The main objective of the article was to describe the molecular mechanisms of insulin resistance. Insulin resistance is characterized by disturbance of the response on the action of external and internal insulin. Insulin resistance causes increase of the insulin level in the blood plasma, as compared to the level of insulin that corresponds to the actual glucose level. The mechanism of insulin resistance is not clear enough. Disorders resulting in the insulin resistance may occur at following levels of the metabolic pathway of insulin: pre-receptor (abnormal insulin), receptor, glucose transport level (decrease the quantity of GLUT4), post-receptor (disturbance of signal transmission).

It is well known, that obesity is always associated with high risk of cardiovascular diseases. One of the mechanisms leading to the cardiovascular complications is hormonal activity of local fat depots. White adipose tissue, located in epicardial, visceral, paranephral and perivascular regions, provide not only local mechanic influence on nearby organs, but a systemic activity with help of bioactive substances. Pro-atherogenic and pro-inflammatory chemokines and cytokines lead to chronic inflammation of vascular side, proliferation and migration of smooth muscle cells, transformation monocytes to macrophages. And in the end, it results in endothelial dysfunction, atherosclerosis plaques formation and acceleration of atherosclerosis progression.

The article reviews data on angiotensin converting enzyme inhibitors in hypertensive patients, and summarizes their role in preventing cardiovascular continuum. The main results of the most important clinical trials, and the recent recommendations on combination therapy are presented.

The article reviews the data on the frequency and the role of hypertension (HT) in the pathogenesis of cardiovascular diseases in rheumatoid arthritis (RA). Most studies indicate high frequency of HT in patients with RA that is associated with extraarticular manifestations, target organ damage. HT development is implemented through angiotensin-aldosterone system, simpatoadrenal system and is supported by endothelial dysfunction. The morphological characteristics of HT in RA patients and correlation of endothelial dysfunction with inflammation in RA are identified. Short-term anti-inflammatory therapy does not affect vascular function in RA, while longer and, in particular, therapy with tumor necrosis factor-alpha (TNF-alpha) or antimalarial drugs reduce the frequency of cardiovascular complications associated with RA. Treatment with non-steroidal anti-inflammatory drugs, leflunomide, cyclosporine, glucocorticoids is associated with the increased HT rate, which requires close monitoring of patients. We discuss the need for revision of the antihypertensive treatment and blood pressure control in RA patients, taking into account the particularities of hypertension and the severity of potential cardiovascular complications.

The article presents an analysis of pharmacotherapy in hypertensive patients (n = 3030) in real practice in Russia based on pharmacoepidemiologic study PIFAGOR III. Results. 784 patients (26 %) get monotherapy, 1126 patients (37 %) - combination of 2 drugs, 1120 patients (37 %) - 3 and more drugs. Average number of antihypertensive drugs is 2,22 per 1 patient. Antihypertensive efficacy by monotherapy (achieved blood pressure (BP) < 140/90 мм Hg) was 71 %. Angiotensin-converting enzyme (ACE) inhibitors (57,3 %), β-blockers (18,2 %), calcium antagonists (7,9 %), thiazide diuretics (7,3 %), angiotensin II (ATII) receptors antagonists (4,5 %) were used as monotherapy, and their antihypertensive efficacy was 70, 73, 60, 86, and 88 % , respectively. In hypertensive, diabetic patients (n = 638) the target BP (< 130/80 mmHg) was achieved by 31 % vs 69 % in general population, average number of antihypertensive drugs was 2,5 per 1 patient, combination therapy was used in 83,7 % patients vs 74 % in general population. ACE-inhibitors and ATII-receptors antagonists were used more frequently in patients with target BP. Among hypertensive patients with myocardial infarction (n = 423) the target BP reached 66 %, average number of antihypertensive drugs was 2,6 per 1 patient, combination therapy rate was 83,2 %. β-blockers were prescribed more often in this subgroup compared to general population. 46 % hypertensive patients with chronic heart failure (n = 980) achieved the target BP, average number of antihypertensive drugs was 2,4 per 1 patient, combination therapy use was the highest (86,2 %), in particular 3 and more drugs were prescribed to 57 % subjects.

Arterial hypertension is one of the most urgent problems in cardiology in the XXI century. Individual approach for antihypertensive treatment is essential in hypertensive women due to the peculiarities of the disease. Both high efficiency and metabolic neutrality are rather important, and angiotensin II receptor antagonists demonstrate both of these properties.

Objective. To evaluate efficiency of the combination treatment of arterial hypertension and dyslipidemia in patients with metabolic syndrome associated with obstructive sleep apnea syndrome. Design and methods. A total of 80 patients were examined. Anamnesis, anthropometric parameters, biochemical data were assessed by standard methods. Hypotensive response to the treatment was evaluated by office blood pressure measurement. Initially all patients had metabolic syndrome criteria (NCEP ATPIII). OSAS diagnosis was made based on cardiorespiratory monitoring (Breas SC20, Sweden) data. Antihypertensive therapy included Lyzinopril 10 mg per day at stage I, 20 mg per day at stage II and combination of Lyzinopril 20 mg per day and Indopamide 1,5 mg per day at stage III. At stage IV Bisoprolol 5 mg per day was added to the treatment. Duration of the treatment at each stage was 4 weeks. All patients received Symvastatin 20 mg per day. The follow-up was 2 years. Results. OSAS severity was positively associated with office blood pressure, blood lipids alteration and insulin resistance. Positive dynamics of BP and lipid spectrum was significantly lower in treated patients with severe OSAS than in patients with moderate and mild OSAS. Conclusion. Therapy resistance manifests with the increase of the severity of sleep breathing disorders.

Objective. To examine the contribution of dyslipidemia (DLP) in early left ventricular remodeling in patients with uncomplicated arterial hypertension (AH) of 1 degree. Design and methods. An open cross-sectional study of 378 patients with AH 1 degree was carried out using echocardiography and bifunctional 24-hour blood pressure and electrocardiography monitoring. Results. Using the standard echocardiography the influence of DLP on left ventricular was not found. Patients with AH and DLP showed a statistically significant increase of LV mass index (р < 0,01), relative wall thickness (р < 0,01), myocardial systolic stress (р < 0,01), end diastolic pressure (EDP; р < 0,01), end diastolic strain (EDS; р < 0,01), and diastolic remodeling index (р = 0,01). We found out that abnormal LV remodeling types were prevalent in patients with AH with DLP. The impact of DLP in cardiac remodeling was estimated by comparing groups AH and AH with DLP, and we found an increase of LV EDP (p < 0,01) and EDS (p < 0,01). Conclusion. Patients with AH 1 degree with DLP demonstrate early deterioration of LV diastolic function including increase of wall stiffness and LV EDP.

Objective. To evaluate cerebrovascular reactivity (CVR) in hypercapnia (HC) and hyperoxia (HO) in hypertensive patients before and after treatment by eprosartan (E). Design and methods. 40 healthy volunteers and 66 hypertensive patients, without cerebral stroke (age 21-56 years), were examined. We used 24-hour ambulatory blood pressure monitoring, ultrasonography of cerebral arteries (CA), and we assessed the changes of flow velocity in HC and HO, coefficient and indices of CVR and results of psychological testing. Eprosartan 600 mg/day was administered for 24 weeks. Results. Three types of CVR alteration were found: 1) decrease of HC reactions, 2) decrease of HO reactions, and 3) distortion of HО reactions of CA. Significant changes of CVR indicators were observed after treatment: normal CVR was found in HC, indicators did not reach normal values in HO, but had unidirectional natural character. We also observed improvement of abstract thinking, memory, concentration and attention switching. Conclusions. CVR and cognitive functions are decreased and altered in hypertensive patients without cerebral stroke. Eprosartan treatment is shown to be effective and safe.

Objective. Thyroid disease is associated with atherosclerosis and cardiovascular disease. Little is known about the relationship between insulin resistance and thyroid function. The study addresses the relationship between thyroid function, body mass index (BMI) and homeostasis model assessment index for insulin resistance (HOMA-IR) in patients with heart ischemic disease. Design and methods. 73 patients were included in our study. Assessed parameters included age, gender and BMI. Fasting blood samples were taken for measuring of thyrotrophic hormone (TSH) level, glucose and insulin concentration. HOMA-IR was calculated as fasting insulin (mU/l) times fasting glucose (mmol/l) divided by 22,5. Results. TSH level was higher in patients with obesity (3,05±1,14 IU/l) and overweight (2,73 ± 0,26 IU/I) than in normal weight subjects, IR was the highest in the obese patients (4,67 ± 1,12). HOMA-IR was statistically lower in group I and II: 1,30 ± 0,26 and 1,52 ± 0,74 respectively (p < 0,002 and 0,05). Conclusion. We can propose that thyroid hormones may take part in mechanisms of peripheral insulin resistance.

Objective. To determine metabolic syndrome prevalence, its components and their combinations at mineral resource industry workers in Yakutia. Design and methods. The data of 391 mine workers of non-aboriginal nationalities survey were analyzed. The diagnosis criteria of International Diabetes Federation (IDF), American Experts of National Cholesterol Education Program (NCEP-ATP III) in modification of 2005 year and Experts of Russian branch of the Metabolic Syndrome Institute (CRE) were used. Results. Arterial hypertension prevalence was the highest if any of the criteria applied (57,5 %). The prevalence of abdominal obesity was 58,3 % if IDF criteria were applied, and only 36,8 % according to NCP-ATP III and CRE criteria. Decreased HDL cholesterol was found in 38,4 %, hyperglycemia and hypertriglyceridemia - in 26,9 and 22,8 % of the investigated population. Metabolic syndrome prevalence was 26,6-26,9 % by all diagnostic criteria, and it was 1,4-1,6 times more often in women, then in men. Conclusion. Three metabolic syndrome components, namely arterial hypertension, abdominal obesity and low level of HDL cholesterol, were found to be predominant among mine workers. Hence, NCEP-ATP III criteria seem to be optimal for metabolic syndrome diagnosis.

Objective. Based on data of clinical and genetic examination of obese children, to identify risk groups for metabolic syndrome (МS) development in order to enable early prevention of its complications. Design and methods. 194 children aged 13,2 ± 0,14 years were examined: 148 with obesity I-IV degrees and 46 children - with normal body weight, matched by age and sex. History, anthropometric data, blood pressure (BP), lipid spectrum (total cholesterol, triglycerides, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol), carbohydrates metabolism and urinary acid were estimated. 83 obese children were genotyped on polymorphisms: I/D gene ACE, G-75A ApoA1, S19W ApoA5, S1/S2 ApoC3, E2/E3/E4 ApoЕ and W/R ADRB3. Results. More than 2/3 of examined obese children had unfavorable heredity on leading cardiovascular risk factors. 35,8 % of obese children had high BP, 77,8 % had lipid disorders, 29,0 % had hyperglycemia and 25,0 % had hyperuricemia. 57,0 % of D-allele carriers of ACE gene had increased BP. More than half of heterozygous carriers of «unfavorable» alleles of apoprotein genes had dyslipidemia. Lipid and carbohydrate metabolic disorders occurred in 60,3 % of homozygous W/W of gene ADRB3. Conclusion. Based on the detected combinations of genetic, metabolic and anthropometric data we propose a protocol for obese children examination to identify risk groups for МS development and to choose therapeutic tactics.

Objective. To study anterior abdominal wall lipectomy influence on lipid metabolism and arterial hypertension development in obese and diabetic patients. Design and methods. 181 patients with obesity and diabetes mellitus were divided into 2 groups: first group consisted of 109 patients, who underwent lipoaspiration or abdominoplasty with subsequent medication: second group included 72 patients suffering from abdominal obesity and type 2 diabetes mellitus, who were treated conservatively without surgery. Arterial hypertension was diagnosed in 167 (92 %) patients: 99 (91 %) in the first group and 68 (94 %) - in the second. Serum triglycerides, cholesterol, high, low- and very-low-density lipoproteids levels, atherogenicity index were determined, systolic and diastolic blood pressure measurement was performed before treatment, in 1 and 6 months and once a year after treatment. The follow-up period was 5 years. Results. There was a significant (р < 0,05) decrease in triglycerides, cholesterol, low-density lipoproteid level and blood pressure in the first group in five years. However, there were no significant changes in the second group. Conclusions. Surgical correction of abdominal obesity leads to fast and strong improvement of serum lipoproteid pattern. Anterior abdominal wall lipectomy decelerates hypertension progression.

A typical clinical case demonstrates how untreated hypertension can lead to fatal outcome through renal failure development. Modern approaches for cardiovascular prevention based on European and national guidelines are presented.