Arterial hypertension in patients with metabolic cardiovascular syndrome (MS) has a number of features which are of great theoretical and practical significance. It has been shown that hypertension is the most frequent component of MS and chronologically follows abdominal obesity while clinical manifestations of atherosclerosis and carbohydrate metabolism disturbances develop much later. In addition, the disorders of hypothalamic-pituitary-adrenal axis contribute to the development of arterial hypertension in patients with abdominal obesity. Besides the abnormalities of central regulatory mechanisms, increased sympathetic tone, insulin resistance and hyperinsulinemia, functional state of adipose tissue is an established important factor for the development of systemic hypertension in patients with abdominal obesity, and in some cases the dysfunction of adipocytes, which can be genetically determined or acquired, may cause the whole cascade of MS. Search for the causes and mechanisms of arterial hypertension in patients with MS can help to find the possible targeted treatment and prevention of the disease.

Elderly age and dyslipidemia are known high risk factors for cardiovascular morbidity and mortality. The article focuses on the evidence of statin benefits in primary and secondary prevention of cardiovascular complications in very elderly subjects. Importance of the achievement of target lipid levels regardless the age and possibilities of combined lipidlowering therapy in elderly patients are demonstrated. Some aspects of statin safety in elderly subjects are highlighted in the paper.

Objective. To compare efficacy and tolerability of «step-down» approach starting from initial antihypertensive therapy with fixed dose combination of telmisartan 80 mg (T80) and hydrochlorothiazide 12,5 mg (HCTZ) and «step-by-step» approach starting from T40 to T80/HCTZ. Design and methods. 60 previously uncontrolled hypertensive patients (men 60 %, smoking 40 %, mean age — 48,0 ± 5,8 years) with metabolic syndrome (ESH 2007, body mass index — 30,1 ± 8,9 kg m², waist circumference — 97,9 ± 8,8 cm, total cholesterol — 6,4 ± 0,8 mmol/l, triglycerides — 1,9 ± 1,0 mmol/l, high-density lipoprotein — 1,5 ± 0,4 mmol/l, low-density lipoprotein — 4,0 ± 0,8 mmol/l, glucose — 5,7 ± 0,6 mmol/l) were randomized for T 80/HCTZ 12,5 mg (group 1) once daily or T 40 mg (group 2) once daily. Blood pressure was assessed by home self- monitoring. In group 1 step-down strategy with switching to T80 and then to T40 under home blood pressure monitoring was implemented. In group 2 traditional up-titration strategy was applied. Results. Both groups were comparable by office blood pressure levels (group 1 — 164,3 ± 5,0/92,8 ± 3,9 mm Hg, group 2 — 165,7 ± 6,7/93,0 ± 4,1 mm Hg) and home self-monitoring data (group 1 — 153,7 ± 2,9/90,9 ± 4,5 mm Hg, group 2 — 154,7 ± 3,87/91,0 ± 4,6 mm Hg). Start of treatment with T 80/HCTZ 12,5 resulted in faster blood pressure control achievement and lower rates of masked uncontrolled hypertension assessed by clinic BP measurement and home BP monitoring. 20 (66,7 %) patients of group 1 managed to withdraw HCTZ, and 10 (33,3 %) subjects decreased Telmisartan to 40 mg daily. In group 2 Telmisartan was increased up to 80 mg daily in all patients at week 4, and by week 24 combination therapy was administered to 22 (73,3 %) subjects. Step-down approach was safe and well tolerated. Conclusion. Step-down approach of initial antihypertensive therapy is feasible in previously untreated hypertensive subjects with metabolic syndrome.

Objective. To find the association between cognitive function and cardiovascular risk factors and to develop statistic model. Results. Our study demonstrated that cognitive dysfunction is more profound in middle-aged patients with metabolic syndrome (MS) compared to the individuals with single risk factors without MS. Multiple regression analysis defined glucose (β = 0,0114) and systolic blood pressure (SBP) (β = -0,212) to be factors related with MMSE-test results. When glucose level was excluded from the model, the following factors were shown to be significant: SBP (β = -0,202), age (β = -0,093), operative memory (β = -0,169), total cholesterol level (β = -0,065), therapy by calcium antagonist (β = 0,082), obesity (β = 0,06), R = 92 %.

Objective. We propose assessment of coronary artery stenoses by estimating the difference in heart and pulse rhythm variability during the controlled respiratory rate test. Design and methods. The study included 30 patients with chronic coronary artery disease, divided into groups according to coronary angiography data: I group — 10 patients with intact coronary arteries, II group — 20 patients with coronary artery stenoses (summary index 3-21). All patients were examined by simultaneous recording of electrocardiogram (ECG) and digital arterial pulse in the supine position. First record was made during 5 minutes of spontaneous breathing, second record followed by 5 minutes under controlled breathing, with subsequent analysis of heart and pulse rate variability. Results. We propose two coefficients K₁ and K₂ for evaluation of coronary artery stenoses, which based on the spectral differences of heart and pulse rhythms as a result of myocardial ischemic impact on the activity of cardiopulmonary baroreceptors. Conclusion. Simultaneous recording of heart and pulse rhythms during the controlled respiratory rate test with subsequent spectral analysis could be used as a method for assessment of atherosclerotic coronary artery remodeling.

Objective. To study the interrelations between vascular and cardiac and vascular remodeling indicators in hypertensive patients. Design and methods. 167 subjects aged 50,9 (45-55) years were examined. Vascular age was calculated with the use of modified SCORE scale. Gender, age, smoking, blood pressure (BP) and serum cholesterol levels were taken into account. Ambulatory BP monitoring was carried out and subclinical heart and blood vessels damage signs were found. Their interrelations with vascular and chronologic age were evaluated. Results. Vascular age prevailed in men and when compared with the chronologic age correlated more closely with left ventricular myocardial mass index, carotid intimae-media thickness, mean daily pulse pressure and ankle-brachial index and proved to be the predictor of left ventricular hypertrophy and carotid artery plaque development. Conclusion. We conclude that vascular age might be the useful tool for myocardial and vascular damage evaluation in hypertensive patients.

Objective. To estimate occurrence and peculiarities of left ventricular hypertrophy (LVH) in highly compliant hypertensive patients without target organ damage under prolonged dynamic observation. Design and methods. A cohort prospective trial was conducted. 428 hypertensive patients without target organ damage took part in the trial. The observation period made up 8,8 ± 2,6 years. Results. At baseline LVH occurred in 36,9 % (95 % CI = 0,34-0,40) of highly compliant hypertensive patients without target organ damage. In males LVH occurred more often than in females: 41,3 vs 32,7 % (95 % CI for males — 0,39-0,44; for females — 0,28-0,38). Left ventricular concentric remodeling was predominant among other cardiac structural changes in patients with LVH. No significant differences in terms of concentric LVH and eccentric LVH occurrence were found. Both odds ratio and relative risk of LVH development in patients who did not achieve target office SBP < 140 mmHg, DBP < 90 mmHg and SBP/DBP < 140/90 mmHg were not significant. Further SBP decrease till 125-130 mmHg and DBP till 80-84 mmHg in daytime, and night systolic hypertension according to 24-hour blood pressure monitoring were associated with the increase of left ventricular myocardial mass index. Conclusions. In highly compliant hypertensive patients under adequate dynamic observation LVH occurred more rarely than in common population, and has specific features.

Objective. To compare parameters of 24-hour blood pressure (BP) monitoring in young men with normal, high normal BP and arterial hypertension 1 degree. Design and methods. 102 men (group 1 — 32 subjects with optimal and normal BP, group 2 — 34 subjects with high normal BP, group 3 — 36 men with 1 degree hypertension) underwent 24-hour BP monitoring, and parameters of BP loading and BP changes during the day night were assessed. Results. To a considerable extent subjects with high normal BP demonstrated hypertension at 24-hour BP monitoring, and are characterized by higher «loading pressure» and higher morning BP elevation compared to those with normal and optimal BP; in the group with higher BP the number of patients with normal night profile of BP decreases. Conclusions. Our data confirm that 24-hour BP monitoring should be performed in all patients with high normal BP, and the latest should be considered a group of a higher cardiovascular risk. The disorders of daily BP profile become more profound as arterial hypertension develops.

Objective. To assess stress changes in haemodynamic parameters and endothelial function during muscular relaxation and mental arithmetic counting in hypertensive patients regarding type D personality. Design and methods. 20 patients (mean age — 48,5 ± 1,7 years, 11 males, 9 females) with stage I—II arterial hypertension were examined. The patients were divided into 2 groups: type D personality group (n = 10) and the group with non-type D personality (the control group, n = 10). Personality type was assessed by DS-14 questionnaire. The changes in systolic and diastolic blood pressure, heart rate, baseline brachial artery diameter, brachial artery diameter during muscular relaxation, mental arithmetic counting and the reactive hyperemia test were performed. Results. Patients with type D personality developed higher diastolic blood pressure increase during mental arithmetic counting compared to controls (15,2 ± 1,8 versus 7,2 ± 3,3 mmHg, р = 0,046). There was a correlation between type D personality and blood pressure changes during mental stress (r = 0,34; p < 0,05). The reactive hyperemia test showed a significant increase in brachial artery diameter in type D personality patients (by 22,0 ± 4,3 %, р = 0,0076) while in the control group this was less obvious. The change in the vasodilator response assessed by the reactive hyperemia test during muscular relaxation and mental stress was significant in patients with type D personality (р = 0,0498). Conclusions. The presence of type D personality in hypertensive patients is associated with the more marked diastolic blood pressure response to mental stress and the changes in vasodilator response during the tests. These stress haemodynamic responses could be one of the mechanisms of the adverse effects of type D personality on cardiovascular disease development and progression.

Objective. To assess the coagulation system reaction and blood loss volume depending on aspirin resistance in hypertensive patients with coronary heart disease who underwent bypass surgery. Design and methods. A total of 66 patients with arterial hypertension and coronary heart disease (angina pectoris of III-IV functional class according to Canadian classification) who underwent myocardial revascularization using extracorporeal circulation were examined. All patients were divided into two groups depending on aspirin resistance phenomenon. 22 aspirin-resistant patients formed the first group, the other group consisted of 44 aspirin-sensitive patients. The patients were 49 to 68 year old, and there were 27 women and 39 men. During intraoperative and postoperative periods blood loss was measured in all subjects. Results. We showed that 22 out of 66 patients were aspirin-resistant. No relationship between blood loss volume during intraoperative and postoperative periods and aspirin resistance was observed. All hemostatic system indices regardless of aspirin resistance phenomenon changed equally in both groups.

Objective. To assess efficiency of oxygenobarotherapy (ОВТ) and hypoxic-hypercapnic therapy (HHT) in complex treatment of hypertensive patients . Design and methods. We examined 44 men (aged 28-42 years) with 1st degree arterial hypertension. 24 patients (study group) who took standard antihypertensive therapy underwent a course of OBT (six 60- minute sessions, pressure 1,8 atm) and 2 days later — a course of HHT (eight 30-minute sessions of ventilation by a gas mixture containing 12 % O₂ and 2 % CO₂). 20 patients from control group received standard therapy and physiotherapy. Results. Inclusion in the complex therapy of hypertensive patients of combination of OBT and HHT led to faster recovering (on average 4-5 days), reduction of hyperkinetic trends in the functioning of systemic hemodynamics, prolongation of remission. Conclusion. The use of OBT and HHT might be recommended as it contributes to successful treatment of hypertensive young and middle-aged patients.

Objective. To evaluate the influence of hypertension on emotional and cognitive decline. Design and methods. We have studied 87 adolescents, aged 17-19 years, with arterial hypertension. All patients underwent neurological examination by A.M. Vein, psychopathological test, self-assessment depression and anxiety scale, M. Luscher and Landolt tests. Results. The following somatoautonomic disorders were defined: subdepressive, subjective-cognitive and quantitative (productivity deficit) and qualitative (concentration deficit) disorders were identified. Deficit of emotional-motivational self-regulation was found. Conclusion. Arterial hypertension is a risk factor for cognitive decline and for the deficit of emotional-motivational self-regulation.

Objective. To assess the contribution of the renin-angiotensin system, lipid metabolism and gene regulators of apoptosis in the development of hypertension and myocardial remodeling using sibling-pair and associative methods. Design and methods. Myocardial mass and myocardial mass index were calculated by echocardiography method, gene polymorphism was identified by polymerase chain reaction. Results. We found the association of genotype M235M AGT gene with hypertension in representatives of the Tatar ethnic group. Genotype A603A gene EAAT2 is associated with higher systolic blood pressure, and genotype CC rs189994 AIF gene is related to the greater myocardial mass in hypertensive patients.

Objective. To assess the effect of lisinopril on the dynamics of circulating endothelial progenitor cells (EPC) as well as the clinical markers of cardiovascular risk in patients with essential hypertension. Design and methods. We have studied the number and functional activity of EPC and clinical markers of cardiovascular risk in carefully selected group of 18 patients with essential hypertension, who have never been treated by angiotensin converting enzyme inhibitors (ACEi), and 19 normotensive control subjects. Hypertensive patients took lisinopril in dose 10-20 mg daily and then were re-examined after 12 weeks of lisinopril therapy. Results. The present study shows that hypertensive patients are characterized by a relative decline in the number of circulating EPC in conditions of endothelial dysfunction. Also the cells with angiogenic potential have a decreased proliferative capacity in hypertensive patients in comparison with healthy controls (1,4 ± 0,9 vs 2,2 ± 1,2 units/mm²; p < 0,01). Changes of the functional activity of EPC are closely associated with pathological vascular remodeling. Conclusions. ACEi lisinopril improves functional properties of the endothelium in hypertensive patients through mobilizing effect on the EPC and stimulates their proliferation activity.

The article is devoted to the analysis of the monograph of the soviet pathophysiologist Alexandr Alexandrovich Bogomolets (1881-1946) «Arterial Hypertension. Pathogenesis Essay». It reveals the place of this work in the study of hypertension and its influence on national scientists.