The paper presents the modern view on beta-blockers that are a heterogeneous group of medicines. Their different features and side-effects should be taken in consideration when negate beta-blockers use. In fact, non-selective beta-blockers have side-effects, in particularly metabolic effects, preventing from their use in patients with metabolic syndrome and type 2 diabetes mellitus. At the same time cardioselective beta-blockers do not influence metabolism and can be prescribed to the mentioned patient groups.

Metabolic syndrome (MS) is an actual problem in cardiology due to its high contribution to cardiovascular diseases. Renin-angiotensin-aldosterone system (RAAS) activation is known to play an important role in hypertension development in MS. In insulin resistant patients RAAS blockade, in particular, angiotensin II receptor antagonists (ARA) can be beneficial. The paper adresses mechanisms of hypertension in MS, the data of clinical trials confirming benefits of ARA for stroke prevention, in diabetes mellitus type 2, left ventricular hypertrophy and nephropathy.

The paper is addressed to combination therapy in hypertension. The advantages of combination therapy, especially foxed combinations are discussed. Combination treatment of arterial hypertension should be the first line therapy in high or very high total cardiovascular risk patients to achieve target blood pressure and prevent complications. The combinations, including renin-angitensin-aldosterone system blocking agents are preferable. They can be combined with diuretics or calcium channel blockers. Physicians should take into consideration the lower limit of blood pressure which can be dangerous for patients with coronary artery disease and cerebrovascular disease. The results of open label randomized trial of efficacy and tolerability of different combinations of antihypertensive drugs in postmenopausal women are presented. High efficacy and toterability of fixed combination of ACE inhibitor perindopril and diuretic indapamide - Noliprel was shown.

Results of multiple clinical studies confirmed the benefit of early start of combination antihypertensive therapy for decrease of cardiovascular risk. The paper discusses the advantages and disadvantages of fixed combinations and fixed in one blister combinations.

The group of heritable connective tissue disorders with abnormality of fibrous structures of extracellular matrix includes a large number of syndromes, traditionally classified as undifferentiated connective tissue dysplasia in Russia. The article presents an approach to diagnosis and classification of this pathology considering the concept of phenotypic continuum of connective tissue disorders and literature data.

Objective. To investigate cerebral hemodynamic and endothelial function in hypertensive patients with ischemic heart disease and aortic stenosis. Design and methods. 229 patients (50.3 ± 13.2 years) with cardiovascular diseases, including chronic cerebrovascular diseases (predominantly dyscirculatory encephalopathy) were studied. Hypertension was diagnosed in 113 patients (49 %); combination of hypertension and ischemic heart disease (postinfarction cardiosclerosis and/or stable angina) in 74 patients (32 %); and combination of hypertension with aortic stenosis of rheumatic or degenerative origin in 42 patients (18 %). 34 gender- and age-matched healthy subjects comprised control group. Results and conclusion. Combination of hypertension with ischemic heart disease or acquired aortic stenosis was associated with the severity of cerebrovascular disease (stage III dyscirculatory encephalopathy) which progressed in the presence of reduced brain perfusion and impaired reactivity of median cerebral artery. представ

Left ventricular hypertrophy (LVH) is associated with unfavorable cardiovascular risk profile. LVH raises The risk of coronary heart disease in more than twice, stroke - three times more, heart failure - nearly 8 times more. According to our observational data (1916 patients with essential hypertension) 23% subjects had concentric LVH, 19% - eccentric LVH, 11% - concentric LV remodeling, 47% - normal LV geometry. Under additional analysis of 5714 cards of hypertensive patients, 0,91% of them had asymmetric LVH. In comparison with eccentric LVH persons, subjects with concentric LVH had higher systolic and diastolic blood pressure (p2) was accompanied by marked decrease of left ventricular mass, overnight blood pressure levels and also by significant reduction of neurohumoral regulatory pattern.

Study objective was to evaluate leptin levels in patients with abdominal obesity - carriers of different genotypes of leptin gene. Material and methods: 472 patients aged 30-55 years with abdominal obesity were examined. Leptin level was determined by ELISA, A19G leptin gene polymorphism was evaluated by polymerase chain reaction. Results and conclusion. High leptin level is seen in patients with abdominal obesity (46,5±1,7 ng\ml vs 24,4±3,56 ng/ml in healthy subjects, p=0,0001). Leptin levels were higher in women than in men (51,7±1,8 vs 29,7±3,1 ng/ml, p<0,0001). Leptin levels in patients with abdominal obesity did not vary depending on different genotypes of leptin gene. In patients with abdominal obesity GG genotype was seen more often that in general population (p=0.04).

Pharmacodynamic and pharmacoeconomical characteristics of two selective beta-blockers, betaxolol (Lokren^®, Sanofi-Aventis) and metoprolol tartrate (Egilok retard^®, Egis) were assessed in an opened prospective comparative clinical trial in a group of 68 patients (40-59 years) with 1-2 stages hypertension. Both drugs exhibited similar efficacy, but the cost of treatment was less for metoprolol retard.

Prognostic value of atrial hypertension (AH) was analysed in 51 patients after reconstructive surgery for mitral insufficiency. In the majority of them (72%) the latter was due to connective tissue dysplasia (CTD). The surger was followed by reduction of heart size, pulmonary artery pressure, decrease in severity of heart failure. According to the results of multivariant analysis a negative impact of AH starts since the third post-operation year. AH together with age and high body mass index are the risk factors for prognosis including mitral insufficiency relapse.

Previous studies implicated endogenous cardiotonic steroids (CTS) in the pathogenesis of preeclampsia (PE) and demonstrated that in PE, immunoneutralization of CTS by Digibind, Fab fragments of digoxin antibody, produces antihypertensive and renoprotective effects. Marinobufagenin (MBG) a bufadienolide CTS, induces vascular fibrosis in vivo and in vitro. Because levels of MBG in PE are markedly increased, anti-MBG monoclonal antibody reduces blood pressure (BP) in a rat model of PE, and MBG exerts profibrotic effects, we hypothesized that in PE, elevated placental MBG levels would be associated with development of fibrosis in feto-placental circulation, and with impairment of vascular relaxation. We studied 18 patients with PE (mean BP = 123 ± 2 mmHg; 29 ± 2 years, 36 weeks gest. age) and 12 gestational age-matched normal pregnant subjects (mean BP = 92 ± 2 mmHg). PE was associated with a two-fold rise in the levels of MBG in placentae, and with a 2-fold increase in the level procollagen-1 in the umbilical arteries. As compared to control vessels, isolated rings of umbilical arteries from subjects with PE, in the presence of unaltered responsiveness to endothelin-1 (EC₅₀ = 20 and 33 nmol/L), exhibited markedly impaired response to the relaxant effect of sodium nitroprusside (EC₅₀ = 141 vs. 0.9 nmol/L p < 0.001). These results demonstrate that in PE, elevated levels of MBG are associated with vascular fibrosis, and impairment of vasorelaxation, and suggest that MBG represents a potential target for therapy.

The late ventricular potentials (LVP) can be registered in 60-86 % by signal averaged electrocardiogram (SA ECG) in heart failure with ischemic or dilated cardiomyopathy. Ventricular arrhythmias can be provoked by delayed ventricular depolarization. LVP is shown to be more frequent in patients with progressive heart failure and seem to be independent of the underlying cause. Abnormal late ventricular low amplitude electrical activity can be an additional negative risk factor in patients with heart failure.

Gene polymorphisms of α-Fibrinogen Thr312Ala, Factor XIII Val34Leu, PAI-1 4/5G и Factor V Leiden, responsible for activity and structure of fibrinogen and plasminogen, are studied as predisposing genetic factors to myocardial infarction. Deoxyribonucleic acid (DNA) extracted from dried bloodspots was used as a matrix for PCR analysis. The new improved molecular genetic methods were elaborated and used. Genotype distribution of Thr312Ala and Val34Leu polymorphisms alleles in patients with myocardial infarction and control subjects was significantly different. 2,5-fold increase of allele 34Leu homozygote frequency in patients with myocardial infarction as compared to control group may indicate an increased risk of the disease in people with LL genotype. It was shown that 4G/4G genotype of PAI-1 gene can predispose to myocardial infarction, and 5G/5G one can be protective. 2,3-fold increase of Factor V Leiden mutation frequency in studied group as compared to control subjects supports the hypothesis that this mutation is also a risk factor for myocardial infarction.

Objective. Long-term surgical results of the 57 patients with left ventricular (LV) aneurism were estimated. Design and methods. Depending on a type of LV reconstruction, patients were divided into two groups. The first group included 42 patients after linear LV repair, and the second group included 15 patients after LV inner LV repair. Results. In first group patients had the following transthoracix echocardiography (TTE) indexes: LV end diastolic volume (EDVLV) - 206±43.1 ml, ejection fraction (EF %) (Simpson) - 41.7±7.2. For the second group, these indexes were 264.8±58.2 ml and 32.8±5.2%, respectively. 7 days after surgery the follow-up data were: 1 group, 165.5±35.7 ml and 44.9±7.9%; 2 group, 180.1±44.9 ml and 41.8±5.5% for EDVLV and EF, respectively. We detected a trend towards an increase in EDVLV and a decrease in EF during the follow-up, but the difference was not statistically significant. Conclusion. Use of this surgical method allows to improve LV function in the postoperative period. The effect of operation remains sustained in the remote period following both linear and inner LV repair.

Objective. To study the I/D polymorphism of angiotensin converting enzyme gene (ACE), the M235T polymorphism of the angiotensinogen gene (AGT) and the A1166C polymorphism of the angiotensin II type 1 receptor gene (AGTR1) in children with arterial hypertension (AH) and in controls. Design and methods. 84 children with the diagnosis of AH, 146 children with normal values of blood pressure and 198 children of population sample were included in the study. АН was defined as systolic/diastolic blood pressure measurements higher than 95 age-gender-height percentile of the adopted reference values. DNA was extracted from blood samples according to standard protocols and analyzed by the PLFP method. Results. The frequency of T235 allele of the AGT gene was significantly higher in hypertensive patients than in children with normal values of blood pressure. The frequency of TT genotype in hypertensive patients was significantly higher than in two control groups. The frequency of T235 allele and TT genotype were significantly higher in group of hypertensive girls compared with girls of two control groups and in hypertensive boys compared with normotensive boys. The distribution of ACE genotype and allele frequency did not differ significantly between patients with АН and control subjects. There were no significant differences in the frequency of CC genotype and C allele of AGTR1 gene in children with АН compared with control subjects. Conclusion. The further investigations of larger samples of children with AH, confirmed by ambulatory blood pressure monitoring, are required for definition of the role of M235T angiotensinogen gene polymorphism in the development AH in children.

The article discusses approaches to treatment of chronic pain in patients with osteoarthrosis and hypertension. The effects of various anti-inflammatory drugs on hemodynamic parameters in hypertensive patients are reviewed. The comparative safety of the selective cyclooxygenase inhibitors and their effects in patients with cardiovascular disorders are assessed.

Objective. To assess tolerability and safety of different forms of acetylsalicylic acid. Design and methods. 120 high-risk patients (100 males, 20 females; mean age 52,5 ± 4,5 years) were divided into 4 matching groups, each consisting of 30 patients, depending on the form of prescribed acetylsalicylic acid. Prescribed therapy included angiotensin converting enzyme inhibitors, beta-blockers, lipid lowering drugs, vasodilatators and acetylsalicylic acid (ASA) (patients of 2 groups got enterosoluble aspirin, one group took magnesium compound ASA, and the fourth group got uncoated ASA). Esophagogastroduodenoscopy (EGDS) was performed at baseline and after 12 months of treatment. Results. After 12-month of treatment 20 patients developed gastric indigestion symptoms, and ulcereation were found in 15 patients (7 of them took uncoated ASA) by EGDS, 6 of them were asymptomatic. Conclusion. Nonsteroid anti-inflammatory drug gastropathy is more common in high-risk patients taking uncoated ASA as compared to those taking enterosoluble and magnesium compound ASA.

We studied the levels of IL-1, IL-6 and TNF- in patients with coronary artery disease (CAD) and with concomitant anxiety and depression. We found a significant growth these parametres in patients with CAD and with concomitant anxiety and depression as compared with patients with CAD without anxiety and depressive disorders. The level of IL-6 was significant decreased in patients with isolated anxiety and depression as compared with patients with CAD and anxiety and depression. Our results support cytocines hypothesis of depression in patients with CAD and concomitant anxiety and depression.

Objective. To assess the results of simultaneous carotid endarterectomy (CEA) and coronary artery bypass grafting (CABG). Design and methods. 2257 patients (mean age 60,6 ± 4,8 years) underwent CABG during the period from 2003 to 2007. CEA was performed in 4,3 % (n = 97) of them. 83,2 % of patients preoperatively showed no neurological events. 2 groups were reviewed: Group 1 - 36 patients with unilateral carotid lesions, Group 2 - 61 patients with bilateral carotid lesions. Results. No strokes were registered in Group 1, 2,8 % of patients experienced myocardial infarction, perioperative mortality rate was 2,8 %. 9,8 % patients in Group 2 suffered stroke, 8,4 % - myocardial infarction, mortality rate was 6,6 %. The most significant neurological complications observed in Group 2 were present in patients with severe (90-100 %) contralateral carotid stenoses. The usage of hypothermical perfusion at the phase of CEA allowed to reduce mortality and stroke rate from 31,6 % to 7,1 %. Conclusions. The results of simultaneous CEA and CABG in patients with unilateral carotid lesions can be considered comparable with isolated CABG (mortality rate - 2,8 %, myocardial infarction - 2,8 %). The results of simultaneous CEA and CABG in patients with bilateral carotid lesions can be improved using hypothermical perfusion, however complication incidence remains rather high.

Objective. The paper addresses enelapril effects and its role in low-renin hypertension (LRH). Design and methods. 190 patients (mean age 54 ± 10 years, mean systolic blood pressure (BP) was 199,6 ± 6,6 mmHg, diastolic BP - 111,4 ± 5,4 mmHg) with LRH were included: 144 of them with low-renin primary hypertension (LRPH), 32 with primary idiopathic hyperaldocteronism (PIHA), and 14 patients had both LRPH and PIHA symptoms. Plasma rennin activity (PRA) and plasma aldosterone (PA) were estimated by radioimmune method at baseline and after 4-week treatment by 20 mg enalapril. PRA was rated as normal if ranged 1,0-3,0 ng/ml/h, PA - 0,18-0,83 nmol/l (5-23 ng/dl or 50-230 pg/ml). Normal PA/PRA ratio was 5-23. Conclusion. Angiotensin-dependent hypertension, rennin stimulation and changes in rennin-angiotensin-aldosterone system activity can be assessed by test with 20 mg/day enalapril intake, that enables differentiating different hypertension forms.

The topical problems of original drugs and generics, including their efficacy, safety and pharmacoeconomic issues, are discussed in the paper.

High prevalence of arterial hypertension and smoking (one of the most important risk factor of cardiovascular diseases) mark out question of arterial hypertension therapy features in consideration of smoking and its probable complications. Smoking increases both arterial hypertension diseases rate and its complications rate, negatively affects endothelium function, worsens metabolic profile, changes metabolism of some medicine drugs, causes elaboration of chronic obstructive lungs disease. The article is dedicated to analysis of treatment of patients with complications risk because of smoking and analysis of evidences and contradictory evidences of existing antihypertensive drugs. Calcium antagonists (Isoptin SR) and angiotensin converting enzyme (ACE) inhibitors (receptor to angiotensin blocker or their combination) are the most prescribed substances for therapy for patients with arterial hypertension.

Objective. The study addresses the influence of sleep disturbances hypertension risk) in male population of 25-64 years old. Design and methods. A sample of men aged 25-64 years was screened in 1994 year as the WHO program "MONICA - psychosocial" in 1994. All cases of hypertension onset were studied in 14-year period (1995-2007). Cox-proportional regression model was used to estimate relative risk of hypertension occurrence. Results. The hypertension risk is 5,4-time-fold in men estimating sleep as "bad" within 5 years, and within 10 years it is 2,3 times as high as in men with satisfactory or good sleep. Conclusion. The study shows, that in male population age 25-64 years hypertension risk is associated with sleep disturbances.