Objective: to investigate the impact ofarterial hypertension (AH) on formation ofthe risk oftotal and cardiovascular mortality. Materials and methods. The 27-year cohort prospective study was conducted on the sample of unorganised population of Tomsk (n=1 546, age 20-59 years, 630 men, 916 women). At the first stage (1988-1991) we studied the prevalence of AH, at the second stage (2015) we investigated overall and cardiovascular mortality and the prognostic significance of AH in shaping mortality. Criterion of AH was blood pressure (BP) ≥140/90 mm Hg or (in persons with BP <140/90 mm Hg) treatment with antihypertensive drugs or discontinuation of this treatment less than 2 weeks before initial examination. Results. The study demonstrated significant contribution ofAH to the formation of the risk of mortality: among individuals with AH relative risk (RR) of all-cause death was 2.2 and that of cardiovascular death - 3.38. An AH related elevation of mortality risk was observed both among women and men and in all age groups. We also observed direct correlation between mean BP values and total and cardiovascular mortality rates. Conclusion. A clear contribution of AH in the formation of the risk of mortality was revealed. Cardiovascular diseases were main cause of death in individuals with AH. In men the risk of cardiovascular mortality was higher, but predictive value of AH was worse in women.

Objective: to determine the predictors of obstructive sleep apnea syndrome (OSAS) basing on clinical examination, results of night pulse oximetry, daily dynamics of heart rate and blood pressure (BP) in men with newly diagnosed arterial hypertension (AH). Materials and methods. Men (n=197, mean age 40.1 ± 8.4 years) with newly diagnosed AH of mild (63%), moderate (26%), and severe (11%) degree. OSAS (Apnea-Hypopnea Index [AHI] ≥5 events per hour) was diagnosed in 156 patients (79%). Patients were divided into four groups depending on the AHI. The control group consisted of 31 men without AH and OSAS. Examination included standard clinical, laboratory and instrumental methods, as well as assessment of daytime sleepiness by the Epworth scale. Diagnostics of OSAS and 24-hour BP monitoring were performed on a portable multifunctional recorder. The duration of sleep was determined from the actigraphy data. Statistical analysis was carried out using descriptive statistics, correlation, regression and Receiver Operating Characteristic (ROC) curve analysis. Results. In the studied sample of patients with AH prevailed individuals with central obesity and dyslipidemia. Mean estimate of daytime sleepiness assessed by the Epworth Sleepiness Scale was 7.8±4.8 points. Of 156 patients with OSAS, its moderate and severe degree (AHI ≥15) was diagnosed in 64%. Predictors of the presence of OSAS were the following: body mass index (odds ratio [OR] 1.13, 95% confidence interval [CI] 1.05-1.22, p<0.002), hypoxemia index (OR 1.12, 95% CI 1.06-1.18, p<0.000l), time indices of hypertension in sleep for diastolic BP (OR 1.03, 95% CI 1.01-1.04, p<0.002) and systolic BP (OR 0.99, 95% CI 0.98-1.00, p<0.045). Basing on these results we created the scoring system for assessment of OSAS risk. The sensitivity of the test was 76%, the specificity - 78%. This model generated a ROC with an area under the curve of 0.848 (95% CI 0.794-0.892, р<0.0001). Conclusion. In men with newly diagnosed AH, snoring and/or daytime sleepiness, predictors of the presence of OSAS were: body mass index, hypoxemia index, and time indices of hypertension during the asleep period for diastolic and systolic BP.

Aim: to assess antihypertensive efficacy of the fixed-dose amlodipine/indapamide/perindopril arginine combination in hypertensive patients in real clinical setting. Methods. We included in the 3-month clinical program 1 599 patients with arterial hypertension (AH) (38.8 % men, mean age 61.6±10 years). Primary outcomes were change of office and ambulatory (home blood pressure monitoring) systolic and diastolic blood pressure (SBP and DBP) from baseline to 3 months and rate of achievement of target BP<140 /90 mmHg. Secondary outcomes included response to the therapy, adherence to treatment and safety. Results. By 3 months office BP decreased from 165.5±15.3/96.2±9.7 to 127.6±8.5/78.3±6.4 mmHg (р<0.001); ambulatory BP - from 146.8±13.0/86.4±7.8 to 128.6±9.0/78.2±5.6 mm Hg (р<0.001). Target office BP <140/90 and ambulatory BP<135/85 mmHg was achieved in 87 and 68.1% of patients, respectively. Adherence score increased from 2.9±1.6 до 5.1±1.0 (р<0.001). Conclusion. Administration of a fixed-dose amlodipine/indapamide/perindopril arginine combination resulted in significant BP decrease and rapid achievement of target office BP in most patients. The combination was safe and well tolerated.

Objective. To assess dynamics of the quality of life (QOL) in patients of the older age group of with initial aortic stenosis in 1, 3, and 5 years after replacement of the aortic valve (AV) with biological or mechanical prosthesis. Materials and methods. QOL was assessed in 282 patients who underwent aortic valve replacement with a biological or mechanical prosthesis. Criterion for inclusion in this retrospective single-center study was primary and elective nature of the operation. Patients with repeated interventions (early postoperative resternotomy, reosteosynthesis, repeat aortic valve surgery) were not included. Using the method of Propensity Score Matching, we distributed 151 patients in whom the long-term results of AV replacement were analyzed according to age, gender, body mass index into groups of AV replacement with biological (group 1, n=74) and mechanical (group 2, n=77) prosthesis. Results. In the early period after operation, there was no significant difference between groups in parameters of quality of life. During the observation period up to 3 years significant increases of parameters bodily pain (BP), vitality (VT), and mental health (MH) occurred in patients with biological prostheses, while physical functioning (PF) was higher in patients with mechanical prostheses. At follow-up to 5 years, indicators such as BP and role emotional functioning (RE) became higher in patients with mechanical prostheses. According to the conducted regression analysis the type of prosthesis affected the quality of life. Conclusions. 1) AV replacement with mechanical prostheses was associated with lowering of the physical component of health by 81.1%, and of the mental health component - by 56.6% per month; 2) significant difference in QOL between groups of patients with mechanical and biological prostheses could be detected only in 3 years after the operation: parameters BP, VT and MH were significantly higher in patients with biological prostheses, while PF was higher in patients with mechanical prostheses; 3) in the longer observation period (up to 5 years) parameters BP and RE became higher in patients with mechanical prostheses.

Objective: to establish associations of candidate genes ACE, AGT, AGTR1, ADRB1, ADRA2B, MTHFR and NOS3 polymorphisms with left ventricular myocardial hypertrophy (LVH) in patients with arterial hypertension (AH) among the indigenous (the Shors) and non-indigenous population of Mountain Shoria. Materials and methods. We examined 788 people in a clinical and epidemiological study of compactly living population in the remote areas of Mountain Shoria, located in the south of Western Siberia (468 members of indigenous ethnic group [the Shors], 320 members of non-indigenous ethnic group [90% Caucasian]). Diagnosis of AH was set in accordance with recommendations of Society of Cardiology of the Russian Federation/Medical Society of the Russian Federation on the Problem of Arterial Hypertension (RMOAG) (2010). Assessment of the structural and functional state of myocardium in patients with AH (n=201 among Shors and 158 among non-indigenous residents) was made by echocardiography. The polymorphisms of genes ACE (I/D, rs 4340), AGT (c.803T>C, rs699), AGTR1 (А1166С, rs5186), ADRB1 (c145A>G, Ser49Gly, rs1801252), ADRA2B (I/D, rs 28365031), MTHFR (c.677C>T, Ala222Val, rs1801133) and NOS3 (VNTR, 4b/4a) were tested by PCR. Results. Among patients with AH LVH occurred more often within the indigenous (Shor) than in non-indigenous (non-Shor) ethnic group (51.5 vs 42.2%, respectively, p=0.034). The frequency of homozygous genotype I/I of the ACE gene among AH patients with LVH in the Shor group was higher than in the non-Shor group (41.2 vs 19.3%, p=0.004). The prevalence of mutant genotype A/A of the ADRB1 gene was lower in the Shor compared to non-Shor group (53.6 vs 75.0%, p=0.014). The percentage of the carriers of prognostically favorable genotype 4b/4b of the NOS3 gene was higher in Shor than in non-Shor group (71.9 vs 52.7%, p=0.018), while the percentage of homozygous genotype 4a/4a carriers in the Shor group was lower (2.1% vs 18.2%, p=0.008). Conclusion. The following studied genes were found to be associated of with LVH: in the Shor cohort - the MTHFR gene (log additive model of inheritance), the A/G genotype of the ADRB1 gene (among people with normal body weight), the I/D genotype of the ACE gene (among men); in the non-indigenous cohort -D/D genotype of the ACE gene (the codominant model of inheritance), the NOS3 gene (the log additive model of inheritance).

Background. More than 10 years passed since conduction of the first clinical-epidemiological study of prevalence of psychosocial risk factors (PSRF) in patients with arterial hypertension (AH) an/or ischemic heart disease in Russian Federation. Purpose: to assess current prevalence of PSRF in patients with AH/CHD and their relationship with traditional risk factors. Materials and methods. Patients with verified AH and/or CHD aged ≥55 years were included into this cross-sectional study in 30 cities of Russia representing 7 federal districts according to the following procedure. In each city we selected 2-5 federal clinics - providers of primary medical care; in each of these clinics we at random invited 2-5 physicians to take part in this study. Each of these physicians for 1-2 days included 10 consecutive patients with AH and/ or CHD. Information collected from patients comprised social demographic and clinical characteristics, risk factors, adherence to therapy; Hospital Anxiety and Depression Scale (HADS) was applied for detection of symptoms of anxiety and depression. Obtained information was used for analysis of prevalence of cardiovascular risk factors and their association with symptoms of depression and anxiety in a framework of Pearson linear and Kendall rank correlation analysis. Results. Symptoms of anxiety of various severity (HADS-A≥7) were detected in 42.2% of patients with AH and/or CHD, in 25.5% they were clinically significant (HADS-A>11). Symptoms of depression of various severity (HADS-D ≥7) were detected in 42.5% of patients with AH and/or CHD, in 16.3% they were clinically significant (HADS-D≥11). We also observed several significant associations of symptoms ofdepression and anxiety with traditional cardiovascular risk factors: low level of physical activity, elevated systolic and diastolic arterial pressure, level of total cholesterol, abdominal obesity; some unhealthy nutritional habits. Conclusions. Prevalence of symptoms of anxiety and depression was found to be high among ambulatory patients with AH and/or CHD. However, in this study it was lower compared with that reported by previous studies in Russia.

Cardiovascular diseases (CVD) are the main cause of death worldwide. A broad study of the pathogenetic mechanisms of the CVD onset and progression has led to understanding of the importance of endothelial dysfunction (ED) in these processes. During recent years intensive work has been conducted in the direction of searching for markers of ED. Metabolomics is an intensively advancing approach to early diagnostics of diseases. Metabolomic analysis based on mass spectrometry allows to study complete metabolic profiles and their deviations resulting from changes in expression of genes and RNA, protein activity, or environmental factors. Metabolomic analysis has already demonstrated significant results in the solving of different scientific and clinical problems. It appears to be a promising method for detecting early biomarkers of CVD. Various aspects of application of metabolomic profiling in the field of cardiovascular diseases are discussed in this article.

The article contains report of 15 most important clinical studies presented at 67-th Annual Scientific Session of American College of Cardiology (Orlando, USA, March 10-12, 2018).

This article presents an overview of data of Russian and foreign literature on possible associations between cognitive impairment and atrial fibrillation (AF). It includes modern classification of cognitive impairment, mechanisms of the effect of AF on cognitive functions and development of dementia, recommendations for the prevention of cognitive impairment in patients with AF. Special attention is paid to the assessment of cognitive status, and safe anticoagulant therapy, which is a priority in the prevention of cognitive impairment in patients with AF. Analysis of literature showed greater efficacy and safety of drugs from the group of Non-vitamin K Antagonist Oral Anticoagulants (NOAC), rivaroxaban in particular, in comparison with warfarin. Drugs from the NOAC group can be recommended for prevention stroke, cognitive impairment and dementia in elderly patients with AF.

This review article presents results of studies on adherence to drug therapy of patients after discharge from hospital. It contains analysis of the reasons for poor adherence, assessment of the impact of quality of adherence on the immediate and long-term results of surgical and medical treatment, structured methods of improvement of adherence to therapy; as well as economic aspects of the problem.

The article deals with the dynamics of echocardioscopy indices during 1.5 years in a patient who underwent an acute myocardial infarction (MI). Two months after the MI left ventricular (LV) end-diastolic size and LV volume were 61 mm and 190 ml, respectively; LV ejection fraction (EF) was 42%. At the background of maximal possible doses of ramipril, bisoprolol, and selective antagonist of aldosterone receptors eplerenone, and after revascularization, within eight months LV end-diastolic size decreased down to 57 mm, LV volume - to 158 ml, and LVEF increased up to 51 %. There was no change of potassium and creatinine blood serum levels. The situation changed dramatically after addition to ongoing therapy because of exacerbation of chronic osteochondrosis of ketoprofen 100, meloxicam 15 and tolperisone (Mydocalm) 450 mg / day. The patient noted an increase in dyspnea during walking, a decrease in exercise tolerance. LVEF fell to 36%, LV size increased up to values registered in 2 months after MI. There were no signs of overt fluid retention (no gain of weight, lower limbs edema, lung congestion on X-ray, hepatomegaly at ultrasound examination). In 4 months after addition to therapy of a loop diuretic torasemide (5 mg) the cardio-hemodynamic parameters almost returned to values prior to administration of anti-inflammatory drugs. Conclusion. Loop diuretic (such as torasemide) can be recommended for elimination of negative consequences of the use of nonsteroidal anti-inflammatory drugs in patients with chronic heart failure.