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Aim: To study the relationship between laboratory markers and echocardiography (EchoCG) parameters in heart failure with preserved ejection fraction (HFpEF) depending on the results of the diastolic stress test (DST)., Material and Methods: The diagnostic algorithm provided by the current guidelines for the assessment of left ventricular (LV) diastolic function was used to select patients. If there were not enough criteria to make a conclusion about increased LV filling pressure (FP) based on standard resting echocardiography data in patients with arterial hypertension and ischemic heart disease, DST was performed to detect HFpEF. 80 patients (50.0% men, mean age 66.3±5.4 years) were included. Group 1 consisted of 41 patients with a positive DST, and group 2 included 39 patients with a negative DST. Concentrations of the markers of immune inflammation, endothelial dysfunction, collagen homeostasis, and myocardial stress were measured., Results: The DST showed significant differences in the E/e' ratio (15.1 [13.4; 15.9] in group 1 and 9.5 [7.9; 10.3] in group 2, respectively, p<0.001) and the diastolic functional reserve index (DFRI) (9.8 [6.8; 14.0] and 21.0 [13.0; 29.0], p < 0.001). Resting EchoCG revealed significant differences in the left atrial reservoir strain (LASr) (22.8 [19.6; 25.6]% and 28.0 [24.8; 30.2]%, p<0.001) and the left atrial stiffness index (LASI) (0.50 [0.40; 0.57] and 0.34 [0.27; 0.41], p<0.001). In patients with HFpEF, the laboratory parameters of collagen regulation had the greatest number of relationships. Correlations were found between the concentrations of matrix metalloproteinase-9 and other biomarkers, including interleukin-10 (IL-10) (r=0.311; p=0.048), myeloperoxidase (r=0.382; p=0.014), N-terminal propeptide of procollagen type I (procollagen I N-terminal propeptide, PINP) (r=0.722; p<0.001) and type III (r=0.591; p<0.001), C-terminal propeptide of procollagen type I (r=0.330; p=0.035), tissue inhibitor of metalloproteinases type 1 (r=0.410; p=0.008), EchoCG parameters, including left atrial volume index (LAVI) (r=0.414; p=0.007) and DFRI (r=0.354; p=0.025). In addition, correlations were found for the concentrations of PINP with IL-10 (r=0.401; p=0.009) and endothelin-1 (r= -0.337; p=0.031); PINP with LAVI (r=0.498; p=0.001) and DFRI (r=0.420; p=0.007)., Conclusion: Patients with HFpEF have a greater number of relationships between markers of collagen homeostasis disorders and EchoCG parameters characterizing an increase in LV FP.

Aim      To determine predictors of acute kidney injury (AKI) related with surgeries for correction of acquired valvular heart disease (HD) and to evaluate the incidence of in-hospital complications in patients with postoperative AKI.Material and methods  This study included 62 patients after surgery for correction of acquired valvular HD (mean age, 61±10.9 years) with a disease duration of 11±5.3 years. NYHA functional class (FC) 1 chronic heart failure (CHF) was observed in 1.6 % of patients, FC 2 in 64.5 %, and FC 3 in 33.9 %.17.7% of patients had chronic kidney disease (CKD). Coronary lesions of ≥50 % of vascular lumen were detected in 27.4 % of patients. Surgical correction of mitral valvular disease was performed in 32 cases, aortic valvular disease in 36 cases, tricuspid valvular disease in 8 cases, and combined operations for correction of valvular disease and coronary bypass in 8 cases. Creatinine concentrations were measured according to the Jaffe method; glomerular filtration rate (GFR) was estimated with the CKD-EPI equation. AKI was diagnosed based on KDIGO (2012) criteria.Results The AKI incidence related with surgeries for correction of valvular HD was 16.1 % (8.1 % of patients had stage 1 AKI, 3.2 % had stage 2 AKI, and 4.8 % had stage 3 AKI), and 3.2% required kidney replacement therapy. AKI was associated with the presence of CKD at baseline (р=0.044), development of hemopericardium requiring drainage (р=0.012), more pronounced coronary lesions (in the AKI group: stenoses from 50 to 70 % in 20% of patients, from 70 to 90 % in 30 % of patients, and ≥90 % in 0 %; without AKI: from 50 to 70 % in 13.4 % of patients, from 70 to 90 % in 3.8 %, and ≥90 % in 5.8 % of patients, respectively; р=0.032). Probability of postoperative AKI significantly increased with the development of hemopericardium requiring drainage. Patients with postoperative AKI compared to persons without AKI had higher mortality (20 % and 0 %; р=0.001), greater incidence of decompensated CHF (40 and 9.6 %; р=0.012) and hemopericardium requiring drainage (30 and 1.9 %; р=0.012).Conclusion      The development of postoperative AKI is associated with CKD at baseline, more pronounced coronary injury, and hemopericardium requiring drainage.

Objective: To study the role of therapeutic exercises (TE) in the correction of blood pressure, stiffness of the vascular wall and disorders of bone mineral metabolism in postmenopausal hypertensive patients., Material and Methods: The study included 78 patients (mean age was 53.32±7.61 years). All patients are divided into 3 groups. The first control group is 20 women without arterial hypertension and menopause. The second group consisted of 27 patients with arterial hypertension (AH) and post-menopause who were not undergone the TE complex and the 3 rd group - 31 women with AH and post-menopause who were undergone TE complex. Patients of all groups were examined in dynamics: at the starting point of the study and 12 months later, out-patient monitoring of blood pressure; sphygmography; densitometry and test for blood serum biochemistry parameters, including sex hormones, vitamin D., Results: In the course of the study, blood pressure, vascular wall stiffness and disorder of bone mineral density were revealed significantly higher in the group 3 with significantly reduced levels of sex hormones. Multidirectional correlation relationships between the studied parameters are revealed. Treatment combined with therapeutic exercises led to permanent improvement tendency in studied parameters like blood pressure, pulse wave velocity, metabolic disorders and T-criterion., Conclusion: The result of the study indicates that the exercise therapy complex used in the form of regular classes, according to the scheme proposed by the exercise therapy doctor, can be recommended for implementation in clinical practice with the aim of comprehensively affecting the patient's body and developing personalized treatment tactics for postmenopausal women with hypertension.

In recent years, accumulated numerous data on the pathogenetic links of the formation of arterial hypertension. A number of studies have shown that vitamin D deficiency, associated with age, changes in sex hormonal status, increased tone of the reninangiotensin-aldosterone system, endothelial dysfunction, and calcium metabolism, can be one of the mechanisms of development and progression of arterial hypertension. The purpose of the review was to summarize the results of the original domestic and foreign studies, prospective observations and meta-analyzes on the relationship between vitamin D deficiency and arterial hypertension., Competing Interests: The authors declare no conflict of interest.

Recently, they increasingly began to pay attention to the role of a nonspecific immune-inflammatory vascular response as a link in general pathogenetic mechanisms with a change in the elastic properties of arteries and phenomena of destructive bone changes, which at the subclinical level is of great importance for the prevention of the development of socially significant diseases. A total of 104 patients were examined (mean age 57.45 years), which were divided into three groups. The first group included 39 healthy women, the second group included 30 patients with hypertension and osteopenia, and the third group included 35 women with hypertension and osteoporosis. The analysis of markers of the immune inflammatory response, endothelial dysfunction, hormonal and mineral-vitamin status parameters was conducted against the background of the study of parameters of daily monitoring of arterial pressure, study of parameters of vascular wall stiffness and densitometry to clarify the predictors of cardiovascular and degenerative bone changes in postmenopausal women. A significant increase in the concentration of HF-CRP, the level of homocystemine, IL-8, parathyroid hormone, against the background of a significant decrease in the level of estrogen, progesterone, testosterone, with a persistent tendency to increase in total cholesterol, atherogenic lipid fractions, myeloperoxidase, endothelin-1 and decrease was recorded calcitonin, total and ionized calcium, with a significantly minimal value of vitamin D in the 3rd group of patients. The risks of development and progression of bone destructive changes were calculated using the logistic regression method for the group of AH with osteopenia and osteoporosis. Thus, for patients with hypertension and osteopenia, a significantly significant parameter associated with the risk of developing osteoporosis was an indicator of the velocity of the pulse wave, an increase in the level of which exceeds 12.05 m/s is associated with an increased risk of developing osteoporosis by 3.8 times. Increased levels of pro-inflammatory parameters, IL-6 and 8, TNF-α, HB-SRB, parathyroid hormone and reduced levels of progesterone and IL10, took the most active part in aggravating the degree of available bone tissue destruction. Timely specialized multidirectional study of biochemical and instrumental parameters (in particular, the study of the speed of the pulse wave and densitometry) can be the basis for the development of personalized prevention and treatment tactics for women in order to prevent socially dangerous cardiovascular and bone complications., Competing Interests: The authors declare no conflict of interest.

The study of the causes of the development of vascular coronary complications after angioplasty with stenting using the evaluation of biochemical parameters in the dynamic observation of patients with IHD with significant coronary stenosis determines the relevance of the study. To analyze the parameters of lipid spectrum and markers of vascular inflammatory reaction in patients with IHD, in groups with stable angina and episode of unstable angina after angioplasty with stenting, to trace the dynamics of biochemical parameters and to reveal the predictors of undesirable coronary events. Patients with IHD with significant coronary stenosis of the arteries (SCS, n = 95) after coronary angiography at the point of maximum increase in the level of markers of the inflammatory reaction (3 months after angioplasty) are divided into 2 groups - patients with persistent stable angina pectoris (SA, n = 77) until the end of the study and patients with developed postvascularization episode of unstable angina (UA, n = 18). The dynamics of observation of biochemical parameters recorded the absence of normalization of the atherogenic spectrum of the lipid profile and the prolonged nature of the vascular inflammatory response to the end point of observation after angioplasty.The method of binary logistic regression revealed that in the general group of patients with IHD, an increase in the level of low density lipoprotein cholesterol by 1 mmol / L significantly increases the probability of significant coronary stenosis in men and raises the risk of UA after angioplasty by 7.38 times. It was found that patients with UA at the initial stage have a significantly higher risk of coronary blood flow instability in the post-vascularization period due to an elevated level of homocysteine. A set of biochemical markers for predicting the significance of coronary stenosis and development of undesirable vascular coronary events after angioplasty in patients with IHD has been identified: male sex, elevated LDL cholesterol and hyperhomocysteinemia., Competing Interests: The authors declare no conflict of interest.

Aim: To evaluate the degree of carotid artery (CA) atherosclerotic lesion and lipid metabolic disturbances in patients with hypertension and in those with hypertension concurrent with coronary heart disease (CHD) in the indigenous and non-indigenous population living in the Yamal-Nenets Autonomic District., Subjects and Methods: Two hundred men and women aged 21 to 55 years (mean age 48.2 ± 0.7 years), who resided in the Far North, were examined. The patients were divided into 4 gender-and age-matched groups of 50 persons in each: 1) natives; 2) newcomers with hypertension only; 3) natives with CHD and hypertension; 4) non-natives with the above conditions. To study CA involvement, all the patients underwent duplex scanning of the brachiocephalic arteries at the extracranial level and blood lipid analysis in an outpatient setting (Salekhard)., Results: In all the patients, common CA intima-media thickness was significantly greater than the upper limit of the normal range defined in the Guidelines, this indicator proved to be highest in the groups of indigenous people (p<0.001). The latter with CHD and hypertension more commonly tended to have atherosclerotic lesion in the left CA (p=0.06) than the non-indigenous people whereas the number of stenosis in other CAs was similar. In the natives versus the newcomers with CHD and hypertension, the atherogenic blood lipid composition was due to the higher levels of total cholesterol and low-density lipoproteins. In the non- indigenous patients with CHD and hypertension, the atherogenicity of the blood lipid composition was characterized by the higher levels of triglycerides (p=0.04) and very low-density lipoproteins (p=0.02) with the lower concentrations of high-density lipoproteins as compared to those in the natives with CHD and hypertension.

Objective: To study special characteristics of the course of arterial hypertension (AH) among native and nonnative population of Yamalo-Nenets autonomous district., Material and Methods: We examined 100 residents of Far North with AH (men and women aged 21-55, mean age 44.08 ± 1.15 years). All patients were divided into 2 equal groups by 50 subjects: group I consisted of representatives of native and group II--nonnative population. Examination was carried out in outpatient clinic in Salekhard and included 24-hour ambulatory blood pressure monitoring (ABPM), registration of heart rate variability, duplex scanning of brachiocephalic arteries, and assessment of blood lipid profile. The groups were matched by age, gender and disease duration., Results: Analysis of heart rate variability detected significant degree of strain of regulatory systems in most patients of both groups. According to results of ABPM "non-dipper" patients prevailed in group I compared to group II (p = 0.01). Common carotid artery intima-media complex was significantly greater compared to normal value in all patients; it was thicker in group I (p < 0.03), but number of carotid artery stenoses was similar in both groups. No dyslipoproteinemia was detected., Conclusion: Compared with group of representatives of nonnative (adopted) population group of native subjects with AH was characterized by greater carotid intima media thickness and prevalence of "non-dipper" patients.

The work aimed at studying atherosclerotic lesions in brachiocephalic arteries and lipid spectrum in coronary heart disease (CHD) and arterial hypertension (AH) in indigenous and alien population of Yamalo-Nenetsky Autonomous District. It included 200 patients with CHD and AH (men and women aged 21-55 years, mean 48.2 +/- 07 yr). They were allocated to indigenous and alien groups (100 persons each). The patients matched for age and sex were examined by duplex scanning based at an outpatient facility (Salekhard). The indigenous population showed more pronounced thickening of the intima-media complex (IMC) of the common carotid artery (p = 0.001) and more frequent lesions of the main head arteries with stenosis of different severity (especially in internal carotid arteries). Total cholesterol, LDLP and atherogenicity index were similar in both groups and higher than normal. Indigenous subjects had less atherogenic structure of the lipid spectrum due to lower TG and VLDLP but higher HDLP levels.

Aim: To investigate the specific features of a 24-hour blood pressure (BP) profile and heart rate variability (HRV) in the indigenous peoples (Nenets, Khanty, Selcups, and Komis) and newcomers with chronic coronary heart disease (CHD) and hypertension, who lived in the Yamal-Nenets Autonomic District., Subjects and Methods: Two hundred male and females patients aged 21 to 55 years (mean age 48.2 +/- 0.7 years) with chronic CHD and hypertension, who resided in the Far North, were examined. All the patients were divided into 4 groups: (1) 50 aboriginal patients with hypertension only; (2) 50 newcomers with hypertension only; 3) 50 natives with chronic CHD and hypertension; (4) 50 non-natives with the above conditions. The groups were matched for gender, age, and the duration of hypertension and CHD. To study the nature of changes in the 24-hour BP profile, all the patients underwent 24-hour ambulatory BP monitoring (ABPM) and HRV examination., Results: The HRV analysis revealed that all the groups had increases in sympathetic autonomic nervous system (ANS) activity (88% in Group 1; 96% in Group 2; 94% in Group 3, and 92% in Group 4) and decreases in parasympathetic ANS activity (76% in Group 1; 74% in Group 2; 78% in Group 3; and 72% in Group 4), which was suggestive of neurocardiopathy. Analyzing the data of 24-hour ABPM showed that among the natives, there were more patients with increased systolic and diastolic BP (SBP and DBP) variability and higher nocturnal SBP time index (TI). These groups also showed a preponderance of patients with abnormal 24-hour BP profiles as compared to the groups of newcomers (p = 0.034). Among the latter, there were more patients with higher SBP and DBP variability and increased daytime DBP TI and also more patients with a normal nocturnal BP reduction (p = 0.012)., Conclusion: The group of indigenous populations displayed a predominance of non-dippers and night-pickers and higher nocturnal SBP and DBP whereas the group of non-indigenous ones exhibited a preponderance of dippers and higher daytime SBP and DBP variability.

Aim: To investigate the effects of ivabradine in combination with perindopril on cerebral blood flow and endothelial functional activity., Subjects and Methods: Sixty-four patients with coronary heart disease (CHD) and arterial hypertension (AH) were examined. Group 1 (n = 38) patients took ivabradine in combination with perindopril and Group 2 (n = 26) received metoprolol. At baseline and 8 weeks after therapy, 24-hour blood pressure (BP) monitoring and electrocardiography were done, cerebral blood flow was estimated by Doppler ultrasound, reactive hyperemia and nitroglycerin tests were performed, and plasma nitrite levels were determined., Results: With a comparable decrease in BP and heart rate in the internal carotid artery basin in both groups over time, there was a fall in peak systolic blood flow velocity; Group 1 showed a reduction in pulsatility index (PI) and systolic/diastolic ratio (ISP). After 8 weeks, there was an increase in endothelium-independent vasodilation and baseline blood flow velocity in the brachial artery in Group 1 and a rise in endothelium-dependent vasodilation in Group 2; in both groups, reactive hyperemia were higher in the brachial artery basin. No changes in nitrite levels were recorded during therapy. There was an inverse correlation between PG and PI in Group 1 and between PG and ISP in Group 2., Conclusion: By unidirectionally affecting the vasomotor function of the endothelium, ivabradine in combination with perindopril versus metoprolol has a more favorable effect on circulatory resistance and blood flow velocity in the brachiocephalic arteries of patients with CHD and AH.

This comparative analysis of structural and functional changes in the heart is based on the results of 24 hour monitoring arterial pressure (MAP) in 393 men aged 20-59 years. Group 1 comprised 220 patients with arterial hypertension (AH) working on a rotating schedule in the Far North. They showed signs of hyper-reactivity of sympathetic component of the vegetative nervous system manifest as the high mean daily heart rate and variability of AP. Significant difference between MAP and office AP values reflected psychoemotional stress reaction during AP measurement. Daily AP rhythm in patients with grade I and II AH was described by a flat AP curve and hemodynamic load at night. The group with grade II AH included a large number of "night peakers" and subjects with inverted daily AP rhythm as a manifestation of external desynchronosis with night-time hypersympathicotonia. Differently directed daily changes of systolic and diastolic AP suggested internal desynchronosis of AP rhythm coupled to a significant increase of left ventricular myocardial mass (LVMM) and LVMM index in the absence of difference between LVDF. Patients with AH showed no correlation between LVMM, LVDF, and MAP values. It is concluded that hyperactivity, desynchronosis, and systemic dysregulation along with hemodynamic loading may play a key role in the development of structural and functional changes in the heart of AH patients during adaptation to extreme conditions of the Far North.

The objective of this study was to evaluate effect of "dry" bi-carbonate baths (DBB) on the circadian profile of arterial pressure (AP) in patients who suffered acute myocardial infarction (AMI). Diurnal AP profiles were analysed in all patients after AMI. The patients comprising group 1 were treated with the use of DBB while the remaining ones received a sham treatment. 24 hour AP monitoring was performed before and after therapy. The study revealed a reduction in the frequency of hypotensive diastolic values at the daytime and in the duration of night-time hypertensive episodes under the influence of therapy with the use of DBB. Variability of systolic AP throughout 24 hours and of diastolic AP at daytime also decreased. Generally speaking, patients with elevated AP showed a more pronounced effect of DBB on the night AP profile. It is concluded that therapy with the use of DBB after AMI has beneficial effect on the clinical state of the patients and reduces the risk of cardiovascular complications.

Aim: To evaluate basic parameters of lipid metabolism in patients with arterial hypertension (AH) stage I and II and normotensive subjects living in the far North of the Russian Federation (Khanty-Mansiysk Autonomic Region, Nyagan)., Material and Methods: Lipid spectrum was studied in 70 males and females with AH stage I and II, 280 normotensive males and females matched for sex, age, time of residence in the North., Results: Sex-related differences by concentrations of blood lipids become less pronounced with progression of AH while a concentration of atherogenic lipid fractions in AH patients rises. High prevalence of dyslipidemia, primarily hypercholesterolemia, in hypertensive and normotensive subjects is a prognostic factor of coronary atherosclerosis. Paired correlations indirectly confirm the effect of climatic factors on blood lipids., Conclusion: It is necessary to correct lipid spectrum and risk factors in hypertensive and normotensive subjects as a prophylactic measure.

Aim: To study endothelial function and vascular elasticity in hypertensive patients with coronary heart disease (CHD) and approaches to correction of the impairments with felodipin and perindopril., Material and Methods: The trial included 34 hypertensive patients with CHD and 17 controls free of cardiovascular diseases. The above cardiovascular patients were randomized into two groups: 15 patients of group 1 received felodipin, 19 patients of group 2 were given perindopril. If the target blood pressure was not achieved after 4 weeks of treatment, 12.5 mg hydrochlorotiazide was added. 24-h monitoring of blood pressure, reactive hyperemia and nitroglycerin tests were made initially and after 8-week treatment. Also, calculations were made of pulse wave velocity (PWV) on the carotid-femoral and carotid-radial segments (Ve and Vm), of elastic modulus for arteries of the elastic and muscular types (Ee and Em)., Results: Baseline endothelium-dependent and non-endothelium-dependent vasodilations (EDVD and NEDVD) in cardiovascular patients were lower than in the controls while Ve and Ee were higher. Systolic blood pressure (SBP), pulse blood pressure (PBP), stress SBP and EDVD correlated. The treatment led to reduction of mean circadian, diurnal and nocturnal SBP, diastolic blood pressure (DBP), PBP, Ve and Ee, to elevation of EDVD., Conclusion: EDVD in hypertensive patients with CHD is related with SBP and PBP. Felopidin had both an antihypertensive and vasoprotective effects due to improved endothelial function and better elasticity of the major arteries comparable to effects of perindopril.

The aim of the study was to evaluate cardiac rhythm variability (CRV) during active orthostatic test (AOT) in patients with arterial hypertension (AH) living in Tyumen near-Ob region. Fifty-two patients with AH and 32 practically healthy persons were examined. Under outpatient conditions in the city of Pyt-Yakh, 5-min CRV recording was performed by standard technique in the supine position and during AOT, and temporary and spectral parameters were evaluated. In both groups, parameters of the temporary analysis of CRV during AOT differed significantly. The values of optimal variability in AH patients displayed significant deviations, while the deviations in the control group were moderate. Analysis of spectral parameters of CRV during AOT revealed an increase in the values of total spectrum power of CRV in both groups. The values of optimal CRV parameters evidenced the presence of disbalance in the vegetative regulation of cardiac rhythm in the subjects. The results of temporary analysis found a lowered activity of parasympathetic vegetative regulation, while spectral analysis revealed an increased sympathetic influence on cardiac rhythm. The values of the index of regulatory system tension during AOT suggest that in both groups the adaptive abilities of the mechanisms of vegetative regulation of cardiac rhythm were preserved.

Aim: To examine heart rate variability (HRV), some biochemical and echocardiographic indices in hypertensive patients living in the Tyumen Ob region., Material and Methods: Registration of HRV, blood count and echocardiography were made in natural conditions of the North in 52 hypertensive patients (36 males, 16 females, age 20-50) living in Tyumen Ob region and 32 healthy controls (19 males, 13 females) matched by age and residence., Results: Time and spectrum analyses of HRV indices show predominance of the sympathetic link of heart rhythm autonomic regulation in hypertensive patients. Night shifts affect the activity of the sympathetic link of heart rate autonomic regulation destroying its circadian pattern both in hypertensive and normotensive patients., Conclusion: Healthy persons initially experience overactivity of the regulatory systems and have the risk for cardiovascular diseases. Working at night shifts accelerates functional exhaustion.

Aim: To evaluate efficacy and safety of a 6-month treatment of 237 patients with arterial hypertension (AH) of degree 1-3 with ACE inhibitor enalapril (mean dose 21.9 +/- 9.0 mg/day), 49.4% of which received adjuvant indapamide (2.5 mg/day), to study effects of this therapy on rigidity of the major arteries by dynamics of pulse wave velocity (PWV) and US rigidity index beta (RIB)., Material and Methods: The study included only patients with initially elevated PWV which was detected in 266 (53%) of 501 examinees., Results: Lowering of systolic and diastolic blood pressure (BP) was 16.8 and 14.0% to treatment month 3 and, in addition, 1.6 and 1. 7% to month 6, respectively (p < 0.001). Target BP (< or = 140/90 mm Hg) was achieved in 82.7% patients. During the trial 3 (1.2%) patients withdrew because of severe cough. Slowdown of PWV measured by brachiomalleolar (PWVbm) and carotid-femoral (PWVcf) methods was equal in the course of the trial and made up 2.45 and 6.1% to treatment month 3 (p < or = 0.05 for both) and additional 3.25 and 7.4% to month 6 (p < 0.001 for both), respectively. High PWV normalized completely in 42.6% patients. After 6 months of the trial US RIB decreased by 30.5% (p < or = 0.001). The correlation analysis detected a significant correlation between SAP fall and PWV decrease only during the first 3 months of therapy (r = 0.402, p = 0.005). In month 3-6 the correlation became insignificant (r = 0.28, p = 0.055)., Conclusion: Combination of enalapril and indapamide is effective and safe in outpatients with arterial hypertension of the first-third degree and baseline high rigidity of the vascular wall. This treatment reduces PWV and rigidity of the major arteries associated with BP lowering (in the treatment month 1-3) and a vasoprotective effect of the drugs.

The circadian and ultradian rhythms of blood pressure (BP) and heart rate (HR) were studied by means of 24-hour BP monitoring in patients with arterial hypertension (AH) and practically healthy people working in Far North shifts. The subjects were 418 men. The main group consisted of 177 men aged 18 to 59 working in trans-polar shifts in Yamburg, Tyumen region, latitude 57 North. The comparison group included 158 residents of a moderate climatic zone (Tyumen, latitude 57 North). The control group consisted of 83 practically healthy men, of whom 43 worked in Far North shifts, and 40 were residents of Tyumen. The groups were comparable by age, AH duration, and office systolic and diastolic BP (SBP; DBP). The study demonstrates that even healthy people working in Far North shifts display high BP variability and the decrease of the stability and power of SBP, DBP and HR circadian rhythms due to the reduction of the amplitude, contribution of the rhythm to the total variability, and the increase of the amplitude of high-frequency harmonics of the spectrum (a manifestation of extracircadian dissemination), which may be a sign of accelerated ageing and biological age increase, and may facilitate AH development. Development of AH under the extreme conditions of Far North shifts, unlike the conditions of moderate climatic zones, is accompanied by progressive BH variability increase, the worsening of the chronological structure of SBP and DBP, the increase of extracircadian dissemination, which can be of both clinical and prognostic significance.

Aim: To compare hypotensive and antiischemic efficacy of enalapril combination with trimetazidine or placebo, effects on plasmic lipid spectrum and membrane-cell parameters of erythrocytes and platelets in hypertensive patients with ischemic heart disease (IHD) in the presence of metabolic disturbances., Material and Methods: A randomized placebo-controlled comparative trial included 64 patients (mean age 55.60 +/- 0.52 years) with hypertension stage I-III, IHD (stable effort angina FC II-III, obesity of the first-third degree, diabetes mellitus type 2. The patients were divided into two groups matched by gender, age, duration of the disease, office blood pressure (OBP), functional class (FC) of effort angina, body mass index, glucose levels in the blood. 43 patients of group 1 received enalapril and trimetazidine. 21 patients of group 2 were treated with enalapril and placebo. The efficacy of the treatment was assessed by changes in the 24-h profile of BP and ECG, blood lipid spectrum and membrane-cell parameters., Results: A significant fall was seen in systolic blood pressure of both groups patients. In group 1 there was an additional lowering of temporal index of systolic pressure, nocturnal diastolic, mean 24-h diastolic, mean 24-h blood pressure, double product of ischemic episodes, total cholesterol, dienic conjugates in platelets. Catalase activity in erythrocytes rose., Conclusion: An antiischemic effect of the therapy in stabilization of blood pressure, normalization of plasmic lipids and lipoperoxidase in erythrocytic and platelet membranes under multidirectional correlations between clinical and biochemical parameters point to different mechanisms of ischemic correction in enalapril and trimetazidine.

Aim: To determine characteristics of a clinical course, 24-h profile of arterial pressure (AP), of renal hemodynamics, involvement of target organs in patients with arterial hypertension (AH) of the third degree and anomalies of renal arteries., Material and Methods: 24-h monitoring of AP, echocardiography, measurement of microalbuminuria, renal hemodynamic were made in 15 patients (9 female, 6 male) having resistant AH of the third degree and different anomalies of renal arteries (mean age 45.3 +/- 1.9 years). The control group consisted of patients with essential AH stage III (mean age 45.3 +/- 1.8 years). The groups were comparable by sex, age, duration of AH., Results: The patients of the study group had a significantly lower pulsatility index in the renal artery and interlobular level and resistance index at the segmental and interlobular level of the RA on the side of the anomaly. There was a significantly higher minimal diastolic blood flow velocity in the segmental level of RA on the side of the anomaly. Renal scintigraphy revealed a decreased index of radiopharmaceutical accumulation. A positive correlation was found between the pulsatility index, resistance at a segment RA level and variability, an increase of morning diastolic blood pressure. The groups had significant differences neither by 24-h AP indices nor by severity of target organ lesion., Conclusion: Patients with RA anomalies have specific renal hemodynamics determining renal hypoperfusion on the side of the anomaly which may be involved in development of resistance to hypotensive therapy.

Aim: To specify a 24-h profile of arterial pressure (AP) in hypertensive patients working in duty regime in the Far North (Tyumen Region)., Material and Methods: AP parameters were studied in 155 males aged 25-59 with hypertension of stage I, II who were employed for duty work in the Far North areas and 38 control patients with hypertension stage I, II living in a moderate climatic zone (Tyumen). The groups were comparable by gender, age, duration of hypertension, office systolic and diastolic AP (SAP and DAP). All the patients have undergone 24-h monitoring of AP with assessment of basic mean parameters., Results: The study group patients had scare symptoms and lower mean 24-h SAP, but high AP variability, high DAD as reflection of more significant structural changes of vessels and special functioning of the autonomic nervous system in the North. Mean 24-h AP showed more unfavourable changes in hypertensive subjects who had flight from Yamburg-Moscow-Yamburg., Conclusion: The data of the study dictate the necessity to develop a differentiated risk strategy for health promotion, prevention and treatment of hypertension in those who work in the North of Tyumen Region in duty regime.

Aim: To study effects of fosinopril on a 24-h profile of blood pressure (BP) in hypertensive patients with obesity and hypercholesterolemia., Material and Methods: A randomized comparative trial enrolled 96 patients aged 30-50 years with arterial hypertension (AH) of the first and second degree. The patients were randomized into 2 groups by age, gender, AH duration, office AP, body mass index, cholesterol level. The patients of group 1 received fosinopril (monopril) in a single daily dose 10 mg with further rise to 20 mg. The patients of group 2 were given metoprolol twice a day in a dose 25 mg with further rise to 75 mg. Examination of the patients was made before the treatment and after 16 weeks of therapy with fosinopril and metoprolol., Results: A 16-week therapy with fosinopril resulted in lowering of office BP, mean day systolic, diastolic, pulse BP. The profile of SBP improved: the number of "dippers" with an adequate day profile of BP rose. Fosinopril significantly reduced left ventricular myocardial mass (LVMM) and myocardial mass index. Metoprolol had the same hypotensive action but had no effect on mean 24-h pulse and mean BP, LVMM, LVMM index., Conclusion: Fosinopril is more effective than metoprolol in relation to a 24-h profile of BP and LVMM reduction.

Aim: To elucidate effect of nebivolol on parameters of cerebral hemodynamics and 24-hour blood pressure (BP) profile in patients with hypertension., Material and Methods: Patients with hypertension of 2nd degree (n=55, age 35-50 years) were divided into 2 groups with similar age, sex, duration of hypertension, and office BP level. Thirty one patients received nebivolol (5-7.5 mg/day), 24 -- atenolol (75-100 mg/day) for 8 weeks., Results: Nebivolol affected positively 24-hour BP profile (decreased variability and morning increase of BP), improved parameters of cerebral hemodynamics (increased index of cerebrovascular reactivity which reflected the state of adaptation of cerebral arteries). Atenolol exerted similar antihypertensive action but did not alter variability and morning increase of BP. Effect of atenolol on cerebral hemodynamics comprised increases of cerebrovascular reactivity index and vasoconstriction reserve., Conclusion: Compared with atenolol nebivolol exerts more favorable effect on 24-hour BP profile and improves cerebral hemodynamics at the account of increased vasodilatation reserve.

Efficacy of combination of trimetazidine (60 mg/day) and enalapril in patients with stable effort angina and metabolic syndrome was assessed in a randomized placebo controlled study of 64 patients. Anti-ischemic activity of trimetazidine was found to be significant. It was most pronounced in patients with abnormal 24-hour blood pressure index, waist/hip circumference ratio >1.0 at the background of satisfactory clinical and laboratory compensation of type 2 diabetes.

Echocardiography and 24-hour BP monitoring were carried out in 177 men with stage 1 and 2 essential hypertension aged 25-59 years when they worked the Far North shift (group l) and in 75 patients with essential hypertension living in moderate climatic zone (group 2). Normal left ventricular geometry was found in 10 and 39% of subjects in groups l and 2, respectively. Left ventricular hypertrophy (LVH) was 2 times more frequent in group 1 where it was predominantly concentric. Contrary to group 2 significant correlations between parameters of 24-hour BP monitoring and echocardiography were found in group 1. All variants of left ventricular geometry in group 1 were characterized by lower systolic BP, high variability of systolic and diastolic BP, impaired 24-hour BP rhythm because of decreased night-day difference. Group 1 subjects with concentric left ventricular hypertrophy had significantly increased left ventricular mass index. Diastolic nocturnal hypertension was the factor most closely related to the structural state of the myocardium in group 1.

Key parameters of 24-h blood pressure monitoring (BPM) in 46 18-50-year-old patients (men and women) with arterial hypertension (AH) stage I, II and 33 healthy persons living in the Tyumen North (Khanty-Mansiysky Region, the town of Nyagan) were investigated. The comparison group consisted of 55 patients with AH stage I, II and 33 healthy persons living in moderate climate (Tyumen) matched by sex, age, duration of AH, office systolic and diastolic arterial pressure (SAP, DAP). General patterns of 24-h and seasonal rhythms of AP fluctuations in healthy northerners and citizens of moderate climatic zone and mismatch of these rhythms in AH patients more evident in the northerners are shown. Paired correlations were obtained which indirectly confirm the priority role of daily AP rhythm in development of visceral lesions irrespective of the season of the year and climatic load. In the North, when winter meets spring, a surge of SAP, DAP and mean AP occurs as well as an increase in heart rate, number of patients with disturbed circadian profile of AP. In moderate climate these changes are more typical for summer period. The results of the study necessitate design of programs of additional pharmacological and preventive measures for hypertensive northerners with consideration of AP seasonal rhythms and climatic load.

Arterial pressure (AP) was monitored in 46 patients with arterial hypertension (AH) aged 18-50 years and in 33 healthy subjects living in Russian North (Tyumen Ob area, Nyagan). The comparison group consisted of 55 patients with AH and 33 healthy subjects living in a moderate climatic zone (Tyumen). The groups were comparable by gender, age, duration of AH, office systolic and diastolic AP (SAP and DAP). Healthy subjects of Tyumen North compared to those living in the moderate climate had more pronounced vegetative imbalance which may transform into AH. The North AH is characterized by high meteorability, impaired circadian AH profile with reduction of the SAP fall day-night and an increase of the DAP fall, greater variability of AP, elevated AP day load, low night DAP. This classifies AH in the northerners as isolated systolic. While AH development in the North takes place due to marked AP fluctuations, in moderate climate it follows a classic variant--due to a DAP rise. The above changes may help prognosis of emergence of cardiovascular complications in hypertensive patients living in the North.

Aim: To study a 24-h profile of arterial hypertension and affection of target organs in hypertensive population of the Tyumen North., Material and Methods: 62 patients (43 men and 19 women, age 18-50 years) with arterial hypertension (AH) living in the North of the Tyumen region entered the test group. The control group consisted of 56 AH patients (36 men and 20 women) matched by age. They lived in the zone of moderate climate (in Tyumen). 24-h arterial pressure (AP) monitoring was made starting on day 2 of the patients' arrival in Tyumen. Echocardiography was made on the arrival day. The examination of the groups was conducted against "clean" background., Results: The groups did not differ significantly by age, sex, AH duration, office systolic and diastolic pressure (SP, DP). However, 37 patients from the test group on arrival in Tyumen showed normalization of both office AP and mean 24-h AP. 25 patients from this group sustained high office and mean 24-h AP. An abnormal 24-h AP profile with nocturnal hypertension was recorded in 76.6% of the test group and 28.31% patients of the control group. Left ventricular hypertrophy was significantly more pronounced in the test group than in the control one., Conclusion: In 2/3 patients from the North with AH stage 1 and 2 office AP and mean 24-h AP normalized upon their arrival to the zone of moderate climate but their left ventricular hypertrophy was more severe and changes in a 24-h AP profile with nocturnal hypertension persisted.

A placebo-controlled parallel trial studied an antihypertensive action of interrupted normobaric hypoxia (INH) in 63 male patients with arterial hypertension (AH) of the first degree and low and moderate risk of vascular complications. The placebo group consisted of 18 patients with AH of the first degree matched by age, the disease duration, initial level of systolic and diastolic pressure. An INH course consisted of 15 daily procedures. INH monotherapy implied oxygen content lowering to 10%. A 6-month follow-up was made with the use of 24-h AP monitoring. The INH course resulted in a significant decrease in systolic and diastolic AP, total peripheral vascular resistance. A morning rise of systolic pressure became slower. A favourable effect of normobaric hypoxia on AP 24-h rhythm was observed. A good hypotensive effect was achieved in 85.7% patients. A 6-month follow-up confirmed a long-term hypotensive effect of INH.

Chronostructure of arterial pressure (AP) and heart rate (HR) was studied in 62 residents of Tumen Region North with arterial hypertension (AH) aged 18-50 years and 56 AH controls living in the temperate zone. The groups were matched by age, sex, AH duration, office systolic and diastolic arterial pressure (SAP and DAP, respectively). Circadian AP profile with night hypertension was registered in 76.6 and 28.3% patients of the test and control groups, respectively. Test group patients had more pronounced defects in DAP and HR chronostructures. Thus, AH patients living in the Tumen North demonstrate abnormal circadian AP profile and AP and HR chronostructure. This may be prognostically important for development of cardiovascular complications.

34 male patients with hypertension stage I and II aged 29-52 years (mean age 40.9 +/- 6.00) having mean 24-h arterial pressure (AP) above 135/85 mm Hg in mean daytime AP above 140/90 mm Hg and heart rate maximum 80 b/m entered the study of AP chronostructure in conditions of pure background and on enalapril treatment week 4, 8 and 12. The initial dose of the drug was 5 mg. Dose selection was controlled by 24-h AP monitoring. Enalapril was shown to significantly reduce mean daytime and 24-h AP as well as hyperbaric index, chronobiological time index, variability of systolic AP. The above dose selection brought more balanced AP lowering at daytime and at night. After 11 weeks of treatment no night-peakers were registered, the number of over-dippers decreased. Circadian rhythm of some hemodynamic parameters was characterized by a significant fall of rhythm average in unchanged acrophase and circadian AP amplitude indicating physiological action of enalapril.

Aim: To assess clinical efficacy and effect on platelet alterations of 12-month captopril monotherapy in essential hypertension (EH) patients with coronary heart disease (CHD)., Material and Methods: A randomized placebo-controlled parallel study was performed. Arterial blood pressure (BP), frequency of angina pain attacks, standard submaximal bicycle exercise test (BET), echocardiography, ADP-induced platelet aggregation (PA), levels of cholesterol (CH), lipid peroxidation products, intracellular Ca, Ca(++)-ATPase activity were studied before and 2 weeks, 2, 6 and 12 months after captopril therapy in 68 males aged 35-58 years with moderate EH in combination with CHD, stable angina of effort and normal left ventricular ejection fraction (57.5 +/- 1.2%)., Results: In spite of a stable antihypertensive effect of C within all the treatment period, frequency of anginal pain attacks and number of positive BET markedly reduced only during 6 months of C therapy. Left ventricular hypertrophy regression was not registered. Of all the platelet parameters only Ca(++)-ATPase, Ca and malonic dialdehyde (MDA) beneficial changes persisted for 12 month treatment period: Ca(++)-ATPase activity increased, Ca and MDA content reduced. The other platelet parameters were less persistent. BP lowering correlated with Ca(++)-ATPase, CH, MDA and PA changes whereas the number of anginal pain attack correlated with CH and PA reduction., Conclusion: A beneficial effect of captopril on BP persisted for 12 months, on angina symptoms--for 6 months. One of the mechanisms of antihypertensive and antianginal effect of captopril is attributed to platelet alterations correction.

In a placebo-controlled study an antihypertensive activity of low-intensive laser radiation (LILR) was evaluated in 52 males with essential hypertension stage I. The placebo group consisted of 14 matched patients. LILR was used as monotherapy of 10 daily procedures. This treatment significantly lowered systolic, diastolic and mean arterial pressure. Moreover, diastolic arterial pressure did not rise high at submaximal bicycle exercise. Total peripheral vascular resistance also decreased. A good hypotensive effect was achieved in 90.4% cases. Thus, LILR is a highly effective treatment in essential hypertension stage I.

The aim of the study was evaluation of ACE inhibitors (captopril and ramipril) effect on water-salt homeostasis in the treatment of patients with arterial hypertension (AH) living in the Far North of Russia. 100 male patients with mild and moderate AH were examined 2 weeks, 3 and 6 months after administration of captopril or ramipril. The drugs are shown to correct water-salt metabolism. This is explained by better renal function due to speeding up glomerular filtration and increased sodium excretion with urine, and by activity of humoral mechanisms (inhibited activity of plasma renin, low plasma concentration of aldosterone and its 24-h excretion). Comparison of captopril versus ramipril demonstrates advantages of prolonged ramipril in respect to regulation of water salt metabolism in the treatment of essential hypertension in the Far North.

A total of 95 hypertensive men working in duty regimen in the extreme North were examined. The men were found to have lipid metabolism disorders, activation of lipid peroxidation, decreased antioxidant defense in red cell membranes in all the examinees vs control hypertensive men living in moderate climatic zone. Effect of 2-week monotherapy with emoxipin was studied in 29 males with mild arterial hypertension free of obesity and coexisting diseases. Placebo was given to 10 patients. Emoxipin had an antihypertensive and antioxidant effects, improved structural-functional condition of erythrocytes in hypertensive patients.

The effect of low-energy laser irradiation used as monotherapy was studied in 42 patients with early essential hypertension. Hypotensive and antioxidant effects of laser therapy, its ability to decrease total peripheral resistance were more pronounced in patients with stage I hypertension.

Aim: To study the role of cell membrane disorders in the formation of arterial hypertension under conditions of Extreme North., Materials and Methods: A total of 128 men aged 20-48 years with essential hypertension (EH) were examined. All of them worked in the duty regimen at the Extreme North. Control group consisted of EH patients living in the temperate climatic zone. Central and peripheral hemodynamic parameters and cell membrane characteristics were studied: activities of transmembrane ion transport enzymes, intracellular electrolytes sodium and calcium, lipid peroxides (LPO), antioxidant defense values in erythrocyte membranes, plasma and cell membrane cholesterol., Results: Activation of LPO processes and decreased antioxidant defense in both groups modified the lipid spectrum of cell membranes. The levels of intracellular calcium and sodium were increased, activities of Na(+)-K(+)-ATPase and Ca(2+)-ATPase decreased; total peripheral vascular resistance and left ventricular myocardium were progressively increasing., Conclusion: Membrane-destabilizing processes and hemodynamic shifts were more expressed in subjects with arterial hypertension working in the duty regimen.

Beta-blocker anapriline and calcium antagonist corinfar are highly effective hypotensive agents. Drop in diastolic arterial pressure with anapriline therapy amounted to 15.9 and 15.6%, with corinfar therapy-to 15.0 and 15.6% in hypertensive disease stage I and II respectively. Hypotensive action of corinfar might result from correction of impaired cation-transport function of cellular membranes, electrolyte homeostasis of cells, phospholipid composition of membranes. No dynamics has been revealed of the membrane tests under study during administration of anapriline therapy treatments.

Intracellular homeostasis of calcium was studied in patients with essential hypertension by two methods: calcium measurements using Lachema kits and study of the kinetics of interaction between chlortetracycline fluorescent probe and cellular membranes. Both the methods are highly sensitive, but they reflect different aspects of calcium homeostasis of the cells and supplement each other, and therefore should be used together to assess the severity of essential hypertension and monitor the therapy administered. The method of interaction of chlortetracycline with cellular membranes should be preferred as a more up-to-date and informative.

A total of 110 young males suffering from hypertensive disease (HD) were studied. Out of them 21 patients had concurrent HD. As HD progresses, there is an accumulation of free cholesterol in the lipid bilayer of erythrocytic membranes, which promotes the limitation of higher membrane permeability for calcium ions. The excessive accumulation of cholesterol also results in an additional decrease in Na+K+. ATPase activity and Ca(2+)-ATPase inhibition in the erythrocytic membranes in hypertensives, which produced atherogenic effects.

In 76 untreated patients with Stages I-II hypertensive disease, spectrophotometry with lipid specific pyrene fluorescence probe revealed higher microviscosity in the lipid phase of neutrophilic membranes, which was induced by elevated levels of cholesterol and enhanced activation of lipid peroxidation. This resulted in increased functional and metabolic neutrophilic activity which was determined by luminol-dependent zimozan-induced chemiluminescence of whole venous blood. The correlation coefficient between the microviscosity of membranes and the chemiluminescence of neutrophils is 0.82 (p).

The effect of cholagogic drugs on blood plasma content of natriuretic hormone (NH) in 41 patients with chronic opisthorchiasis was studied. The drugs were found to exert no effect on NH content and the kidney function in this pathology. The use of essentiale in patients with persistent hepatitis and cirrhosis of the liver was shown to increase sodium excretion due to an increase of NH content.

A study is presented of the activity of Na(+)- K(+)-, Mg2(+)- and Ca2(+)-ATP-ases, lipid spectrum of the erythrocytic membranes and the content of intracellular sodium and potassium in 26 patients with borderline arterial hypertension (BAH) and 41 patients with hypertensive disease, stage I (HD). It was shown that these patients revealed an essential reduction of Na(+)-K+ATP-ase. The diagnostic and differential diagnostic value of these tests is discussed.

A study was made of transmembranous ionic transport enzymes (Na(+)-K(+)-, Mg2(+)- and Ca2(+)-ATPases) in 95 patients with essential hypertension (EH) and 39 healthy persons. The activity of Na(+)-K(+)-ATPase was decreased for the most part at the early stages of EH. Measurements of the content of natriuretic hormone in the plasma did not reveal any significant differences between EH patients and healthy persons. However, the daily excretion of natriuretic hormone was significantly increased at the early stages of EH, which correlated with the changes in the activity of Na(+)-K(+)-ATPase in red blood cell membranes. This may lead to the derangement of homeostasis of intracellular electrolytes, attesting to an important role played by these factors in the pathogenesis of EH. As EH progressed, the cholesterol/phospholipid ratio increased which may also influence the activity of Na(+)-K(+)-ATPase. After enlargement of the intravascular liquid volume (drinking load 22 ml/kg) the EH patients manifested the loss of an adequate reaction of Na(+)-K(+)-ATPase towards elevated production of natriuretic hormone.