Objective. To study lipid and carbohydrate metabolism in patients with different types and degree of obesity. Results. Patients with abdominal obesity have more severe atherogenic lipid abnormalities, higher levels of nonesterified fatty acids and decreased tissue insulin sensitivity than patients with gluteofemoral obesity. Lipid parameters did not differ in obese patients with type 2 diabetes and obese non-diabetic patients. Treatment with metformin resulted in weight loss, decrease of waist-to-hip ratio, insulin resistance and hyperinsulinemia, and improvement of lipid profile in non-diabetic patients with abdominal obesity. Conclusion. Our findings show that in patients with abdominal obesity biguanides should be recommended at the stage preceding the development of full metabolic syndrome.

The data on the endothelial function in thyrotoxicosis is insufficient. There are many case reports of trombosis in patients with high level of von Willebrand factor (VWF). Present study addresses the influence of thyrotoxicosis on the VWF level, endothelium-dependent vasodilatation and remodeling of the heart and vessels. 143 normotensive patients with thyrotoxicosis without known cardiovascular diseases were included. Mean level of thyroid hormones had been increased before the therapy and it decreased till the normal values after 3 weeks and was stable one year after the treatment. Our results demonstrated, that increase of VWF is associated with thyrotoxicosis, and normalization of thyroid hormones is associated with the decrease of VWF level. The endothelial dysfunction developed at thyrotoxicosis is related to the level of thyroid hormones and thyrotrophic hormone receptor remodeling of the heart and vessels, and, particularly, to the development of pulmonary hypertension.

А total of 615 patients with type 1 diabetes mellitus from St Petersburg Municipal Diabetes Centre for Children and Adolescents were included in the present analysis. Risk factors for early diabetic nephropathy were age of puberty (> 11 years), high HbA1c at onset of disease, high height, female sex. Arterial hypertension, dyslipidemia, diabetic retinopathy development did not appear to be risk factors in children and adolescents with type 1 diabetes mellitus.

Abstract Objective. To determine the effect of valsartan on the androgen status and erectile function in hypertensive patients. Design and methods. 60 hypertensive patients of 40-65 years of age were included in the study. All patients filled in the questionnaire on aging male symptoms scale and international index of erectile function before and 3 months after the course of antihypertensive therapy. Patients of the first group received angiotensin II receptor antagonist (valsartan) as monotherapy. Valsacor was administered starting from the first 24 hours after destabilization of blood pressure, and the dose was titrated from 80 up to 160 mg/day. Traditional treatment of hypertension including angiotensin converting enzyme inhibitors, calcium antagonists, diuretics and beta-blockers was prescribed to controls. Results. Valsacor treatment reduced the intensity of the symptoms of erectile dysfunction in hypertensive males (by 11,3 against 2,2 % in the control group, p < 0,05). In addition, this therapy led to a decrease in androgen deficiency symptoms (20,2 against 12,1 %, respectively, p < 0,05). Systolic and diastolic blood pressure reduction was comparable in both groups. There was an increase in the number of «dippers» at valsacor treatment, while the number of other categories («over-dipper», «non-dipper», «night-peaker») decreased (p < 0,05). In the control group, circadian blood pressure profile was not changed. Conclusion. Thus, therapy with valsartan normalizes diurnal variations in blood pressure, reduces the symptoms of androgen deficiency and does not contribute to erectile dysfunction.

We studied the influence of hormonal activity on 24-hour blood pressure changes, myocardial remodeling and dysfunction in 66 patients with acromegaly, 41 of them had arterial hypertension. Hypertensive patients with acromegaly are characterized by disturbance of 24-hour blood pressure dynamics, in particular of nocturnal parameters, by the left atrium dilatation, concentric hypertrophy and left ventricular diastolic dysfunction. It was found that myocardial remodeling depends on hypertension severity and hormonal activity.

Objective. To evaluate the influence of drugs Norvasc and Coronim on indices of ambulatory blood pressure monitoring (ABPM) in hypertensive patients. Design and methods. 69 patients with essential hypertension II degree (ESH/ESC, 2007) of 48 to 65 years old, were included. Depending on the antihypertensive therapy they were divided into 2 groups: group 1 (n = 33) included patients treated with Coronim (amlodipine 5 mg/day) for 6 weeks, and group 2 (n = 31) was formed by patients treated with Norvasc (amlodipine 5 mg) for 6 weeks. ABPM was preformed to all subjects before and after 6 weeks of treatment. Results. Both drugs reduce mean 24-hour SBP and DBP, and the effects are comparable.

Background. Increasing prevalence of dementia in the last decade rises a high interest to the mild cognitive impairment, considering its predictor. There is and assumption that high body mass index (BMI) and obesity are one of the underlying causes of cognitive disorders as well as of metabolic syndrome, hypertension and diabetes. Methods. In current study 38 middle-aged females and 51 middle-aged males with BMI ≥ 25 kg/m² passed a cognitive testing. Results. Our data demonstrate a mild cognitive impairment in both males and females, but in particular in middle-aged males with BMI ≥ 25 kg/m², diagnosed based on a screening testing.

Objective. To investigate efficacy of combination therapy including I1-imidazoline receptor agonist, angiotensin receptor blocker, and thiazide diuretic in metabolic syndrome (MS). Design and methods. We investigated 34 patients (mean age 52,3 ± 6,7 years old, mean systolic blood pressure (ВР) 175 ± 21,0 mmHg, mean diastolic BP 102,4 ± 10,5 mmHg) with MS. Blood tests for serum lipids, plasma renin activity, aldosterone, immunoreactive insulin, and leptin, peroral glucose tolerance test, semiquantitative test for microalbuminuria, 24-hour ECG-monitoring for heart rate variability (HRV) analysis were performed. All patients were treated with moxonidine 200 mg per day, and combination of eprosartan 600 mg/day with hydrochlorothiazide 12,5 mg/day for 18-week period. Results. After 18 weeks target BP levels were achieved in 88 % of the patients. HRV analysis demonstrated increase of the total power, decrease of sympathetic (low frequency [LF n.u.] and low to high frequency ration - LF/HF), humoral and metabolic (% VLF), and increase of parasympathetic parameters (HF n.u. and % HF) (р < 0,05). We found a decrease of triglyceride levels, increase of high-density lipoprotein levels, and decline of percentage of patients with microalbuminuria (р < 0,05). Aldosterone, leptin, and immunoreactive insulin levels were lower compared to basic levels (р < 0,05). Conclusion. Three-component therapy of MS with eprosartan, hydrochlorothiazide, and moxonidine provides high antihypertensive and metabolic efficacy, affecting the majority of the pathological mechanisms.

Objective. To optimize treatment of hypertensive patients with chronic digestive diseases based on the pharmacokinetics and pharmacodynamics of angitensin converting enzyme (ACE) inhibitors and β-blockers. Design and methods. The study included patients with hypertension grade 2, and pathology of the digestive system. Conclusion. Enalapril, as a prodrug, is metabolized in the liver and gets its activity, and lisinopril itself has biological activity. Lisinopril has more marked antihypertensive effect compared to Enalapril in hypertensive patients with liver cirrhosis. β-blockers regardless the characteristic of the drug (lipophilic metoprolol or hydrophilic atenolol) decreased blood pressure. Episodes of bradycardia in the atenolol treatment were detected in 14,4 % of patients, while in metoprolol group - in 22,2 %, as hypertensive patients with liver pathology have marked disturbances of metoprolol pharmacokinetics.

Objective. To assess arterial stiffness (AS) and to determine its influence on cerebral damage in patients with arterial hypertension (AH) and atherosclerosis. Design and methods. The 1^st group included 60 patients with cerebrovascular disorders: 23 with chronic vascular encephalopathy (CVE) and 37 with post-stroke lesions. 2^nd group consisted of 23 patients with cardiovascular risk factors without any cerebrovascular disturbances. AS was assessed by 24-hour bifunctional ECG and blood pressure monitoring (data were processed by the computer program «Vasotens», MnSDP-3, BPLab, «Pyotr Telegin», Russia). Results. In both groups AS parameters did not differ in the groups considering matched main vascular risk factors. But AS was higher in patients with CVE. There was a significant association between increased AS and focal cerebral (particularly multiple deep lacunar lesions) or diffuse (leucoaraiosis) lesions and subarachnoid space and ventricular system expansion visualized by brain magnetic resonance imaging. Conclusion. Thus, increased AS may be considered as an independent factor of cerebral damage (including silent lesions) in patients with AH and atherosclerosis.

Background. Ischemic postconditioning (IPost) has been recognized as an effective mechanism of protection against ischemia-reperfusion cerebral injury. However, a neuroprotective effect of IPost against prolonged global cerebral ischemia-reperfusion injury has not been studied yet. Objective. In the present study we investigated putative protective effect of IPost after prolonged global cerebral ischemia in Mongolian gerbils. Design and methods. Cerebral ischemia was induced using bilateral carotid artery occlusion method. Ischemic postconditioning was elicited by different numbers of ischemic and reperfusion stimuli of different duration after 30-min. global cerebral ischemia. Neurologic deficit and mortality were analyzed. Results. We demonstrated that neuroprotective effect of IPost is not evident after prolonged global ischemia in Mongolian gerbils. Moreover, the use of 2-min. ischemia/reperfusion stimuli for IPost after prolonged ischemia results in increased manifestations of neurologic deficit and increased mortality. Conclusion. IPost is not effective after prolonged global cerebral ischemia in Mongolian gerbils.

Obesity and sympathetic hyperactivity are strongly related. Arterial hypertension in obese individuals associated with the sympathetic hyperactivity has an unfavorable prognosis. Different substances and hormones produced by adipocyted lead to the increase of sympathetic activity and contribute to the weight gain. Processes controlled by leptin and brown adipose tissue can be novel targets for therapeutic interventions.

The review presents both literary and some own data on the medico-social signifi cance of co-morbidity state including arterial hypertension, type 2 diabetes mellitus and atrial fi brillation. Association of all these pathologies is related to both targetorgan damage and unfavorable metabolism, and is characterized by markedly worse prognosis compared to combinations of arterial hypertension and type 2 diabetes mellitus or arterial hypertension and atrial fi brillation.

Arterial hypertension and type 2 diabetes mellitus often go together. This «criminal duet» leads to a significant increase of the risk of both micro- and macrovascular complications. The angiotensin receptors antagonists, and, in particular, Irbesartan, take the leading position among all classes of antihypertensive drugs in the treatment of arterial hypertension combined with diabetes mellitus.