To demonstrate the benefits of perindopril 10 mg/indapamide 2,5 mg fixed combination in comparison with other variants of two-component antihypertensive therapy to achieve target blood pressure in association with metabolic neutrality. Design and methods. The study cohort included 60 patients (mean age 61,9 ± 11,7 years) with essential arterial hypertension, treated with two antihypertensive drugs and not achieved target blood pressure (< 140/90 mm Hg). The dynamics of 24-hour blood pressure monitoring results, serum levels of total cholesterol, glucose and potassium were assessed. Also the number of patients, who achieved target systolic (< 140 and < 130 mm Hg in case of diabetes mellitus) and diastolic blood pressure (< 90 and < 80 mm Hg in case of diabetes mellitus) was evaluated. Results. Administration of perindopril 10 mg/indapamide 2,5 mg fixed-dose combination allowed to decrease mean daily systolic and diastolic blood pressure by 18,2 and 18,5 %, respectively, mean nighttime systolic and diastolic blood pressure - by 18,6 and 19,8 %, and velocity of systolic, diastolic blood pressure morning surge. Even the short-term antihypertensive therapy (2 months) with perindopril 10 mg/indapamide 2,5 mg fixed combination resulted in improvement of lipid and carbohydrate metabolism, which can be explained by the fact, that every fifth patient took 2,5 mg indapamide instead of 25 mg hydrochlorothiazide. Conclusions. The substitution of the two-component combination antihypertensive therapy to perindopril 10 mg/indapamide 2,5 mg fixed-dose combination provides additional reduction of systolic and diastolic blood pressure by 29 and 19 mm Hg, respectively, and favorable influences the levels of total cholesterol, fasting glucose and glycosylated hemoglobin.

The data of world literature highlighting a problem of antihypertensive therapy in patients with type 2 diabetes mellitus are cited in the paper mainly from the point of view of large randomized trials results. In the article possibilities of traditional and modern approaches in relation to blood pressure lowering, maintenance of target organs necessary protection and metabolic neutrality, influence on prognosis, maintenance of high antihypertensive treatment adherence in people with type 2 diabetes mellitus are discussed.

To compare baseline central pulse wave characteristics in relation to response to initial antihypertensive treatment in previously untreated hypertensive patients. Design and methods. The study included 57 subjects (mean age 50,2 ± 13,7 years) with untreated arterial hypertension grade 1-2 without target organ damage on routine examination. Antihypertensive therapy was initiated after baseline ambulatory blood pressure monitoring (ABPM) and pulse wave analysis. Response to treatment was classified by joint evaluation of ABPM and clinic BP after 8 weeks of treatment. The baseline pulse wave velocity (PWV) was compared in 4 groups: 1) true responders (TR, normal clinic and ambulatory BP), 2) masked responders (MR, elevated clinic and normal ambulatory BP), 3) masked non-responders (MNR, normal clinic and elevated ambulatory BP), 4) true non-responders (TNR, elevated clinic and elevated ambulatory BP). Results. There were 21 (36,8 %) TR, 11 (19,3 %) MR, 11 (19,3 %) MNR, 14 (24,6 %) TNR. MNR was the youngest group but their baseline central systolic, pulse BP and PWV were at least similar or even higher than in the other groups. Conclusion. The results suggest that increased arterial stiffness may be responsible for insufficient response to initial antihypertensive treatment in non-diabetic hypertensive patients.

To investigate the prevalence, clinical manifestation and hemodynamic parameters of short-time arterial hypotension episodes in relation to risk factors and target organ damage in elderly hypertensive patients. Design and methods. 260 hypertensive patients aged 75,0 (68-79) years were investigated. The ambulatory blood pressure monitoring (ABPM) was performed. In the ABPM curves the extreme systolic BP falls were identified, and the hemodynamic parameters and circadian structure of these episodes were analyzed. Antihypertensive treatment regimens, prevalence of risk factors, target organ damage and established cardiovascular diseases were compared in patients with and without BP extreme falls. Results and conclusions. We detected 63 short-time BP falls in 48 (18,5 %) hypertensive patients. Most of them (68,8 %) were asymptomatic. Two time intervals of most frequent BP falls incidence were found, including early morning and postprandial hours. BP falls were associated with the total cholesterol level and left ventricular mass increase, reduced glomerular filtration rate, previous myocardial infarction and angiotensin converting enzyme inhibitors administration. These facts should be taken into account when antihypertensive therapy is administered to elderly subjects.

Phylogenetically, the following scheme is relevant in vivo: cell → cell community → structural unit of an organ → organ → organ system. A paracrine-regulated cell community is a structural and functional unit of an internal organ; the nephron composed of renal capillary, afferent (efferent) muscular arteriole, and paratubular loose connective tissue is the basic unit of the kidney. In primates the nephron is induced from three germ layers within the first 16 weeks of embryogenesis, which is followed by nephron development during prenatal period; neonephrogenesis does not occur in the postnatal period. Impaired biological function of exotrophy, protein deficiency in mother's diet, and glucocorticoid therapy reduce the number of nephrons, which is reflected by low body weight of the newborn. If a newborn weights less than 2,5 kg, the number of nephrons is so small that they cannot provide the biological function of endoecology in adults without compensatory hypertrophy, which leads to the hydrodynamic pressure elevation in the arterial bed over glomerular filter and increased glomerular filtration. However, hypertrophy is not optimal for compensation of the nephron function. Low body weight at birth and small number of nephrons are risk factors of programmed arterial hypertension in an adult organism.

To study clinical and predictive value of inflammatory markers in patients with essential hypertension and coronary heart disease (CHD) in correlation with serum lipids, haemostatic parameters, and myocardial anatomy. Design and methods. We examined 256 people, including 70 healthy volunteers, 79 hypertensive patients, 82 - with stable angina pectoris II-III functional class, 25 - with myocardial infarction (MI). Serum levels of interleukins (IL) -1, -6, -17, tumor necrosis factor alpha (TNF-α) and C-reactive protein (CRP) were measured by the immunoenzyme method. Blood pressure and Holter monitoring, echocardiography, tredmil-test, serum lipids, biochemical and clinical blood analyses were also performed. Results. The groups differed by the change of the inflammatory cytokines. CRP, TNF-α, Il-1 and -6 were higher in all groups with cardiovascular diseases compared to the controls (p < 0,05). Patients with MI had the highest hs-CRP level- 4,8 ± 3,16 mg/l. No correlation was found between Il-6 and hs-CRP. Higher cytokine levels were found in patients with CHD compared to hypertensives, but the difference was not significant. Hypertensive patients had increased levels of serum cholesterol and low density lipoproteins, compared to the controls (5,8 ± 2,26, 3,7 ± 1,17 versus 4,7 ± 0,18, 2,9 ± 0,45 mmol/l, р = 0,004, р = 0,02, respectively). The performed regression analysis revealed the age, serum cholesterol, TNF-α and Il-6 to be the independent predictors of arterial hypertension. Age, serum cholesterol and hs-CRP are considered to be the independent predictors of CHD. No significant correlations between the peripheral blood cells, inflammatory cytokines and heart structural parameters were found. Conclusion. Chronic asymptomatic inflammation can be mentioned as one of the additive risk factors for essential hypertension and CHD.

Stiffness of the arterial wall is an independent predictor of cardiovascular morbidity and mortality from cardiovascular causes. Therefore, search for more effective therapeutic approaches to improve the elasticity properties of the arterial wall are necessary. Objective. Compare the effects of angiotensin-converting enzyme (perindopril), dihydropyridine calcium antagonist (lercanidipine), angiotensin receptor blockers II (valsartan) and its combination with a statin (rosuvastatin) for the elasticity of the arterial wall in elderly patients with nonvalvular atrial fibrillation (AF) and hypertension (AG) on the basis of ultrasound examination.
Design and methods. We examined 189 patients (110 men and 79 women) aged 65 to 80 years with nonvalvular atrial fibrillation and hypertension, which were randomly assigned to four groups. Patients in the first group (n = 47) took perindopril in the dose of 5-10 mg/day, in the second (n = 48) - valsartan at the dose of 80-160 mg/day, in the third (n = 48) - valsartan at the same dose in combination with rosuvastatin 10 mg/day, in the fourth (n = 46) - lercanidipine at the dose of 10-20 mg/day. At baseline, after 1 and 2 years blood pressure levels, elastic properties of the thoracic aorta and carotid arteries by ultrasound and cardiovascular complications were assessed. Results. Treatment increased distensibility index of the common carotid artery, decreased stiffness aortic wall and pulse wave velocity in all four groups compared to baseline. The combination of valsartan with rosuvastatin exerted the most pronounced effect on the vascular wall compliance, reduces the frequency of ischemic stroke, myocardial infarction, and mortality.
Conclusion. Valsartan in combination with rosuvastatin may be regarded as the best strategy to improve the elastic properties of the arterial wall and reduce the incidence of cardiovascular complications in geriatric patients with nonvalvular AF.

To evaluate neurogenic theory of essential hypertension taking into account the recently obtained findings. Design and methods. We analyzed evidence data and our own results from a group of 630 hypertensive patients. The threshold of their gustatory sensation to dietary salt (DS), urinary sodium excretion, daily blood pressure monitoring, echocardiography, cardiointervalography were studied; psychological state was assessed. The control group consisted of 350 healthy persons. Results. According to our data, inсreased DS consumption is the main factor leading to clinical and functional manifestations of arterial hypertension. According to the literature data citizens of blocked Leningrad obtained excessive amount of DS that could be the main cause of the epidemic of arterial hypertension in the blocked city. Conclusions. Decrease of DS consumption by population is fundamental preventive measure of lowering hypertension prevalence