The article reviews possible mechanisms responsible for drug resistance in hypertensive patients with obstructive sleep apnea. Data about more profound target organ damage, partly explained by activation of inflammation, endothelial dysfunction due to recurrent hypoxia episodes and by blood pressure pattern in apnea patients are presented. Stimulation of renin-angiotensin-aldosterone system has a negative impact on cardiovascular system and deteriorates sleep apnea severity.

A clinical case of a patient with heart rhythm and conduction disorder, and uncontrolled arterial hypertension is described. Severe obstructive sleep apnea-hypopnea syndrome was found by cardiopulmonary monitoring. Combined treatment (medication + CPAP-therapy) enabled the achievement of goal blood pressure and lipid levels. No heart rhythm and conduction disorders were found by the control Holter ECG monitoring. As a result, almost 10-fold reduction of the calculated ten-year risk of myocardial infarction in PROCAM was achieved.

Objective. To assess the attitude of primary care physicians in Russia to antihypertensive therapy administration and their readiness to achieve goal blood pressure, as well as causes of physicians’ inertia. Design and methods. The survey was performed in St Petersburg, Leningrad region (North-West region) and Irkutsk. The questionnaire was filled by 790 primary doctors (368 from St Petersburg, 57 in Leningrad region and 365 in Irkutsk). Results. More than half of Russian physicians were found to be predisposed to clinical inertia and the structure of its reasons is generally the same as in USA and Western Europe. The most frequent causes are contradictions between the good knowledge of the guidelines and subjective barriers to follow them in practice, especially in the elderly patients, overestimation of treatment success. Economical reasons are also relevant while lack of knowledge is less important.

Objective. To assess the effects of several antihypertensive drugs on diurnal rhythms of blood pressure (BP) in sleep deprivation. Design and methods. The research included 58 patients with initial stages and levels of arterial hypertension (AH) divided into four groups (no medication, lisinopril, metoprolol, anaprilin before night with sleep deprivation). All patients underwent 24-hour blood pressure monitoring during the day with and without sleep deprivation. Results. Sleep deprivation was found to cause either inversion of daily blood pressure profile (DBPP) with higher night BP values, or at least reduction of night BP dipping. Among all mentioned medications only Anaprilin had some corrective effect on DBPP in sleep deprivation, and it can be recommended for night workers with arterial hypertension immediately before a night shift.

Background. Several previous studies suggest that the drug in the biguanide class — metformin, in addition to the well-known hypoglycemic action can exert a significant cardioprotective effect. Molecular mechanisms of cardioprotection mediated by metformin are practically unknown. Objective. To examine the role of AMP-activated protein kinase (AMPK) — a key regulator of energy metabolism in myocardial tolerance to ischemia and reperfusion injury under the action of metformin in animals with type 2 diabetes mellitus (T2DM). Design and methods. The Wistar rats with streptozotocin-induced neonatal type 2 diabetes mellitus were used in the study. Ischemia-reperfusion of the myocardium was modeled according to Langendorf on the isolated heart with the preliminary intraperitoneal administration of metformin for 3 days. Cardioprotective effect of metformin was assessed by hemodynamic parameters and the size of myocardial infarction. AMPK activity in the myocardium was assessed by Western blot analysis. Results. Metformin did not significantly affected infarct size and nature of the postischemic recovery of left ventricular function in control group and in animals with T2DM. At the same time, the infarct size in T2DM was significantly lower than in the controls, which confirms the phenomenon of metabolic preconditioning. Activation of AMPK in the myocardium compared with the control group was observed in animals with T2DM, and in both metformin groups. Administration of metformin to animals with T2DM was accompanied by the maximum increase in AMPK activity. Conclusions. T2DM led to the activation of AMPK and was accompanied by improved myocardial tolerance to ischemia. In the absence of significant cardioprotective effect pre-ischemic systemic administration of metformin led to the increase of AMPK activity in the myocardium that was the highest in the animals with T2DM and metformin administration.

Objective. To study the incidence and risk factors of contrast-induced nephropathy (CIN) resulted from percutaneous coronary interventions in cardiology practice. Design and methods. Retrospective analysis of 100 history cases of patients aged 37-73 years (mean age 56,1 ± 6,0 years) was preformed. 0mnipac-350 was used as a contrast agent during angiography. Glomerular filtration rate (GFR) was assessed by Cockroft-Gault formula before and 48 hours after the intervention. The patients were divided into 2 groups depending on the type of intervention: the first group included the patients with planned intervention and the second — with urgent endovascular intervention. Results. In the first group 3,0 % (n = 2) patients developed CIN, and one case was registered (2,95 %) in the second group. It developed in patients with initial decrease of GFR, in patients with diabetes mellitus and with the combination of both factors.

Objective. To assess the influence of simvastatin vs. atorvastatin therapy on cognitive function in obese hypertensive patients. Design and methods. This open clinical trial included 40 patients (mean age 47,7 ± 5,6 years). 20 patients received simvastatin and 20 — atorvastatin. Monotherapy lasted 12 months. At baseline and 12 months later, all participants underwent neuropsychological testing and cognitive evoked potential (P300) to assess cognitive function. Results. 12-month therapy with simvastatin and atorvastatin significantly improved cognitive function (neuropsychological testing and P300) in obese hypertensives.

Objective: To assess the prevalence and forms of metabolic syndrome in patients with abdominal obesity in population of St Petersburg according to criteria of International Diabetic Federation (IDF, 2005) and European Cardiology Society (ESH and ESC, 2007). Design and methods. 966 employees, aged 30-55 years, were examined. Waist circumference, weight, body mass index (BMI), height, blood pressure were measured. The levels of total cholesterol, triglycerides (TG), low- and high- density cholesterol (LDL-C and HDL-C), glucose were defined by COBAS INTEGRA 400/700/800. Results. 52,1 % subjects had abdominal obesity (AO) in accordance with IDF criteria (2005). Different components of MS were found in 91,3 % subjects with AO. The occurrence of MS components among patients with AO according to criteria of IDF and ESH-ESC was the following: arterial hypertension (AH) — 78,6 %, low level of HDL-C — 54,2 and 46,4 %, high level of TG — 35,4 and 34,3 % and disorders of glucose metabolism — 39,1 and 35,6 %, respectively. MS was found in 66,5 (IDF, 2005) and 55,9 % (ESH and ESC, 2007) subjects with AO respectively (p > 0,05). The majority of patients had 3 components of MS, and it occurred more frequently in subjects older than 50 years and in patients with BMI > 40 kg/m². Conclusion. Arterial hypertension is the second component of MS in subjects with AO. Combination of AO, arterial hypertension and low level of HDL-C is the most prevalent clinical form of MS in population of St Petersburg.

Background. Genetic factors have clinical significance in arterial hypertension and coronary heart disease (CHD). Objective. To assess A603G tissue factor gene polymorphism and mediators of immune inflammation in patients with arterial hypertension and СHD. Design and methods. The A603G genotype was determined in a sample of 105 patients with arterial hypertension and CHD by a polymerase chain reaction-restriction length polymorphism (PCR-RFLP)-based method. We studied the mediators of immune inflammation — interleukin-8 (IL-8), interferon-gamma (IF-gamma), tumor necrosis factor-alpha (TNF) and interleukin-10 (IL-10). Results. 24 patients (13,3 %) were the carriers of AA genotype, patients had AG and GG genotype. CHD was diagnosed at the age of 52,1 ± 2,48 years in patients with GG genotype compared to 59,2 ± 2,54 years in AA genotype group and 60,1 ± 1,84 years in AG genotype group (p < 0,05) . Levels of IL-8 (9,81 ± 2,14 pkg/ml) and IF-gamma (1,58 ± 0,25 pkg/ml) were elevated in patients with GG genotype in comparison with AA genotype patients (3,08 ± 0,59 и 0,99 ± 0,21 pkg/ml, respectively, p < 0,05). Conclusion. Our data support that GG genotype of tissue factor in patients with arterial hypertension is associated with early debut of CHD and activation of proin-flammatory cytokines, mediators of endothelial dysfunction.

Objective. To evaluate G-75A and C+83T polymorphisms of apolipoprotein A1 gene and Q192R polymorphism of paraoxonase 1 gene and their association with blood pressure and lipid levels in patients with abdominal obesity. Design and methods. We examined 222 obese patients (57 males and 165 females), residents of St Petersburg, Russian Federation. Results. High incidence of arterial hypertension (61 %) and dyslipidemia of different types was revealed. The frequency of different alleles of apolipoprotein A1 and paraoxonase 1 genes was analyzed. The results of gene-gene interactions and their associations with blood pressure, obesity and lipids profiles are presented.

Vessel occlusion by rupture or atheroma erosion leading to thrombosis is the underlying cause of severe complications, including sudden cardiac death, myocardial infarction, and stroke. Tissue factor is known to play the key role in the initiation of the majority of stages of coagulation cascade. Recent studies explained the structure, synthesis and activation mechanisms of tissue factor. Tissue factor is the main component of atherothrombotic process and is associated with the immune inflammation, endothelial dysfunction, angiogenesis, and cell migration that play an important role in the development of cardiovascular, inflammatory and oncological pathology. Basal activity of tissue factor is the independent parameter of cardiovascular risk, the predictor of thrombolysis efficacy and affects the results of angioplasty interventions. The effects of medications (e.g. statins), including those in drug-eluting stents, on tissue factor are the objective of further investigation. Studies of physiological and pathogenic role of tissue factor will have a great impact on our understanding of cardiovascular pathology and other diseases.

This article is devoted to Nikolai Sergeevich Korotkov who suggested a method of blood pressure measuring one century ago. Details of this invention are described. The value of the method for the development of medicine is disclosed. It is also reported how the memory of this national scientist is kept in contemporary conditions.