The paper summarizes data on antihypertensive treatment in hypertensive patients with concomitant hepatic diseases when inflammation and fibrosis result in liver cytoarchitecture changes. Rennin-angiotensin-aldosterone system blockade enables to reduce tissue damage and fibrosis development regardless of blood pressure decrease. The majority of hypertensive patients requiring combination antihypertensive therapy can benefit in achieving target blood pressure faster, decreasing side effects risk, and in improving liver function. Key words: hypertension, liver diseases, rennin-angiotensin-aldosterone system blockade.

The paper reviews the role of matrix metalloproteinases of proteolytic system that perform a great variety of function and control almost all biological processes. According to the classification all proteases are divided into four families serine, cysteine, aspartate and metalloproteinases (last also called matrix metalloproteinases (MMP)). Up to now 28 MMP are known (from MMP-1 to MMP-28). Based on structural features and substrate specificity MMP family was divided into identified 4 subfamilies: collagenases, gelatinases. stromelizines and unclassified MMP. Study of MMP family in cardiology significantly expands the understanding of the pathogenetic mechanisms of cardiovascular diseases and demonstrates different MMPs functions: stromelizine MMP-3, collagenase - MMP-8, gelatinase - MMP-9. It is assumed that MMP-3 and MMP-9 play an important role in acute myocardial infarction, unstable angina, rehabilitation after a heart attack, left ventricular remodeling. There are data of special role of MMP-3, MMP-9 gene polymorphism associated with susceptibility to cardiovascular disease, atherosclerosis of the arteries, heart attack, aneurysm of the aorta. However, role of MMP-2, MMP-7 and unclassified MMPs in cardiac pathology is not well investigated and remains controversial.

The prognosis of complications and outcomes of myocardial infarction in the course of some years is one of the most important problems in cardiology. With a wide choice of drugs and preventive techniques used for the treatment of myocardial infarction, the most important task is to identify groups of patients at high risk of developing complications such as cardiogenic shock, recurrent myocardial infarction, acute left ventricular failure, ventricular fibrillation, early postinfarction angina pectoris.

Randomized trial ESCAPE adressed the lipid-lowering efficacy, safety and tolerability and vascular effects of simvastatin (ZOCOR®, MSD) 20 and 80 mg/day in the long-term treatment of 50 patients with coronary heart disease and familial hypercholesterolaemia (FH). The study lasted for 76 weeks and demonstrated a reduction in low-density lipoprotein cholesterol (LDL-c) level by 32,7 % in patients treated with simvastatin 20 mg/day, and by 44,5 % in patients treated with simvastatin 80 mg/day (p < 0,001 for both groups). Long-term treatment with simvastatin 20 and 80 mg/day was well tolerated, there were no clinical significant adverse effects observed.

The paper addresses the dependence of common carotid arteries (CCA) remodeling parameters from systolic blood ressure value in patients with essential hypertension aged 30-62 years. Ultrasound examination of CCA and heart was arried out. Structural changes of CCA and central haemodynamic indices were estimated. Correlation between systolic blood pressure, CCA diameter and intima-media complex thickness was detected. Reduction of wall elasticity was revealed blood pressure increased.

Giant left atrium is a condition defined when the left atrial diameter exceeds 60-65 mm. It is commonly associated with mitral valve disease due to excess intracavitary pressure resulting in strain and dilation of the left atrial chamber. The enlarged left atrium leads to expansion of the left atrial volume that leads to the pressure increase in the main bronchus, lung and right ventricle with corresponding cardiopulmonary failure. As giant left atrium is a risk factor of sudden death, its existence merits careful evaluation and surgical intervention.

54 patients 42-65 years old with uncomplicated hypertension (stage 2) were studied. The 24-hour blood pressure (ВР) monitoring and doppler-echocardiograpy were performed at baseline and after 16 weeks of treatment. Patients were randomized into 2 groups. In the 1st group patients received combination indapamide with verapamil retard, and in 2nd group, combination of indapamide with amlodipine. The circadian rhythm of BP profile was normalized in 83,9 % of patients in 1st group and in 78,6 % of patients in the 2nd group. In the 1st group, the combination therapy is more effective in patients with diastolic left ventricular dysfunction (DDLV) type I, non-dipper profile of circadian rhythm of BP, and with a hyperkinetic type of circulation. In the 2nd group, combination therapy was effective in patients with DDLV type 2-3 and with a hypokinetic type of circulation.

Objective. To assess international standards for hypertension management compliance in out-patient departments in Samara region. Design and methods. Patients 18-60 years old with the diagnosis «hypertension» indicated in the ambulatory history cases were included. A special assessing card and instruction for medical care quality assessment for the experts were developed. Results. Only 28 % of patients achieved target blood pressure (< 140/90 mmHg) and target cholesterol level. Only 76 % of compulsory diagnostic methods are carried out, among them only 17 % of patients underwent 24-hour blood pressure monitoring, 28 % - doppler examination of neck vessels, 60 % - echocardiography, 15 % - microalbuminuria test. Conclusion. Thus, improving professional education and knowledge of evidence-based medicine and pharmacology and providing sufficient and available diagnostic instrumental and laboratory devices seem to be necessary.

Monitoring of secondary prevention in 1368 hypertensive patients was performed using special quality indicators of medical care with Internet technology paying attention to National Guidelines on Hypertension. Better blood pressure control was achieved, and positive dynamics of medical care in hypertensive patients was demonstrated.

4 patients with non-rheumatic aortic valve stenosis were assessed before the aortic valve replacement and 6 month the operation. It was found out that inflammation, thrombocytes and coagulation activation tightly interacted with each other and with left ventricular remodeling. There is a negative correlation between left ventricular hypertrophy regression thrombin level in plasma. Key words: aortic stenosis, thrombin, myocardial hypertrophy, inflammation, thrombocytes.

Objective. To study the influence of different forms of hypertension on course, target organs and hemostatic parameters in pregnant women with thrombogenic risk factors in a cohort study with mixed cohort (retrospective and prospective). Design and methods. 2 groups were formed: main group included pregnant hypertensive women (n = 200), and comparison group - normotensive pregnant women (n = 300). Results. Hypertensive women were oftener overweight (41 % vs. 6,7 %, p < 0,001; RR = 9,8, 95 % CI 5,9-15,9), compromised heredity upon hypertension (52 % vs. 5,3 %, p < 0,001: RR = 6,2, 95 % CI 3,9-9,7). Left ventricle hypertrophy and microalbuminuria were found in 21 % hypertensive women (in retrospective cohort). Women with chronic hypertension showed higher frequency of thrombogenic haemostatic shifts since the first trimester, women with gestosis - since the second trimester with the highest expression in the third trimester of pregnancy. The pregnancy hypertensive women was characterized by higher frequency of early gestosis (34,5 % vs. 22,3 %, p = 0,003; RR = 1,5, 95 %CI 1,2-2,1), chronic placental insufficiency (26,5 % vs. 12 %, p < 0,001; RR = 2,2, 95 % CI 1,5-3,2) and premature delivery (22,5 % vs. 8,3 %, p < 0,001; RR = 2,5, 95 % C1 1,5-4,1) in comparison with women without hypertension.

Objective. To analyze heart rhythm variability, hemodinamics, pro- and anti-inflammatory plasma cytokines production in pregnant women. General clinical examination was carried out in both groups, echocardiography, Holter monitoring with subsequent calculation of generally accepted heart rate variability indices were performed. The circadian heart rate index (ratio day/night) was calculated. It was found that pregnancy-induced hypertension was accompanied by impaired cytokine balance. Altered immune homeostasis has been established to be a leading factor in the pattern of gestational complications.

Risk factors (RF), initial stages, progression, and final stage of both cardiovascular disease (CVD) and chronic kidney disease (CKD) were analyzed in a cohort of 159 pregnant women with hypertensive disorders versus a cohort of 32 healthy pregnant controls. Cardiorenal continuum factors were separately investigated in patients with different gestational hypertension (HT) depending on the diagnostic method: 13 with isolated clinic HT (1CHT), 11 - isolated ambulatory HT (IAHT), and 18 - HT found by all three blood pressure (BP) measurement methods (clinic, ambulatory, and home BP). The number of RF (age, family history of CVD and pre-eclampsia, pre-pregnancy history of smoking, lack of physical exercise, and oral contraception, BP levels, abdominal obesity, dyslipidaemia, anxiety and depression, oxidative stress, altered fasting plasma glucose, metabolic syndrome), signs of subclinical organ damage (cell membrane destabilization, left ventricular hypertrophy, intima-media thickening, slight increase in serum creatinine, hyperuricaemia, endothelial dysfunction, albuminuria, low glomerular filtration rate), and total cardiovascular risk progressively increased from the condition of being normotensive at the time of office, home, and 24-hour measurements to the condition of being found hypertensive by one, two and all three BP measurement methods, forming the continuum «healthy pregnant women - ICHT - IAHT - gestational HT». Assessment of cardiorenal state in all pregnant women allowed to compose the cline «healthy pregnants- gestational HT- stage I essential HT - stage II essential HT - pre-eclampsia - essential HT with superimposed pre-eclampsia» with the growing risk of CVD and CKD and potential danger of cardiovascular events and chronic renal failure.

The present research addresses left ventricular hypertrophy (LVH) frequency by voltage criteria in male population (representatives of native-born population and non-residents) with verified coronary atherosclerosis in Yakutia. Design and methods. Electrocardiography (ECG) analysis of LVH voltage criteria in patients with verified coronary atherosclerosis was carried out. ECG was analyzed in age-matched male groups - native-born (n = 200) and non-residents (n = 174). LVH criteria included the following measurements: RaVL > 11 mm, RV5(V6) ≥ 27 mm, Sokolow-Lyon voltage > 35 mm, Cornell voltage criteria > 28 mm for men, Cornell voltage duration product > 2440 mm/ms and Gubner-Ungerleider voltage > 25 mm. Results. The following ECG criteria of LVH are more often identified in Yakut inhabitants with verified coronary atherosclerosis: Cornell voltage duration product, RaVL > 11 mm, Cornell voltage criteria and Sokolow-Lyon criteria, more rarely RV5 (≥ 27 mm and Gubner-Ungerleider voltage criteria). LVH with one ore more voltage criteria was defined in 42,8 % of cases, more often among native-born population as compared to non-residents. Conclusion. Therefore, LVH by voltage criteria is defined more often in native-born population in Yakutia. Arterial hypertension is one of the underlying causes leading to LVH.

62 patients with coronary heart disease (CHD), II-III functional class of angina pectoris were observed during rest and stress cold exposure conditions (hand dipping in 4°C water). 75 % of patients had concomitant hypertension. Finger microcirculation flow (FMCF) was measured by laser doppler flowmetry (LDF) method. According to the results of the cold test and systolic blood pressure (SBP) response normotensive patients were divided into 3 groups: 1nd group included patients with normal tonic type of reaction (SBP increase for 0-10 mmHg); 2nd group - with moderate hypertensive reaction (SBP increase for 10-20 mmHg); 3nd group - with marked hypertensive reaction (SBP increase for more than 20 mmHg). The changes in FMCF, hand temperature (HT), finger temperature (FT) and cardiovascular system indices (BP and heart rate (HR)) were assessed. The 3'1 group was found to be different from the others by the lowest FMCF at rest (24,1 ± 3,2 ml/100 g/min.). At the same time FMCF decline during cooling was lower than in the others groups (21,8 ± 3,1 ml/100 g/min.). as well as was FMCF increase (15,4 ± 2,58 ml/100 g/min.) after the test. This testifies the increased sympathetic activity. The local cold test enables establishing the BP response type in normotensivc subjects with CHD and assessment of FMCF changes.

Objective. To study the hemodynamics in left ventricle (LV) cavity of the left ventricle by Doppler method. Design and methods. 50 children (20 female, 30 male) including 15 athletes (aged from 5 days to 18 years old) were examined. Ultrasonic scanner «SonoACE-9900» was used. Results. The wave with biphasic amplitude on peak E of transmural blood stream (named «Sh»-wave) was registered when the «control volume» was placed in LV cavity, and its velocity characteristics and duration of positive and negative phases were determined. Children with average heart rate 95,4 ± 5,2 b/min. «Sh»-wave duration was 39,4 ± 10,6 msec, and velocity characteristics of positive and negative phases were 75,4 ± 9,4 and 41,3 ± 6,5 cm/sec. respectively. Athletes with sinusal bradycardia (average heart rate 58,7 ± 2,3 b/min.) had longer «Sh»- waves (66,1 ± 15,2 msec), higher velocity characteristics of positive phase (78,8 ± 11,3 cm/sec.) and lower velocity of negative phase (32,6 ± 5,3 cm/sec.). Conclusion. The spherical turbulent blood stream in the LV can be formed during diastolic filling. It presents as an echo-signal of biphase amplitude in the middle third of LV.

The paper presents the history of Russian internal Medicine Society and its lsl Congress called in 1909 year and concerns main reports dealing with diagnosis and pathogenesis of cardiovascular diseases, in brief the lectures on diagnosis, pathogenesis and treatment of gastrointestinal and infectious diseases, including tuberculosis.