This review addresses issues of history and current state of diagnosis of hypertension and antihypertensive therapy with angiotensin receptor antagonists. On the basis of modern literature the current approaches to therapy for this disease are presented.

Contemporary data confi rm an important role of coenzyme Q10 in cell and body energy homeostasis maintenance through the implementation of co-enzyme and antioxidant functions. The role of coenzyme Q10 in prevention and treatment of hypertension is also proven. The article discusses the mechanism of its therapeutic action in cardiovascular pathology, effi cacy of different doses of coenzyme Q10 and the benefi ts of soluble forms of Kudesan.

The article reviews data on angiotensin converting enzyme inhibitors (ACEi) in patients with coronary artery disease (CAD). High risk patients require complex therapy that would lower cardiovascular risk and include desaggregants, hypolipidemic drugs, ACEi and beta-blockers. Renin-angiotensin-aldosterone system (RAAS) blockade is the main therapeutic target in hypertensive patients with CAD. ACEi benefi ts include antihypertensive effects by plasma RAAS blockade and organoprotective effects by tissue RAAS blockade unfolding starting from 3-4 weeks of treatment. These enable us to lower cardiovascular risk including risk of myocardial infarction and stroke, to delay the development of arterial hypertension, chronic heart and renal failure, thus, mediating the prognosis improvement. Conclusion. There is evidence of the benefi cial effects of two ACEi in patients with CAD, they are Perindopril and Ramipril. The article presents the data on clinical trials proving clinical effi ciency of Perindorpil in patients with cardiovascular diseases.

To assess the impact of obstructive sleep apnea-hypopnea syndrome (OSAHS) on cardiovascular morbidity and mortality with relation to other major cardiovascular risk factors. 147 patients from out-patient clinic were recruited for a prospective study. Based on cardiorespiratory monitoring patients were divided into 2 groups: 42 patients without sleep breathing disorders (SBD), and 105 patients with OSAHS. Among these 12 patients started CPAP therapy and formed third subgroup. The mean follow-up period was 46,4 ± 14,3 months. Event-free survival was lowest in the OSAHS untreated patients (log rank test 6,732, p = 0,035). OSAHS hypertensive patients are at higher risk of fatal and non-fatal cardiovascular events. Moreover, untreated OSAHS patients demonstrate higher rates of hospitalization caused by the onset or deterioration of cardiovascular disease.

Objective. To assess antihypertensive and organ protective effi cacy of Eprosartan in hypertensive young patients. Design and methods. 6-months study involved 108 patients with non-target blood pressure (BP). Eprosartan (Teveten, Abbott Products) (group 1) and ramipril (group 2) were administered; if necessary indapamid retard was added. Echocardiography, microalbuminuria, heart rhythm variability and signal-averaged electrocardiography assessment were performed regularly during the follow-up. Results. Within 6 months in group 1 BP target level was achieved in 87,3 % of patients, combined antihypertensive therapy was administered in 30,9 % of patients. In group 2 BP target level was achieved in 88,7 % of patients, combined antihypertensive therapy was administered in 30,2 % of patients. Only patients of the group 1 demonstrated signifi cant reduction of an excessive nocturnal BP lowering (over-dipper type). These changes are associated with the reduction of late ventricular potentials and sympathetic activity. Left ventricular myocardium mass index and microalbuminuria reduction were found in both groups.

Objective. To assess the role of disorders of psychological adaptation to professional stress in development of metabolic syndrome (MS) in bank employees. Design and methods. 703 bank employees (206 males and 497 females) aged 20-59 years were screened. Fasting lipids, glucose, anthropometry, blood pressure were measured. The questionnaires regarding life-style risk factors, professional satisfaction and coping style (CISS questionnaire) were applied. Results. Signifi cant association between MS components and psychological adaptation to professional stress was not revealed. Employees older 40 years with MS components have higher satisfaction in professional activity. Females younger 40 years with MS components more seldom apply emotionally-focused coping strategy and more often use smoking in stressing situations, but age-matched males more often use coping strategy called «social diversion». In elder employees (both males and females) MS risk was associated with preference of avoidance-oriented coping strategies aimed at distraction from actual problems and decrease of emotional tension by switching attention to entertainments, including emotional food intake. Conclusions. A weak direct association between psychological adaptation to professional stress and risk of MS was revealed only in the group of younger employees. Preference of avoidance-oriented coping strategy might play an important role in development of MS.

We evaluated effects of telmisartan on serum lipids, CRP, TNF-? levels, and quality of life in patients with arterial hypertension and abdominal obesity. We studied 23 patients, aged 51,1 ± 0,9 years old. Dose of telmisartan was 40 mg per day during 2 months. Systolic blood pressure decreased from 153,8 ± 4,5 to 122,6 ± 2,4 mm Hg (p < 0,0001), and diastolic -from 94,0 ± 2,5 to 78,8 ± 2,0 mm Hg (p < 0,001) after 8 weeks of therapy. Serum cholesterol and low-density lipoprotein levels also decreased (from 5,9 ± 0,3 to 5,6 ± 0,3 mM; p < 0,05; and from 3,8 ± 0,3 to 3,4 ± 0,2 mM; p < 0,03; respectively). Serum CRP signifi cantly decreased after therapy (8,7 ± 4,1 versus 4,9 ± 2,0 mg/l; p < 0,05). The level of TNF-? tended to decrease. Treatment with telmisartan improved quality of life in all patients.

Objective. To estimate effi ciency of angiotensin converting enzyme (ATE) inhibitor Quinapril in patients with II stage hypertension (H II stage) and heart failure II functional class (HF II) based on its effects on regulatory-adaptive state (RAS). Design and methods. 47 hypertensive patients with HF II (21 males and 26 females, average age 57,5 ± 1,3 years) were included. Cardiorespiratory synchronization test, treadmill test with the measurement of maximum oxygen consumption on effort, echocardiography and N-terminal-natriuretic propeptide (NT-proBNP) were assessed at baseline and after six months of Quinapril therapy (Accupro®, «Pfi zer», USA) with 24,7 ± 6,3 mg/day Results. Quinapril therapy results in improvement of myocardium structure and effort tolerance and positive neurohumoral activation, and RAS. Thus, Quinapril benefi ts in hypertensive patients with HF II are due to both positive infl uence on cardiac remodeling and positive changes in RAS.

The pharmacokinetic and pharmacodynamic parameters of the angiotensin-converting enzyme inhibitor enalapril were assessed in the elderly hypertensive patients. Patients older than 75 years demonstrate changes in pharmacokinetic and pharmacodynamic parameters that require an individual approach for treatment, i.e. individual selection of single and daily dose of enalapril, use of combined therapy, pharmacokinetic and pharmacodynamic monitoring.

Objective. To assess antihypertensive activity and some effects of new medical form of Perindopril A as monotherapy and as a part of the combined therapy in patients with untreated arterial hypertension (AH) or with uncontrolled AH under other therapy (trial PANORAMA). Design and methods. 27 patients with AH 1-3 degree were included: 12 men (44,4 %) and 15 women (55,6 %) aged from 30 to 60 years (middle age was 48,9 ± 8,05 years). All patients were followed-up for 12 weeks. Results. New medical form of Perindopril A showed higher antihypertensive effi ciency in patients with uncontrolled AH (systolic blood pressure decrease up to 28,9 mmHg and diastolic blood pressure - up to 15 mmHg). 70 % of patients reached target blood pressure with Perindopril A 10 mg/day 3-months therapy with Perindopril A also led to the reduction of left ventricular hypertrophy and diastolic dysfunction.

Objective. To assess prevalence of the basic types of cardiovascular remodeling in men of 40-55 years old with high normal blood pressure (HNBP), and to defi ne their association with risk factors, salt sensitivity and HNAP profi le. Design and methods. 406 male subjects were included. 171 (42 %) of them had arterial hypertension, 162 (40 %) had HNAP, and 73 (18 %) had optimal and normal BP Results. The determinants of HNAP development and maintenance were the following: family anamnesis of cardiovascular diseases, smoking intensity, total cholesterol level, and increased salt sensitivity. Prevalence of left ventricular (LV) hypertrophy, mainly its eccentric type, was 18 % in HNAP males. LV dilation was associated with night systolic and diastolic BP (r = 0,30), LV hypertrophy - with high day systolic BP (r = 0,31). 24 % males with HNBP have thickened carotid artery wall, and it is associated with total serum cholesterol (r = 0,32), waist circumference (r = 0,41), and salt sensitivity (r = 0,31).

Objective. To assess blood pressure (BP) changes in hypertensive patients depending on sodium salt intake. Design and methods. 532 hypertensive patients were examined: 213 with uncomplicated hypertension, 210 with myocardial infarction in past and 109 suffered from type 2 diabetes mellitus. We determined the threshold of taste perception for salt (TTPS), daily salt excretion and daily BP monitoring. 251 healthy individuals formed control group. Results. TTPS level in healthy individuals is higher than in hypertensive ones. Healthy subjects excreted 9,6 g of salt daily, while hypertensive patients excreted 14,6 g. All hypertensive subjects showed BP increase and more profound day and night BP changes when daily salt intake raised. Conclusion. The increase of salt intake leads to BP rise and reduction the therapy effect in hypertensive subjects.

Mitochondrial dysfunction is shown to develop progressively in people older than 55 years due to anaplerotic pathway disturbances accompanied by methylmalonic acidemia. Hyperhomocysteinemia and methylmalonic acidemia are accompanied by decrease of valine and leucine, and methionine elevation. Systemic manifestations of mitochondrial dysfunction depend on the methylmalonyl-CoA-mutase activity, and the adenosylcobalamine, as a cofactor and the others proteins defi ned, as transporters of the cofactor. This metabolic state was defi ned as an anaplerotic dysfunction in the paper. The discussed metabolic dysfunction in elderly people differs from the one in adults with Vitamin B12 functional defi ciency. The elevation of branched chain amino acids is usually observed in methylmalonic acidemia. We conclude that anaplerotic dysfunction should be considered a possible factor of initiation and progression of arterial hypertension.