Objective. To assess the glycemia status and risk of progression to diabetes mellitus (DM) depending on diagnostic criteria (fasting glucose, 2-h glucose, glycated hemoglobin HbA1c and their combination) in hypertensive patients with high cardiovascular (CV) risk without known DM. Methods. 433 hypertensive patients with high CV risk were included in the study. Stratification of CV risk was done in accordance with national guidelines for the management of arterial hypertension (2010). Patients were divided into groups with noncomplicated (n = 201) and complicated (n = 232) arterial hypertension. Follow-up was 6 years. Fasting glucose, 2-h glucose during oral glucose tolerance test (OGTT) and HbA1c were assessed in all patients each 6 months. The patients were divided into groups with normoglycemia, impaired fasting glucose (IFG), impaired glucose tolerance (IGT), its combination (IFG/IGT), isolated HbA1c 5,7-6,4 % and newly diagnosed DM (ADA2011). Results. Impaired glucose status was diagnosed in 82 % of patients with arterial hypertension and high CV risk according to fasting glucose, 2-h glucose, HbA1c diagnostic criteria. IFG was the most prevalent in patients with non-complicated arterial hypertension, and newly diagnosed DM — in complicated arterial hypertension. HbA1c used as an additional criterion of impaired glucose metabolism in addition to OGTT contributes to the better identification of newly diagnosed DM in high risk hypertensive patients for 10 %. Two-hour hyperglycemia has higher predictive value for diagnosing DM in patients with complicated arterial hypertension, thus imposing the obligatory OGTT assessment in this group of patients. OGTT is desirable, but non-obligatory in patients with non-complicated arterial hypertension. Conclusion. The assessment of HbA1c and fasting glucose/2-h postload glucose has independent and complementary importance and helps to identify patients with different pathogenetic mechanisms of glucose metabolism impairment. Prognostic value of HbA1c as a diagnostic criterion of risk progression to DM is comparable with fasting glucose/ 2-h postload glucose assessment.

Objective. To assess cost-effectiveness of selective aldosterone antagonist eplerenone in patients with chronic heart failure (CHF), including those with prior myocardial infarction. Design and methods. Markov modeling was performed on the basis of the results of multicenter clinical trials EMPHASIS and EPHESUS. Cost analysis was performed on the basis of obligatory medical insurance foundation tariffs in St Petersburg in 2011 year. Results. Eplerenone therapy preserved 17 lives per 1000 patients during 6 months in patients with CHF after myocardial infarction (EF ≤ 40 %) and 24 lives in patients with EF ≤ 30 %. The additional cost per patient is only 15,100-15,200 rubles for 6 months. For patients aged 70 years with CHF FC II, receiving eplerenone therapy, the ratio of cost/effectiveness is 360,800 rubles for one additional year lived. Conclusions. Eplerenone therapy is economically feasible in patients with prior myocardial infarction and left ventricular systolic dysfunction. Maximum effectiveness of eplerenone was found in an early phase of myocardial infarction and in patients with ejection fraction ≤ 30 %. These data prove that the inclusion of eplerenone in the list of the medications used in the state system of drug supply, as well as standards of the medical care is possible and highly required.

Objective. To assess the etiology of drug-resistant hypertension in patients with combination therapy. Design and methods. Out-patient subjects (n = 336, 94 males and 242 females, mean age — 54 ± 3 years) were followed up for one year (every 2-4 weeks during first three months, and then every 3-6 months till one year of follow-up). Examination included assessment of cortisol and aldosterone levels, renin activity, duplex scan of renal arteries, sleep study. Results. Secondary hypertension was verified in 29 (8,6 %) patients: primary aldosteronism — in 9 cases, pheochromocytome — in 2 cases, intracranial tumor — in 2 cases, renovascular hypertension — in 16 subjects. Moderate-to-severe sleep apnea was diagnosed in 45 (13,4 %) patients, and 21 subject (6,3 %) demonstrated «white-coat hypertension». Inadequate therapy was the cause of resistant hypertension in 198 (59,1 %) cases and included low compliance, suboptimal treatment, and medical inertia. True refractory hypertension was diagnosed in 42 subjects (23 males and 19 females). We achieved significant blood pressure decrease during first three months of follow-up just by therapy optimization: 162 ± 8/98 ± 5 mm Hg at baseline vs. 134 ± 4/86 ± 2 mm Hg at 3-month visit (р < 0,001), and 167 ± 9/101 ± 6 mm Hg at baseline vs. 144 ± 4/94 ± 2 mm Hg in 3 months in true resistant hypertension (р < 0,01 for systolic blood pressure and р < 0,05 for diastolic blood pressure). Conclusion. Low compliance, suboptimal therapy regimen and medical inertia are the most common causes of drug-resistant hypertension. Sleep-breathing disorders are highly prevalent in subjects with refractory hypertension.

The article reviews the trials in hypertensive patients with obstructive sleep apnea syndrome (OSAS). The relation of arterial hypertension and OSAS and the underlying mechanisms, as well as the possible causes of drug-resistant hypertension are discussed. The results on the use of non-invasive ventilation (so called CPAP-therapy, continuous positive airway pressure) are presented.

Recently the research has been focused on the earlier stages of the atherosclerotic process, i.e. subclinical atherosclerosis. Endothelial dysfunction is a suitable marker of subclinical atherosclerosis. In routine clinical practice, ultrasonography is the most useful and accessible non-invasive method for diagnosis of subclinical atherosclerosis. Carotid intimai media thickness (IMT) was shown to be predictive for the risk of cardiovascular events. Furthermore, vascular stiffness can be a helpful marker for assessment of the vascular wall state and blood flow. Calcium antagonists (CA) seem to be promising for the prevention of subclinical atherosclerosis progression, and amlodipine has the priority due to the metabolic neutralilty, vasodilation effect and favourable effects on renal hemodynamics. The data on IMT assessement showed that amlodipine slows down the development of atherosclerotic lesions in hypertensive patients.

The endocannabinoid system plays an important role in different physiological processes including memory and learning. Its activation can affect cognitive function and cause cognitive deficit in obese patients. Objective. To assess the association between cognitive function and activity of the endocannabinoid system in obese patients. Design and methods. 32 subjects (18 females and 14 males) aged 35-55 years old (mean age — 47,8 ± 2,3 years) were included in the study. All participants underwent neuropsychological testing, assessment of cognitive evoked potentials and plasma level of the endocannabinoids. Results. Our study showed that obese patients demonstrate cognitive dysfunction. Cognitive evoked potential is an objective and early sing of cognitive dysfunction. Activation of the endocannabinoid system is associated with cognitive deficit in obese patients.

Objective. To assess the effectiveness original Indapamide (Arifon Retard, Servier, France) in patients with arterial hypertension and type 2 diabetes mellitus. Design and methods. 30 hypertensive subjects (mean age — 55 ± 4,0 years) with type 2 diabetes mellitus and uncontrolled hypertension, who took any of generic forms of Indapamide. Generic forms were substituted by original drug in all subjects (Arifon Retard). The follow-up lasted for 3 months. We assessed blood pressure changes, achievement of target blood pressure level, the changes of blood pressure according to 24-hout blood pressure monitoring. All subjects also filled in the questionnaires on life quality MOS SF-36 (MOS 36-ltem Short-Form Health Survey). Results. The mean decrease of blood pressure was 29/15 mm Hg. 80 % patients achieved target blood pressure levels. The therapy with original form of Indapamide was safe. We observed the decrease of plasma glucose level, of serum levels of total cholesterol, triglycerides, and low density lipoproteins, while there was a slight increase of the level of high density lipoproteins. According to the survey, the quality of life (MOS SF-36) the indicators of physical and mental health considerably increased. Results. Original Indapamide shows benefits in controlling blood pressure in high risk subjects, in particular, in hypertensive patients with type 2 diabetes mellitus.

Objective. To study the features of the impact of atrial fibrillation on left ventricular diastolic function in hypertensive patients. Design and methods. We examined three groups of patients: hypertensive patients with atrial fibrillation, hypertensive patients with sinus rhythm and patients with idiopathic form of atrial fibrillation. All patients underwent cardiac ultrasound examination (Vivid 7 Dimension, General Electric). Results. The integral of blood flow linear velocity (VTI), period of pressure gradient half decrease (PHT) between left chambers of heart and time of transmitral blood flow (TE) were greater in patients of second and third groups compared to first group. They did not differ in second and third groups. The time of isovolumic relaxation (IVRT) was 0,102 ± 0,015; 0,091 ± 0,012 and 0,073 ± 0,013 seconds in first, second and third groups, respectively. The differences between all groups are significant (p = 0,001). The mean values of maximal (Vmax) and middle velocity (VMN), maximal (Gmax) and middle (GMN) pressure gradient between left heart chambers did not differ between groups. Conclusion. Atrial fibrillation contributes the development of left ventricular diastolic dysfunction: it reduces VTI, decelerates IVRT and shortens PHT significantly.

Objective. To estimate the changes of voltage electrocardiographic criteria of the left ventricular hypertrophy in arterial hypertension in subjects of different gender. Design and methods. The study included 94 hypertensive patients (55 males, 39 females). Mean age was 51 ± 6 years. Based on gender and the presence of left ventricular hypertrophy patients were divided into four groups. Results. There were significant differences of indices of Sokolow-Lyon and Cornell in males with I and II stages of arterial hypertension (р = 0,012 and р = 0,017, respectively). The same differences were found in females with I and II stages of arterial hypertension (р = 0,037 and р = 0,001, respectively). Specificity was 92 % for both indices, and the sensitivity was 26 % for Sokolow-Lyon index, and 39 % for Cornell index. In women sensitivity was 0 and 72 % for Sokolow-Lyon and Cornell indices, respectively, and specificity was more than 90 % for both criteria. Conclusion. Gender differences should be considered when voltage electrocardiographic criteria of the left ventricular hypertrophy are assessed in hypertensive patients.

Objective. To study the frequency and degree of atherosclerotic lesions of eхtra- and intracranial vessels in patients with coronary artery disease (CAD) before coronary arteriography and planned cardiac intervention. Design and methods. 100 patients with CAD, angina pectoris I-III functional class were examined: 58 men aged 48-72 years old (mean age — 58 ± 3 years) and 42 women aged 37-68 years old (57 ± 2 years). Duration of CAD varied from several weeks to 15 years (mean duration — 10 ± 2 years). Extra- and intracranial vessels were examined by Duplex scanning with colour Doppler (Vivid 7Pro, HP, the USA). Results. Atherosclerotic lesions of the common carotid arteries (CCA) with stenoses from 17 to 45 % awere revealed in 78 % males and 54 % females. Atherosclerotic plaques in a mouth of internal carotid arteries (ICA), narrowing vessel lumen from 25 to 57 %, were found in 38 % males and 20 % females, stenoseis from 25 to 34 % in brachiocephalic trunk (BCT) and in right subclavian arterys (SА) — in 30 and 18 % in males, and in 34 and 14 % in females, respectively. The right CCA was found to be S-shaped in 10 patients, both CCA were S-shaped in 8 subjects. Pathological S-shaped curve of IСА was found in 4 men and 7 women. Pathological trace of the vertebral arteries (VA) was found in 10 subjects. Hypoplasia of the right VA was visualized in 3 patients and hypoplasia of the left one — in two cases. S-shaped curve of VA was visualised in I segment in 23 % subjects, more frequently in females. 57 % subjects showed a moderate decrease of cerebrovascular reactivity. Mean decrease of reactivity was 18 % on hypercapnic load, 13 % on hypocapnic test, and 15 % decrease of vasomotor reactivity was observed. Conclusions. In one third of patients with CAD atherosclerotic lesions of extracranial vessels and local abnormalities of haemodynamics in the area of pathological curve caused the changes of brain circulation. Presence of a double gradient of systolic speed between proximal and distal segments (against the pathological curve) was the most significant indicator of local haemodynamic abnormalities in the curved extracranial arteries.

We present a clinical case of a young female patient with resistant hypertension and fetal loss. The examination showed a fibromuscular dysplasia of renal artery. Brief literature review of fibromuscular dysplasia is included.

The metabolic cardiovascular syndrome (MS) is a common cluster of metabolic abnormalities (abdominal obesity, hypertension, dyslipidemia and carbohydrate metabolism disorders) that are related to insulin resistance and hyperinsulinemia and are associated with accelerated atherogenesis. Insulin excess is known to promote the development of the whole metabolic cascade. Recently it has been shown that the inflammatory and hemostatic abnormalities, immunological disorders, endothelial dysfunction, hyperhomocysteinemia and hyperuricemia are also important features of MS. Despite the numerous studies of MS its underlying cause is still not established. The dysfunction of visceral adipocytes (adiposopathy) might be genetically determined, and is considered nowadays as the main factor contributing to the development of the MS. Understanding the underlying mechanisms is of particular interest for prevention and target therapy of all the components of MS.