Heart failure is a major public health problem. Decompensation of heart failure is the cause of hospitalization of each second patient in cardiology departments (49%). Prevalence of heart failure with normal ejection fraction is 30-74 % (mean 45 %). The population of patients with heart failure with normal ejection fraction is characterized by a higher proportion of women and more advanced age. Patients with heart failure with normal ejection fraction are more frequently hypertensive and have atrial fibrillation and chronic obstructive pulmonary disease

To assess the antihypertensive and organoprotective efficiency of Perindopril arginin in hypertensive patients with left ventricular hypertrophy (LVH). Design and methods. 12-months study involved 59 patients with non-target blood pressure (BP) and LVH divided into 2 groups. Prestarium A (group 1) and enalapril (group 2) were administered; if necessary the other antihypertensive medications were added. Echocardiography and albuminuria assessment were performed regularly during the follow-up. Results. Within 12 months in group 1 systolic BP (SBP) was decreased by 22 % and the target level was achieved in 92 % of patients, diastolic BP (DBP) was decreased by 14 % and the target values were achieved in 91 % of patients. In group 2 SBP was decreased by 16 %, DBP was decreased by 10 % (the target levels were achieved in 83 % of patients). Only patient of the group 1 demonstrated significant reduction of urine albumin excretion. Left ventricular myocardium mass index reduction was found in both groups, however only patients of the group 1 showed the improvement of diastolic function. Conclusion. Prestarium A contributes to the effective BP control, regression of left ventricle hypertrophy, improvement of left ventricle diastolic function and endothelium function.

Objective. To examine efficacy of moxonidine in non-complicated hypertensive crisis. Design and methods. Twenty hypertensive patients, including 11 males and 9 females (mean aged 51,3 ± 7,2 years), were examined. Systolic blood pressure (BP) was 206,7 ± 3,1 mmHg and diastolic BP was 104,6 ± 3,4 mmHg. Ambulatory BP monitoring (ABPM) was performed in all patients. 400 mg of moxonidine once daily was prescribed to all patients. Results. Systolic and diastolic BP was reduced by 20,0 and 11,9 % respectively (within 2 hour),and by 24,4 and 17,2 % respectively within the next 2 to6 hours. Conclusions. Moxonidine can be used in non-complicated hypertensive crisis. Our data indicate that moxonidine is generally welltolerated.

Objective. To evaluate haemodynamics, autonomic regulation, and endothelial dysfunction in teenagers with arterial hypertension of 1 degree (AH 1) compared to healthy young men. Design and methods. 41 hypertensive teenagers and 27 healthy young men were included in an open randomized study. Examination included «office» blood pressure (BP) measurement, evaluation of heart structure and function (echocardiogram, veloergometry), heart rhythm variability (HRV), endothelial function (reactive vasodilation test, endotelin-1 and microalbuminuria assessment), large arteries stiffness (LAS), and intima-media thickness (IMT). Results. Teenagers with AH 1 showed isolated systolic hypertension (systolic BP/diastolic BP - 148,4 ± 8,2/85,3 ± 6,9 mm hg), hypertension type of reaction to overload, hyperkinetic type of haemodynamic reactivity, and the increase of endotelin-1 (р < 0,01). 82,9 % of patients had microalbuminuria (MAU) - 39,8 ± 12,4 mg/day. Our analysis demonstrated the decrease of the general autonomic tone, decreased parasympathetic activity, and the prevalence of the sympathetic tone. Endotelin-1 correlated with autonomic regulation changes that reflects the increase of sympathetic activity (р < 0,01). Patients with AH 1 compared to healthy patients had increased LAS (р < 0,01) and IMT (р < 0,05). Conclusions. Our data indicate the presence of isolated systolic arterial hypertension in teenagers with AH 1, which, apparently, forms the hyperkinetic type of circulation. BP increase, endothelial dysfunction, and autonomic dysregulation that contributes to the pathological functional and structural changes of the heart, which are one of the major links of cardiovascular continuum.

Autonomic system regulation can be helpful in different chronic diseases, including bronchial asthma, enabling the choice of therapy and its efficacy control. We examined 8-10 year-old children with bronchial asthma in remission: 135 of them had mild, and 133 - moderate-to-severe course of bronchial asthma. We used «Mikard-MT» device for heart rate variability assessment. We found some functional autonomic state differences depending on the severity of bronchial asthma.

Objective. To investigate the possible association between autonomic cardiac rhythm regulation and the polymorphism Arg389Gly of beta 1-adrenergic receptor gene (ADRB1) and -381T/C natriuretic peptide precursor B (NPPB) in pregnant women with preeclampsia <http://www.ncbi.nlm.nih.gov/pubmed/18326281>. Design and methods. Seventy-nine patients with preeclampsia and 32 non-hypertensive pregnant women in third trimester were included. Frequency domain parameters nHF (normalized high frequency), nLF (normalized low frequency) and LF/HF ratio were obtained by spectral heart rate variability analysis. Non-invasive cardiac reflex test was performed. The polymorphism Arg389Gly of gene ADRB1 and -381T/C NPPB were genotyped by using polymerase chain reaction. Results. The Arg/Arg genotype of the Arg389Gly polymorphism was significantly increased in women who developed preeclampsia (p < 0,05). Patients with preeclampsia were characterized by a significantly reduced cardiac vagal control and lower autonomic reactivity in the low frequency band compared to healthy pregnant woman (p < 0,05). Individuals with preeclampsia who are homozygous for the Arg389 allele of the ADRB1 and NPPB C allele carriers have the most attenuated autonomic reactivity in the LF band of cardiac rhythm spectrum (p < 0,05). Conclusions. Autonomic cardiac rhythm regulation <http://www.ncbi.nlm.nih.gov/pubmed/19055010> <http://www.ncbi.nlm.nih.gov/sites/entrez?db=pubmed&cmd=link&linkname=pubmed_pubmed&uid=19055010>in pregnant women with <http://www.ncbi.nlm.nih.gov/pubmed/18326281>preeclampsia depends on polymorphism of sodium metabolism genes.

Objective. To assess possible association between PON1 activity, PON1 gene polymorphism, plasma lipid spectrum alterations, and the oxidative stress level in coronary artery disease (CAD) development. Design and methods. 227 male patients with CAD (mean age 46,9 ± 0,5 years), survived myocardial infarction being under 45 years old, and 114 healthy men (mean age 40,0 ± 0,5 years). Plasma total cholesterol (TC), triglyceride (TG), high-density lipoprotein cholesterol (HDLC) levels, and arylestarase PON1 activity have been measured. Plasma malondialdehyde (MDA) concentrations, a lipid peroxidation product, were used as a marker of the oxidative stress levels. Q192R and L55M polymorphisms of the PON1 gene have been identified using PCR-RFLP. Results. CAD patients had significantly higher levels of TC and TG (р = 0,024 and р < 0,001, respectively), and significantly lower levels of HDLC (р < 0,001), compared to the controls. Plasma MDA levels were significantly higher in CAD patients than in the controls (р < 0,001), and correlated positively with TC and TG levels (р = 0,01 and р < 0,001, respectively). The patients had significantly lower levels of serum PON1 activity (p < 0,001), which directly correlated with HDLC levels (p = 0,05). Also among the patients, there was difference in PON1 activity depending on the Q192R polymorphism in the PON1 gene. RR-homozygotes had significantly lower levels of serum PON1 activity compared to QQ-homozygotes (p = 0,012). Conclusions. Thus, investigation of the PON1 activity together with atherosclerosis risk factors, such as oxidative stress, atherogenic plasma lipid profile and genetic polymorphism, is important for CAD diagnostics and treatment.

Objective. To assess endothelial function in women with coronary artery disease without angiographic sings of coronary stenoses, considering structural features of DNA. Design and methods. 38 women of 34-80 years old with stable angina pectoris I-III functional class were examined. Myocardial ischemia was confirmed in all patients, and angiographic signs of coronary atherosclerotic lesions were absent. Endothelial function was assessed by measuring flow-mediated dilation and nitroglycerin-mediated dilation of the brachial artery using high-resolution ultrasound. Polymorphisms of genes of endothelial NO-synthase (T-786C, 4a/b, G894T polymorphisms); endothelin-1 (G198T polymorphism), β1-adrenoreceptor (C/G polymorphism) were investigated by polymerase chain reaction. Results. The high frequency of flow-mediated dilation damage, including the paradoxical vasoconstriction reaction, was defined. Nitroglycerin-mediated dilation was normal in all patients. The association the paradoxical vasoconstriction reaction with T-786C and G894T polymorphism of the gene NOS3, G198T gene polymorphism of EDN1, combined genotypes T-786T/G198T, C-786T/G189T, C-786C/G198T, ab/G198T, bb/G189T, G894G/G198G, G894T/G198T, T894T/G189T NOS3 gene and EDN1, С-786С/ С389G gene NOS3 and ADRB1 was found.

Objective. To study the diagnostic and prognostic value of matrix metalloproteinase 9 (MMP-9) proteolysis system and its relationship to universal inhibitor alpha-2-macroglobulin (A2-MG) in serum of patients with acute coronary syndrome (ACS). Design and methods. 188 patients were included in the study of the MMP-9 activity and A2-MG level. Results and conclusions. The maximum increase in MMP-9 was observed in patients with myocardial infarction (MI) compared to those with unstable angina (UA) and controls. Negative correlation between MMP-9 and A2-MG levels was found in patients with IM, indicating the enhanced proteolysis. Significant reduction of A2-MG serum level in patients with MI contributes to local inflammation in atherosclerotic plaque (AP) with its subsequent weakening, destabilization and rupture.

Objective. To study the impact of matrix metalloproteinases (MMP) and extracellular matrix proteins on the ascending aorta structural changes in patients with ascending aortic aneurysms of different etiology. Design and methods. 32 patients were included: 26 patients with ascending aortic aneurysm and 6 controls. Both the content and activity of MMP-2, -9 were estimated in the intraoperative biopsies together with the amount of fibrillin, elastin and collagen. Results and conclusion. The development of ascending aortic aneurysm is associated with increased MMP activity. The ascending aortic dilatation in bicuspid aortic valve is associated with increased MMP-2, -9 and collagen/elastin ratio in aortic tissue.

Objective. To assess the value of smoking in early left ventricular (LV) remodeling in hypertensive patients. Design and methods. Two groups of patients with arterial hypertension (AH) (95 non-smoking subjects and 39 smoking patients) and a group of healthy individuals were analyzed. All of them underwent echocardiography (Echo-CG). Results. No significant distinction in cardiac structural and functional characteristics in smokers and non-smoking hypertensive patients were found at routine echo-CG. However, we found the increase of myocardial diastolic stress (MSd, p = 0,05) and LV end diastolic strain (EDS, p = 0,05), as well as the prevalence eccentric LV hypertrophy in smoking hypertensive patients (р < 0,05). Compared to healthy patients, hypertensive smoking and non-smoking subjects had higher LV mass index and RWT (р < 0,05), as well as the increased MSs and MSd (р < 0,05), higher values of LV end diastolic pressure (EDP) and EDS and altered structural and functional interrelation in LV (ejection fraction to myocardial stress (EF/MS), myocardial stress-volume (MSs/ESVI, р < 0,05). Conclusions. In spite of the absence of any significant influence of smoking on LV function in current time, smoking promotes the increase of burden on myocardium and strain of LV, impaired interrelationship between structure and function, followed by more frequent development of eccentric LV hypertrophy.

Design and methods. 117 men at the age 27-72 years old (mean age 52,7 ± 1,5 years) have been included. Healthy 32 smoking men (mean age 46,5 ± 1,8 years) have composed the first group; 54 hypertensive smoking men (mean age 51,7 ± 1,4 years) - the second group, and 31 smoking men (mean age 60,3 ± 1,2 years) with arterial hypertension of 1-3 degrees and coronary artery disease (having postinfarction cardiosclerosis and/ or stable angina)formed the third group. Results. Decrease in quality of life, presence of symptoms of the disease, decrease in functional abilities and perception of illness is not sufficient for termination of smoking. In smoking hypertensive men the various motivation to smoking and various types of smoking behavior is observed, moderate nicotine addiction in a combination with high motivation to smoking is prevalent, however, one third of them have high nicotine addiction in a combination with high motivation to smoking. Different types of smoking behaviour should be considered when giving-up smoking. In smoking men with hypertension and coronary artery disease the strong motivation to smoking is prevalent, and in 50 % of cases it is combined with strong nicotine addiction. Conclusions. Most of smoking males with arterial hypertension demonstrate high motivation to smoking and moderate and high nicotine addiction. Counseling hypertensive patients on giving-up smoking, it is necessary to consider the degree of nicotine addiction, its level and motivation to smoking.

Objective. To investigate the number of circulating CD105-«positive» mononuclear cells and sVCAM-1 blood level for specification of their role in the pathogenesis of acute coronary syndrome (ACS) accompanied by arterial hypertension (AH). Design and methods. We examined 56 patients with ACS (30 patients with unstable angina and 26 with myocardial infarction) and 14 healthy individuals. AH has been identified in 15 patients with unstable angina and in 17 with myocardial infarction. Results. sVCAM-1 level was significantly higher in patients with ACS compared to controls. There was no significant difference between patients with unstable angina and myocardial infarction. Patients with myocardial infarction especially hypertensive ones showed a significant increase in blood CD105-«positive» mononuclear cells number compared to patients with unstable angina. We found correlation between sVCAM-1 level and the number of circulating CD105-«positive» mononuclear cells. Conclusions. Thus, in patients with ACS, especially in hypertensive ones, endothelial cell apoptosis is enhanced resulting from hemodynamic abnormal changes and leads to the activation of cellular antiapoptotic mechanisms.

Objective. To determine the relationship of personal anxiety (PA) with the levels of blood pressure (BP), coronary artery disease (CAD) and other psychosocial factors (PSF). Design and methods. A random representative sample of men aged 25-64 years, residents of one district of Novosibirsk were surveyed in 1994 as part of the WHO program «MONICA-psychosocial». Blood pressure, CAD and their relationship to PA, as well as to the other PSF were examined. Results. Higher blood pressure (both systolic and diastolic), definite and possible coronary artery disease were more frequent in subjects with high levels of PA than n those with low PA. High PA was more frequently associated with high major depression, high hostility, average vital exhaustion, sleep disturbances, and low social support. Conclusion. The results show that males aged 25-64 with high PA have higher blood pressure, and higher rate of verified CAD.

Objective. To assess the possibilities of 24-hour arterial stiffness monitoring in evaluation of antihypertensive treatment efficacy. Design and methods. We performed an open, cross-sectional, randomized trial in 32 patients with stable arterial hypertension (mean age 55 ± 0,2 years) treated consequently by enalapril (E) 5-20 mg/day and metoprolol (M) 100-200 mg/day. 24-hour blood pressure and arterial stiffness monitoring (BPLab) was performed 4 times: initially, at the end of treating by each of the drugs and in «wash-out» periods between different treatment. The following parameters were assessed: pulse wave velocity (2 ways of evaluation - PTT1 and PTT2); augmentation index (AIX), arterial stiffness index (ASI), maximal blood pressure gradient ([dP/dt]max). Results. Both drugs had an antihypertensive effect (- 20,5 ± 1,6/11,6 ± 1,3 mmHg at M treatment and -18,4 ± 1,6/12,3 ± 1,2 mmHg at E therapy, p < 0,05). Significant spontaneous changes of arterial stiffness and 24-hour parameters PTT1 and PTT2 were not found. However, 24-hout AIX significantly improved at both therapy schemes (in M treatment from -7,6 ± 2,7 to -14,0 ± 2,8 %, and in E treatment to 15,0 ± 2,7 %). ASI and dP/dtmax significantly decreased. Conclusions. According to our data, 24-hour arterial stiffness monitoring presents additional important data on antihypertensive efficacy of the treatment. Our results on arterial stiffness changes under therapy by angiotensin-converting enzyme inhibitor and beta-adrenoblocker differ from the current view on their effects. This can be due to the 24-hour monitoring of the parameters that we used in our study.