Review deals with atrial fibrillation and arterial hypertension. Possible pathological mechanisms of atrial fibrillation due to hypertension include haemodynamic effects, structural and electrophysiological heart remodeling partly connected with activation of renin-angiotensin-aldosterone system. Problems of primary and secondary prevention of atrial fibrillation in hypertensive patients are discussed, particularly the role of antihypertensive treatment including angiotensin-converting enzyme inhibitors and angiotensin II receptor blockers. Risk stratification for stroke and thromboembolism and anticoagulation therapy are discussed.

Objective. To evaluate the influence of natural illumination on diurnal dynamics of blood pressure (BP). Design and methods. We studied diurnal blood pressure profile (DBPP) in people living at different latitudes. We analyzed polar day and night time periods, and the group living at 69º northern latitude was of the greatest interest. The study included 13 000 persons, and in total 150 000 BP measurements were performed. All subjects were night shift workers (with night shift starting at different hours); BP measurement was performed before the beginning of the shift. Therefore, all DBPP curves were plotted based on values during work periods. Results. Level of nocturnal blood pressure dipping (LNBPD) in the mentioned periods lowered with increasing latitude. People living beyond the Polar Circle have no differences in DBPP during light (polar day) and dark (polar night) hours, and their LNBDP approached zero. Nocturnal blood pressure dipping was present in the same cohort in control time periods of mid-spring and mid-fall, when light and dark periods are almost equal. Conclusion. Diurnal BP rhythm depends on illumination changes during a day, but not on its level or exposure time.

Background. Latent arterial hypertension (LAH) is a serious health problem and is often underdiagnosed in routine examination. Thus, a sensitive and economical test to detect latent hypertension is needed. Objective. To assess the opportunity of pressure response to voluntary breath holding (30 second breath holding test) to detect masked arterial hypertension in young subjects. Design and methods. 269 young subjects (18-36 years old) with no clinical signs of cardiovascular disease, diabetes mellitus, any chronic diseases including pulmonary diseases, who did not do sports professionally, underwent 30 second breath holding test. Results. The results of breath holding and 24 hour monitoring tests coincided in 250 out of 269 cases (93 %). Latent hypertensions was diagnosed (by 24 hour blood pressure monitoring) in none of the subjects with normal or high normal resting blood pressure and negative breath holding test (negative predictive value - 100 %). For subjects with normal or high normal resting blood pressure, a positive breath holding test (53 subjects) detected latent arterial hypertension in 34 subjects (positive predictive value - 64 %). Conclusions. The breath holding test helps to effectively exclude latent arterial hypertension in healthy subjects and accurately identifies subjects who should be further tested for arterial hypertension.

Background. The spontaneously hypertensive rat (SHR) strain is the most common animal model both of hypertension and of cognitive impairment. SHR show genetically determined calcium homeostasis abnormality. Objective. To investigate protein metabolism disturbance and reveal the difference in the level of a major proteinkinase C substrate, NAP-22, between SHR and normotensive WKY strain. Design and methods. Our experiments were carried out on SHR and WKY rats. NAP-22 amount was examined in developing hippocampus and in parietal cortex by immunoblotting with anti-NAP-22 serum. Results. In all studied age groups (5-30 days), the amount of NAP-22 (including both aggregated and non-aggregated NAP-22 forms) in SHR telencephalon was considerably higher than in control WKY strain rats. There was also a significant difference between rate of development during considered period in SHR and WKY rats. Conclusion. Our results demonstrate that calcium homeostasis alterations could result in both cardiovascular abnormalities and in the damage of central nervous system through NAP-22 dysregulation.

Objective. To assess heart rate variability (HRV) and some biochemical and echocardiographic parameters in hypertensive patients and in the control group living in Tyumen Priobje. Design and methods. 52 patients with stage 1 or 2 of arterial hypertension and 32 sex- and age-matching healthy subjects aged 20-50 years living permanently in Tyumen Priobje were examined. 5-minute ECG was recorded at baseline (at out-paient department in the town of Pyt-Yakh) using standard method, and analysis of time and spectral parameters was performed. Lipid profile and blood glucose were measured. The groups did not differ by shift work schedules (presence or absence of night shift). Results. The functional condition of hypertensive patients and controls permanently living in Tyumen Priobje is characterized by overexertion of regulatory systems in the controls and exhaustion of regulatory systems in hypertensive patients. The time and spectral parameters of HRV indicate a predominance of sympathetic regulation in hypertensive patients. Night shift work influences the activity of sympathetic regulation of heart rate, affecting its circadian rhythm in both hypertensives and controls. Healthy subjects are initially characterized by overexertion of regulatory system activity and they are at risk of developing cardiovascular pathology. As arterial hypertension progresses a reduction in overall HRV structure is observed. Night shift work contributes to more rapid change in functional condition towards the exhaustion phase.

Objective. Development of differentiated method for selection of antihypertensive drugs in hypertensive patients based on assessment of individual features of autonomic cardiovascular dysfunction evaluated by spectral parameters of heart rate variability (HRV) and synchronization of 0.1 Hz oscillation in heart rate and microcirculation. Design and methods. 105 patients with arterial hypertension stage 1-2 aged 47 ± 8 years were examined. 0.1 Hz oscillations in heart rate and microcirculation were registered during passive tilt test under spontaneous breathing. The signals were recorded before and after three-week treatment by angiotensin-converting enzyme (ACE) inhibitors (fosinopril or enalapril) and β-blockers (atenolol or metoprolol). Phase differences between 0.1 Hz oscillations were used to measure the synchronization index S. Power of low- (LF) and high-frequency (HF) bands of HRV spectrum was also assessed. Results. ACE inhibitors are preferred for treatment of hypertensive patients with initially severe systemic autonomic dysfunction (index S is < 25 % in vertical body position) and sufficiently intact autonomic heart regulation (power of LF band of HRV spectrum is > 250 ms² in supine position). β-blockers are recommended for patients with initially severe systemic autonomic dysfunction and dysfunction of autonomic heart regulation (index S < 30 % and power of LF band of HRV spectrum < 350 ms² in vertical body position). If severe autonomic dysfunction (index S is > 25 % and power of LF band of HRV spectrum is > 250 ms²) is not present the treatment by ACE inhibitors and β-blockers is not recommended. Conclusions. The type of antihypertensive drugs (ACE inhibitors or β-blockers) should be selected based on individual features of autonomic cardiovascular dysfunction. Sensitivity and specificity of this method was 65 and 73 %, respectively.

Objective. To carry out a pharmacoeconomic analysis of the antihypertensive therapy in elderly patients of high cardiovascular risk by the means of the method assessing «expenses - benefits», cost minimization, the increment of cost efficiency. Results. The cost of the daily efficient dose of the original (Renitec, MSD) and generic Enalapril (Hemofarm) was 6,54 and 7,25 rubles, respectively. Minimal coefficient «expenses - benefits» was defined in the group of patients receiving two drug combination therapy including original Enalapril (Renitec, MSD) compared to combination of three drugs including generic Enalapril (Hemofarm) while the antihypertensive effect was comparable. The cost efficiency increment (CER incr) was 169,12 rubles regarding original Enalapril (Renitec, MSD) benefit.

Objective. To study heart rhythm variability (HRV) in ethnic groups of pregnant women with and without arterial hypertension during all gestation period. Design and methods. 100 pregnant Russian and Buryat women with arterial hypertension formed the main group. The control group included 100 healthy pregnant women with a normal current of pregnancy, without arterial hypertensions. All subjects underwent Holter ECG monitoring («Incart», «Kardiotechnika-04-BP-3», Russia). Results. There is a significant decrease in time parameters of rhythm variability n pregnant Buryat women with arterial hypertension in the second trimester. In the third trimester of pregnancy heart rhythm variability is higher in hypertensive women compared to those without hypertension. In Russian population indicators of heart rate variability do not vary during the day. In an ethnic group of women with arterial hypertension an increase of indicators of low and high frequencies due to the prevalence of vascular sympathetic regulation is observed in the first trimester of pregnancy. Conclusions. Pregnant women of the Buryat population with arterial hypertension have lower heart rhythm variability in the first and second trimesters of pregnancy. In Russian population the variability parameters do not change.

Objective. To investigate homocysteine ​​levels in pregnant women with chronic hypertension in different terms of pregnancy, and to evaluate the prognostic significance of hyperhomocysteinemia in the development of preeclampsia, placental insufficiency syndrome and fetal growth retardation. Design and methods. It is a cohort prospective study. Pregnant women were divided into 2 groups: group 1 was formed by women with chronic hypertension (n = 80), group 2 consisted of 40 women without hypertension. Results. Pregnant women with chronic hypertension had higher homocysteine ​​levels throughout the pregnancy compared to those without hypertension. Homocysteine ​​level was higher in pregnancy complicated by preeclampsia, placental insufficiency and fetal growth retardation syndrome. Conclusion. Homocysteine ​​levels above 5,8 mmol/l in the III trimester of pregnancy may be used as a prognostic risk factor for preeclampsia development.

Background. Elevated levels of Na⁺/K⁺-ATPase(NKA)-inhibitory cardiotonic steroids (CTS) including marinobufagenin (MBG) contribute to pathogenesis of preeclampsia (PE) via induction of vasoconstriction and of vascular stiffness. In PE, Digibind (affinity-purified digoxin antibody) exhibits beneficial effects primarily due to immunoneutralization of CTS including MBG. Because Digibind is not available and the only other «clinically-usable» digoxin antibody is DigiFab (BTG International Ltd), we compared DigiFab and Digibind with respect to their ability to interact with CTS in PE plasma and to ex-vivo reverse PE-induced NKA inhibition. Objective. We compared effects of Digibind and Digifab on erythrocyte NKA from patients with PE and normotensive pregnant subjects. Using competitive fluoroimmunoassays based on Eu-labeled DigiFab and Digibind we compared profile of elution digoxin-immunoreactive material following fractionation of PE plasma on reverse-phase HPLC column. Design and methods. 7 patients with PE (28 ± 2 years; gestational age, 39,0 ± 0,5 weeks, urinary protein excretion, 2,12 ± 0,46 g/24 hours, blood pressure 157 ± 5/94 ± 2 mm Hg) and 9 normotensive pregnant subjects (26 ± 1 years; gestational age, 37 ± 1 weeks, blood pressure 112 ± 2/75 ± 3) were studied. Results. PE was associated with substantial inhibition of erythrocyte NKA (1,47 ± 0,17 vs. 2,65 ± 0,16 umol Pi/mL/hr in control group, p < 0,001). At concentration 10 ug/mL (which mimics dose of Digibind administered in PE) both Digibind and DigiFab partially, but significantly restored NKA activity (2,1 ± 0,2 and 2,05 ± 0,3 umol pI/mL/hr, respectively). In competitive immunoassay Digibind and Digifab exhibited comparable cross-reactivity with MBG and endogenous ouabain. Following HPLC fractionation of plasma, both Digibind and Digifab detected PE-associated increase in CTS material in fractions 16-18; 176 vs. 75 pmoles for Digibind, control and preeclampsia, respectively; 221 vs. 70 pmoles for Digifab, control and PE, respectively. 4G4 anti-MBG monoclonal antibody detected preeclampsia-induced CTS increase (1056 vs. 421 pmoles) mainly in fraction 16. Conclusions. We conclude that: (i) Digifab and Digibind exhibit comparable cross-immunoreactivity with CTS; (ii) in patients with PE plasma levels of digoxin-like immunoreactivity are elevated proportionally when measured by both Digifab and Digibind and both antibodies reverse preeclampsia-induced NKA inhibition, and (iii) following HPLC fractionation of PE plasma, Digifab and Digibind interact with endogenous bufadienolides including MBG, rather than endogenous ouabain.

Prevalence of diastolic heart failure (DHF) is 30-74 % (mean 45 %). Вecause of nonspecific clinical symptoms diagnostics is difficult. Presence of DHF can be confirmed by echocardiography. However a simple, cheap test, which could be helpful in diagnostics of DHF, is necessary. Evaluation of plasma natriuretic peptides is common. Nevertheless, search of new biomarkers, which can give more information on prognosis and efficacy of therapy, is going on. Use of the most sensitive and specific biomarkers allow to find individual approach to each patient.

The article focuses on antihypertensive effect, organoprotection properties and clinical use of angiotensin II receptor antagonist valsartan in patients with cardiovascular diseases.

Objective. Evaluate the clinical efficacy and safety of moxonidine selective inhibitor of imidazoline I1-receptors, compared with angiotensin-converting enzyme inhibitor captopril in patients with uncomplicated hypertensive crisis (UHC). Material and Methods used in Study.The Study has been conducted on 225 patients (125 female and 100 male), average age 56.2±14.4 with uncomplicated hypertensive crisis (UHC). All patients were randomly divided into two groups: patients in moxonidine group (n=113) received a single dose of 0.4 mg moxonidine orally and patients in captopril group (n=112) received a single dose of 25 mg captopril. Along with general clinical tests, the following tests were conducted: dynamic measurement of blood pressure (BP), heart rate, electrocardiogram, creatinine, potassium and glucose levels in blood. Performance indicators for patients were the time of onset of antihypertensive effect, blood pressure level and duration of antihypertensive effect. To evaluate each medicament effectiveness, the blood pressure monitoring has been performed daily. Output dynamics were analyzed for 12 hours. Results. Anti-hypertensive effect, expressed in terms of a significant reduction in systolic blood pressure in both groups, has been reached after 30 minutes, significant reduction in diastolic blood pressure - after 60 minutes, following the administration of drugs. Level of BP reduction did not exceed 25% of the baseline. Moxonidine advantage was detected primarily in the course of anti-hypertensive action with sustained drop in blood pressure over the entire period of observation. The favorable metabolic effects of moxonidine were confirmed. In particular, its effects were manifested in significant reduction of serum creatinine. When compared, in moxonidine group 26.9% more of the patients were with efficiency above satisfactory, tolerance above satisfactory - 18.8% more than in captoril group.Conclusions. The results show a higher level of moxonidine efficacy and a good degree of tolerability in comparison with captopril in patients with uncomplicated hypertensive crises. The drug can be successfully used for treatment of uncomplicated hypertensive crises, starting in the phase prior to admission to hospital, especially in patients with concomitant illnesses (diabetes, metabolic syndrome, chronic renal failure).

Effective blood pressure (BP) control remains a key factor in the reduction of cardiovascular morbidity and mortality. Main criteria of choice of rational antihypertensive therapy include optimal antihypertensive effect and documented reduction of the risk of cardiovascular events and mortality. On 18^th June, 2011, at the European Meeting on Hypertension and Cardiovascular Prevention, the symposium «Is hypertension a fatal disease today?» was held with discussions on the effective antihypertensive therapy in hypertensive patients using fixed-dose combination of perindopril and amlodipine (Prestance). This treatment can be recommended as preferable for hypertensive patients with uncontrolled BP, with high risk of complications, with diabetes mellitus and coronary heart disease.

The article reviews therapy in drug-resistant hypertension. Current therapeutic approaches to treatment and rational combination therapy are discussed.