Objective. To assess the efficiency of perindopril (Prestarium A) 10 mg daily in hypertensive patients with dyslipidemia. Design and methods. 276 medical doctors (physicians and cardiologists) took part in the study. 2075 patients aged 18-67 years old with 1-3 degree arterial hypertension were included (mean age 55.4 ± 8.1 years). Perindopril 10 mg daily (in the morning) was prescribed to all patients. In case the patients were taking blockers of renin-angiotensin-aldosterone system, the drugs were withdrawn, while therapy by the antihypertensive drugs of other classes was continued if necessary. Antiaggregants were taken by 17 % of subjects, anti-inflammatory drugs — by 11 %, statins — by 23.2 %, and the target lipid levels were not achieved. Results. After 4 months of therapy by Perindorpil 10 mg daily more than 90 % of patients achieved target blood pressure, and blood pressure was lower than 140/90 mm Hg in 100 %. The change for Perindopril led to the decrease of systolic and diastolic blood pressure for 21 и 17.1 %, respectively (p < 0.05). Improvement of lipid profile was observed: total cholesterol level decreased for 15 %, and level of low density lipoproteins — for 16.3 %, while high density lipoproteins increased for 9.5 % (p < 0.05). Conclusion. At real clinical practice Perindopril 10 mg/day effectively decreases total cholesterol, low density lipids and increases high density lipids in patients with arterial hypertension and high lipids. Moreover, 90 % of patients achieved target blood pressure.

Despite our knowledge about pathogenesis, clinical characteristics and treatment, chronic heart failure (CHF) remains widespread disease with poor prognosis. However, there is not a common opinion whether statins are reasonable in patients with CHF. The data about efficiency and safety of statins are contradictory and demand evidences due to regular exclusion of patients with CHF from the majority of clinical trials of statins. The reduction of the level of low-density lipoproteins is not the unique mechanism of favourable effect of statins in patients with CHF, therefore, their pleiotropic effects are considered very important.

Peroxisome proliferator receptors alpha (PPAR-α) and their role in atherogenesis has a great practical significance, since there are drugs that can enhance the activity of these receptors. Activation of PPAR-α by fibrates is known to lead to both significant reduction of serum triglyceride levels by activation of lipoprotein lipase, and to the increase of synthesis of the main apolipoproteins within high-density lipoproteins (HDL), contributing to the reverse transport of cholesterol from chylomicrons and very low-density lipoproteins to the liver. Besides, PPAR-α increase the capture of HDL by liver. PPAR-α also participate in the regulation of inflammation, expression of adhesive molecules, production of chemotactic factors, as well as inhibit the proliferation of smooth muscle cells and activity of fibroblasts. These data suggest that PPAR-α are directly involved in the processes of atherogenesis, and their activation may contribute to the regression of atherosclerotic plaque and significant reduction of cardiometabolic risk.

Background. Some studies suggest that serum 25(OH) vitamin D level could be associated with fat mass quantity and glucose metabolism parameters. However, the data seem to be contradictory. Objective. We examined the interrelatoins between serum 25(OH)D with body composition, glucose metabolism parameters in healthy women. Design and methods. We examined 320 healthy late reproductive age women (aged 40 to 52 years old, mean age — 46.1 ± 4.5 years). Serum 25(OH)D and insulin levels were determined by ELISA, plasma glucose levels — by standard biochemistry. Insulin resistance was evaluated by HOMA-IR and insulin sensitivity index (ISI-0,120).We used DEX in 134 women to determine fat mass and calculate fat mass index (FMI). Results. Serum 25(OH)D level was from 19.4 to 134.0 nMol/L (mean — 52.9 ± 22.7). Vitamin D insufficiency and deficiency (lower than 75 nMol/L) was revealed in 86.8 % of healthy women. The study showed, that low vitamin D level was associated with obesity (r = -0.35, p < 0.01), increased plasma glucose level after oral glucose tolerance test (OGTT) (r = -0.31, p < 0.01) and decreased insulin sensitivity index (r = -0.28, p < 0.01). We found that Vitamin D level lower than 50 nMol/L was associated with obesity (OR 2.1; CI 95 %) and type 2 diabetes mellitus (OR 1.67; CI 95 %). Conclusion. Our results show that vitamin D deficiency is highly prevalent in the population of healthy women, and low Vitamin D level correlates with high fat mass, postprandial glucose level and decreased tissue insulin sensitivity. Hence, vitamin D insufficiency might possibly be a risk factor for obesity and insulin resistance development leading to type 2 diabetes mellitus.

Objective. To perform a complex laboratory and instrumental and prognostic assessment of hypertensive subjects with type 2 diabetes mellitus (DM) and atrial fibrillation (AF). Design and methods. Based on the retrospective analysis out of 3150 case records we selected 443 clinical cases of arterial hypertension combined with type 2 diabetes mellitus (DM 2) and with or without atrial fibrillation (AF). They were divided into groups: 1st group included hypertensive patients with DM 2 and AF; 2nd — hypertensives with DM 2, and third — hypertensives with AF. We analyzed haemodynamic, electro-and echocardiography, routine biochemical (blood sugar, glycated hemoglobin, uric acid, potassium, microalbuminuria, cholesterol, low and high density lipoproteins, triglyceride, prothrombin and international normalized ratio, C-reactive protein) parameters, as well as adipokine levels (tumor necrosis factor alpha, adiponectine, leptine, resistine). Kaplan-Meyer’s analysis was performed to assess survival rate. Results. Patients from the 1st group showed subclinical target organ damage, dysregulation of metabolism and hormonal and regulatory activity. Compared to other groups these patients demonstrated a lower survival rate. Conclusion. The association of arterial hypertension, DM 2 and AF can be considered as a mutual burdening phenomenon, increasing the cardiovascular risk.

Objective. To evaluate diagnostic value of renal collagen matrix injury in hypertensive patients and to estimate the benefits of antihypertensive therapy in renal dysfunction correction depending on the choice of management approach. Design and methods. A two-stage examination was performed. At the first stage diagnostic value of1^st type tissue inhibitor of matrix metalloproteinases (TIMP-1) was determined in hypertensive patients with normal glomerular filtration rate (GFR) and without microalbuminuria. Patients were divided into two groups depending on GFR level. The first group consisted of 16 patients with GFR more than 60 mL/min/1.73 sq.m; the second group consisted of 15 patients with GFR less than 60 mL/min/1.73 sq.m. At the second stage 60 hypertensive patients with renal dysfunction were divided into two equal groups depending on baseline antihypertensive therapy. Patients from the first group received the fixed combination of eprosartan mesylate 600 mg and hydrochlorthyazide 12.5 mg QID regardless of blood pressure level at the baseline. The second group received either enalapril as monotherapy or its different combinations with hydrochlorothyazide depending on blood pressure level and cardiovascular risk. Results. TIMP-1 increase from 138 to 183 ng/mL was observed in hypertensives with normal GFR and without microalbuminuria. In patients with GFR less than 60 mL/min/1.73 sq.m TIMP-1 level was higher than 183 ng/mL. During therapy patients in the first group showed reliably more expressed correction of renal dysfunction, than in the second one. Particularly, more evident deterioration of unfavorable renal extracellular collagen had been observed when fixed combination of eprosartan mesylate and hydrochlorothyazide was taken compared to enalapril as monotherapy or its different combinations with hydrochlorothyazide. Conclusions. Increased TIMP-1 level in hypertensive patients with normal GFR and without microalbuminuria can be a new method of detection of an early subclinical renal injury. Administration of the fixed combination of eprosartan mesylate and hydrochlorothyazide is the most effective antihypertensive strategy for renal dysfunction correction independently from baseline blood pressure level and cardiovascular risk in untreated hypertensive patients.

Control over blood pressure is an existing problem in cardiology and does not exceed 30 % for Europeans, despite prevalence and availability of effective antihypertensive drugs. Low adherence to treatment is one of the reasons of low control of blood pressure. Implementation of the combined antihypertensive drugs with the high fixed doses allows to simplify therapy in subjects receiving combination therapy and to increase the adherence in high risk patients receiving drugs separately.

Objective. To investigate endothelial function in asthmatic subjects including patients with essential hypertension (EH). Design and methods. The levels of endothelium-dependent and endothelium-independent vasodilation, pulmonary artery systolic pressure (PASP) were evaluated by ultrasound scanner before and after the treatment of the asthma exacerbation. Results. The PASP values before treatment in patients with asthma and concomitant EH (31.3 ± 0.6 mm Hg) and II stage (31.4 ± 0.7 mm Hg) were higher, than in patients with normal blood pressure (28.3 ± 0.6 mm Hg), p < 0.05. The levels of endothelium-dependent vasodilation after treatment in patients with asthma and concomitant EH I stage (11.12 ± 1.00 %) and II stage (10.04 ± 0.88 %) were lower, than in patients with normal blood pressure (15.60 ± 1.58 %), p < 0.05. The levels of endothelium-dependent and endothelium-independent vasodilation, PASP were comparable in patients with different asthma severity. Conclusion. Endothelial function, PASP in asthmatic subjects are related to the presence of concomitant EH.

Objective. To investigate short-term effects of thyroxin replacement therapy on blood pressure (BP), left ventricular mass index (LVMI), interstitial fluid volume (IFV) and skin vessels resistance in patients with first diagnosed primary hypothyroidism (PH) and past history of arterial hypertension (AH). Design and methods. 49 patients with PH and AH were examined twice: before the therapy onset and after euthyroid state was achieved. All patients underwent daily BP monitoring, echocardiography, body integral rheography and high frequency ultrasound dopplerography of nail ridge arterioles. Results. Decrease in daytime systolic BP by 8.5 (95 % CI: 5.5-11.5) mm Hg, nighttime systolic BP by 5.3 (2.5-8.1) mm Hg, daytime diastolic BP by 3.8 (1.2-6.4) mm Hg, nighttime diastolic BP by 3.5 (0.9-6.1) mm Hg, IFV by 1.5 (0.11-2.91) l, LVMI by 8.5 (1.9-15.0) g/m² and Purselo index by 0.19 (0.05-0.33) units (or 25 % to initial level) were found in patients with PH when euthyroid state was achieved. Conclusion. IFV can play a key role in AH development in patients with PH.

Objective. To study circadian blood pressure parameters in patients with stage II essential arterial hypertension (AH) combined with chronic hepatitis C virus (HCV). Design and methods. 54 patients (45 males and 9 females) with AH II combined with chronic HCV were included in the study: mean age 56.3 ± 5.1 years, body mass index — 30.1 kg/m². The control group included 60 hypertensive subjects without clinically significant concomitant pathology. 24-hour blood pressure profile was assessed in all patients. Results. Subjects with AH combined with chronic HCV are characterized by higher «loading pressure» (time index of systolic blood pressure, TI SBP — 75.35 ± 0.58 %) compared to those with subjects with AH without concomitant liver pathology (TI SBP — 70.59 ± 1.41 %, p < 0 .05). Conclusion. Thus, BP is constantly increased in hypertensive patients with chronic HCV compared to subjects without concomitant liver pathology.

Objective. To determine the relationship between blood pressure measured during the first trimester of pregnancy and the risk of the development of gestational diabetes mellitus. Design and methods. A total of 209 pregnant women were screened for gestational diabetes mellitus between weeks 24 and 28 of gestation, as defined by WHO criteria. Blood pressure, weight and waist circumference data were obtained by review of the medical records. Results. An elevated blood pressure at first trimester of pregnancy was associated with a six-fold increase in the risk of the development of gestational diabetes mellitus (OR = 5.8, 95 % CI 1.9-17.5, p = 0.001) compared with non-hypertensive women. Arterial hypertension (including controlled forms) in the first trimester of pregnancy was followed by a three-fold (OR = 3.04, 95 % CI 1.5-6.3) increase in the risk of gestational diabetes mellitus compared with non-hypertensive women (p = 0.005). Conclusion. Obtained data indicate that women with elevated blood pressure in the first trimester of pregnancy have an increased risk of the development of gestational diabetes mellitus.