hypertension were examined. The average arterial hypertension length was 7,1 ± 1,2 years. Ultrasound examination of heart and common carotid arteries was performed. The subgroups were formed depending on the type of geometric left ventricle remodeling recommended by A. Canau et al. (1992). Structural changes of common carotid arteries walls and central hemodynamics parameters were estimated. Results: patients with concentric left ventricle hypertrophy demonstrated high arterial stiffness index (6,81 ± 1,1 units) and thickness of arterial intima-media complex (1,0 ± 0,18 mm), significantly differing from subgroups with normal type of LV and eccentric hypertrophy of LV (EHLV) (p < 0,05). Patients with EHLV have bigger internal diameter of carotid arteries (6,42 ± 0,2 mm) as compared to other subgroups (p < 0,05). Summary: patients with essential arterial hypertension show different structural changes of elastic arteries wall depending on the type of left ventricle remodeling.

Objective. To estimate vaso- and organoprotective effects of a fixed low- and full-dose combination of perindopril/indapamid in hypertensive patients. Design and methods. 56 patients with arterial hypertension of the 1-2 degrees (AH 1-2) aged 50,6 ± 0,6 years old, and 25 healthy volunteers were included into an open randomized investigation. A single dose of a fixed low- and full-dose combination of perindopril/indapamid (Servier, France) was administered for a period of 12 months. The following parameters were monitored dynamically: office blood pressure (BP), internal patients' state, endothelial function, aorta and large arteries stiffness, indices reflecting remodeling of the heart, renal and cerebral blood vessels (echocardiogram, sonography of renal and cerebral blood vessels at the device ALOKA 4000 with TRIPLEX-scanning), microalbuminuria and glomerular filtration rate. Results. By the end of the 12^th month of the therapy with the fixed low- and full-dose combination of perindopril/indapamid 96,3 % of the AH 1 patients and 86,2 % AH 2 patients have reached the target blood pressure level; a high compliance had been observed (92-99 %), the beneficial drug effects on the remodeling of heart (decrease of the left ventricle myocardial mass index, p < 0,05) and blood vessels (stiffness reduction, the increase of aorta extension, and endothelial function restoration) were found. The antihypertensive therapy resulted in the reduction of hypertensive nephropathy and encephalopathy, and cerebrovascular reactivity improvement. Conclusion. A long-term therapy with a fixed low- and full-dose combination of perindopril/indapamid in patients with arterial hypertension of the 1-2 degrees leads to the reverse cardiovascular remodeling providing with a vaso- and organoprotective effects as well as the target BP achieving.

Adiponectin levels, lipid profile and parameters of glucose metabolism were evaluated in patients with abdominal obesity. It was found that adiponectin level negatively correlated with body mass index (BMI). The significant correlations were found between levels of adiponectin, triglycerides, and high-density lipoprotein (HDL) cholesterol in patients with abdominal obesity. Patients with abdominal obesity and arterial hypertension had higher levels of total cholesterol, low-density lipoprotein (LDL) cholesterol, and triglycerides comparing to non-hypertensive patients with abdominal obesity. BMI increase positively correlated with insulin level and insulin resistance index estimated by homeostasis model assessment (HOMA-IR). Positive correlations were also determined between HOMA-IR and waist circumference, BMI, and adiponectin level.

Aim of the study. To evaluate the re-stratification of total cardio-vascular risk according Russian guidelines for treatment of arterial hypertension (HT) 2004-2008. Materials and methods. All diagnostic procedures recommended by Russian guidelines for treatment of HT 2004-2008 were applied. Results and conclusions. There were no patients with low added risk in the cohort with newly diagnosed or nontreated HT. According to the previous version of recommendations 69 % of them has high/very high added risk. If new dislipidemia criteria applied, fasting plasma glucose, glucose tolerance test as risk factors included, and metabolic syndrome and low estimated glomerular filtration rate as subclinical organ damage considered 87 % patients could be stratified as high/very high added risk patients. Attention should be paid mainly to the patients with grade I HT and younger than 55 years old.

Objective. To evaluate the functional condition of pituitary-adrenal system of juveniles and young men with hypertension. Design and methods. 87 juveniles with obesity (including only 69 with hypertension) and 24 normal weight juveniles with hypertension were examined. Results. The laboratory criteria of subclinical Cushing's syndrome and congenital adrenal hyperplasia with 11-β-hydroxylase failure with corticosteroid identification in blood and urine by high-efficiency liquid chromatography at dexamethasone and corticotropin tests were developed.

Aim. The study addresses the role of left ventricular hypertrophy (LVH) in development of sudden cardiac death (SCD) in patients with myocardial infarction (MI). The incidence of characteristic features of arrhythmogenic substrate in myocardium (late ventricular potentials, left ventricular ejection fraction) and trigger factors of fatal arrhythmias (decreased heart rate variability, ventricular arrhythmias) was higher in patients with MI and LVH. The level of leukocytes, monocytes and eosinophils, CD-95 lymphocytes was significantly higher in patients with LVH. The incidence of general mortality and of SCD was also higher in group with LVH.

The object: to estimate functional condition of men with arterial hypertension of various disease length using veloergometry. Materials and methods. 86 men with arterial hypertension of 1 degree of various duration were examined: 60 men with the disease length 1,5 ± 0,2 year and 26 men with the disease length 8,0 ± 1,6 year, and 25 apparently healthy men were included. The standardized veloergometry was performed in all subjects using step-by-step increasing technique till either submaximal heart rate or limiting criteria were achieved. Results. Patients with long duration of arterial hypertension show reduced physical exertion tolerance, greater increase of systolic arterial pressure at small, average and high exertion power as compared to patients with short anamnesis of hypertension. They also have greater oxygen consumption by myocardium and its greater increment at average exertion power if compared to the rest level. The veloergometry test was discontinued due to the top level of systolic blood pressure, which occurred more often in this group.

The study addresses hemodynamics and metabolic status in patients with arterial hypertension (AH), complicated by stroke, and its contributing factors. It was demonstrated, that AH is a leading risk factor in patients, who suffered stroke, and daily profile of blood pressure has certain peculiarities. Thus, these patients show diastolic hypertension and increased variability of blood pressure. Early onset of diastolic myocardial dysfunction is often present in patients with AH, complicated by stroke.

Psychoemotional status, neurohumoral profile and their interrelations were studied in patients with arterial hypertension. Psychoemotional dysfunction was found in 67,8 %. All patients with arterial hypertension were divided into 2 groups according to psychoemotional status disbalance: 1^st group included patients with high aggressiveness (28,7 %); 2^nd group - patients with high situational and personal anxiety and high hostility (39,1 %). There can be distinguished three types if psychoneurohumoral disbalance depending on gender and clinical characteristics: anxiety-metabolic, anxiety-adrenergetic and aggressive-metabolic. Differential therapeutic and psychotherapeutic approach regarding the type of psychoneurohumoral disorder improves quality of life, normalizes hormonal status and psychoemotional balance in hypertensive patients.

Aim. The study addresses estimation of pre-trip blood pressure (BP) and temporary disability at workers of locomotive brigades before and after performing treatment and prevention service in a prospective study. 247 males were included in the study. Results. Average systolic BP during the year was key parameter connected with number of days of temporary disability and quantity of discharges from trip because of the BP increase. Analysis of the discharges from trip by criteria of the automated system of pretrip control because of arterial hypertension (AH) revealed workers of locomotive brigades with AH who had the longest temporary disability. After 3-year-long treatment and prevention service were applied disability cases due to BP extreme variation were not registered in the group without discharges from trip because of BP increases, and there was a 30 % decrease in number of discharges from trips due to BP increase in the group with discharges because of AH.

Objective. To assess pharmacoeconomical benefits of the combination therapy in hypertensiму patients with metabolic syndrome using free combinations angiotensin converting enzyme inhibitor and non-dihydropiridine or dihydropiridine calcium antagonists. Design and methods. Overall, 150 patients with arterial hypertension of 2-3 degree and metabolic syndrome were examined. After primary admission they were randomized in 2 matching groups of 75 patients. The combination therapy was administered to all patients: enalapril and verapamil SR for 1^st group, and enalapril and amlodipine for 2^nd group. Before and after 12 weeks of the treatment all patients underwent 24-hour blood pressure monitoring and echocardiography examination. Also microalbuminuria, plasma levels of lipid and glucose were estimated. An original database was used to assess the cost/efficiency parameters. Results. The effect of combination therapy on the 24-hour blood pressure monitoring data, microalbuminuria and methabolic profile was comparable in both groups. There was found significant difference in pulse pressure level with the more expressed reduction in the group of enalapril/verapamil SR (p < 0,001) after 12 weeks of the treatment; also heart rate in patients of the 1^st group has reduced significantly while it has increased in 2^nd group. Diastolic left ventricular function was significantly higher in the group of enalapril/verapamil SR after 12-week therapy. Conclusions. This study proves the pharmacoeconomical benefit of the combination enalapril/verapamil SR in hypertensive patients with metabolic syndrome.

The article presents the results of the sociological analysis performed in hypertensive patients living in the Chechen
Republic. Economical status and education level are the main factors infl uencing health self-appraisal, emotional condition
and psychological environment in the family of hypertensive patients. The low level of medical activity and the absence of
the elementary preventive measures such as regularly blood pressure control independent of economical status and education
level are remarkable. The medical activity is higher but health self-appraisal is lower in patients who have relatives with
cardiovascular pathology. The lonely patients have worse rates of health state. Revealed features can be useful in planning
of prevention programs to reduce risk of different vascular complications in these patients.

Functional morphology of left ventricular (LV) myocardium and right atrium(RA) auricle intraoperative biopsies from 48 patients with ischemic cardiomyopathy (ICMP) was studied. In the early (1 year) postoperative follow-up period all the patients were divided into 2 groups: those with positive and negative dynamics of end diastolic volume index and effusion fraction (EF) of LV. Retrospective analysis of echocardiography (EchoCG) data did not allow to reveal predictors of postoperative heart remodeling in both groups of the patients. On the contrary, drawing clinical-morphological parallels of negative dynamics of the early postoperative period showed that presence of diffuse, lymphocytic-macrophage inflammatory infiltration of myocardial stroma in combination with pronounced fibrosis, low values of trophic index (< 0,015) and specific volume of atrial natriuretic peptide granules in atrial cardiomyocytes as well as high values of pericapillar diffusion zone (> 1000 mcm) and Kernogan index (> 1,6) of LV myocardium were morphological predictors of postoperative heart remodeling.

The same mediators of the autonomic nervous system can be both triggers and modulators of internal organs activity,
and heart autonomic regulation can be best estimated by studying heart rate variability (HRV). The objective of the present
research is the estimation of both time and spectral HRV parameters in patients with non-rheumatic myocarditis depending
on its clinical course. 58 patients (20 men and 38 women) aged 35,3 1,3 years were examined. 22 (37,9 %) patients
have established acute myocarditis, and 36 (62,1 %) - postmyocardic cardiosclerosis (PMC). HRV parameters were
estimated depending on the disease stage, and on presence of heart rhythm disturbances. Patients with acute myocarditis
compared to those having PMC had decreased HRV parameters (SDNN, SDANN, SDNNi, pNN50, rMSSD) refl ecting
vegetative imbalance, and ventricular ecthopic activity in patients with myocarditis is associated with the activation of
both sympathetic and parasympathetic system, and these changed are more expressed in patients with high ventricular
extrasystole gradation.

The article addresses the problem of treatment hypertensive patients with dyslipidemia. Questions of adherence to antihypertensive and lipid-lowering therapy are discussed. Effects of first fixed combination CADUET (amlodopine/atorvastatin) dealing with more than one risk factor are analyzed.

Classifi cations of clinical forms of arterial hypertension (AH) are based on differentiating its etiology; we propose a
classifi cation that is based on the common pathogenesis of hydrodynamic pressure elevation in the intravascular pool of the
intercellular medium, i.e., arterial blood pressure (BP). We believe that there are only three options for hydrodynamic pressure
elevation in a mechanical model of the cardiovascular system: 1) a decrease in the arterial bed volume at a constant volume
of the intravascular fl uid, 2) an increase in the volume of intravascular fl uid at a constant volume of the vascular bed and
3) an increased blood fl ow resistance at constant volumes of the vascular bed and intravascular fl uid. These options include
all clinical forms of AH in which BP increases by common mechanisms. The fi rst option can be related to AH occurring
in pheochromoblastoma, glucocorticoid hyperproduction and psychoemotional stress. The second is associated with AH
developing in excessive NaCl consumption, increased aldosterone production in Conn syndrome (primary aldosteronism) and
reduced production of atrial natriuretic peptide by phylogenetically modifi ed myocytes of the right atrium. The third option
can be linked to all forms of increased peripheral blood fl ow resistance in the arterial bed presented at coarctation of the aorta,
renovascular hypertension, impaired fl ow/endothelium-dependent vasodilation and moderate spasm of muscular arterioles,
arterial wall atherosclerotic lesion (atheromatosis and atherothrombosis), Takayasu syndrome and obliterating endarteritis.
BP elevation in erythremia, under the effect of leukocyte colony-stimulating factor and after injection of a recombinant
erythropoetin can also be regarded within the frames of the third option. From the general biology viewpoint, all forms of AH
developing against the background of impaired biological function of transcytosis (macropinocytosis) and crossing by food
substrates and humoral mediators of bilayer structures between common and local pools of the intercellular medium, i.e.,
blood-brain barrier can be referred to as hematoencephalitic form. AH developing in impaired transcytosis across the bloodbrain
barrier (endothelium + astrocytes bilayer) is an encephalopathic form; across endothelium + podocytes bilayer - renal
form; endothelium + trophoblasts - placental AH; endothelium + pneumocytes - pulmonary AH; and endothelium + intimal
macrophages - atherosclerosis-related AH. Normal BP points at the physiological level of transcytosis between all pools
of the intercellular medium, the absence of peripheral blood fl ow resistance in the arterial bed, normal function of muscle
arterioles, and the physiological levels of metabolic processes in all paracrine cell communities in vivo.