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The aim of this work was to study morpho-functional myocardial characteristics in patients with masked arterial hypertension (AH) and white coat hypertension (WCH) given antihypertensive therapy (AHT) and without it. This cross-sectional cohort study included employees of a large industrial enterprise who annually underwent routine medical examination supplemented by 24 hr AP monitoring and echocardiography carried out at specified time of the working day. The participants of the study were divided into 6 groups based on the relationship between clinical AP and mean AP during work. Group I comprised 20 (7%) subjects with normal AP, group 2--20 (7%) with masked AH, group 3--40 (14%) with WCH, group 4--81 (28.3%) with optimal A HT effect, group 5--64 (22.4%) with unmanifest inefficiency of AHT, group 6--40 (14%) with WCH during AHT. Criteria for masked AH and unmanifest AHT inefficiency were clinical AP below 140 and 90 mm Hg in combination with mean AP during work 135 and/or 85 mm Hg and higher. Echocardiography was performed in a standard positions in M- and B-modes as well as in three Doppler regimes. One-factor ANOVA was used to analyze differences between the groups and Pearson's Chi-square test to determine the relationship between categorical variables. 206 (72%) of the 286 employees of the large industrial enterprise had a diagnosis of AH. It was shown that ambulatory AP values obtained by 24 hr monitoring better characterized the patient's condition than clinical AP since they correlated with the frequency of disorders in the target organs and the risk of cardiovascular complications in patients with AH. Patients with masked AH more frequently developed left ventricular hypertrophy and diastolic dysfunction than those having normal clinical and ambulatory AP. The mean width of the left ventricle wall and left ventricular isovolumic relaxation time (therefore, the degree of LV hypertrophy and diastolic dysfunction) in the patients with unmanifest inefficiency of AHT were greater than in those with optimal AHT effect. The occurrence of WCH was comparable in the two groups. These data were used to determine intensity of preventive AHT at the workplace with a view to improving medical and occupational prognosis.

To develop integral assessment of the health status based on the examination of representative samples from different regions of Russia (Veliky Novgorod, Nizhni-Novgorod, Vologda, Omsk and Nalchik) with the use of special questionnaires and simple anthropometric and functional methods in the framework of a prospective 3-year population study of organized groups.The above questionnaires allowed to elucidate the socio-economic status of the patients, their somatic and psychological conditions (lifestyle index or psychological protection mechanisms (PPM), social adaptation, sanogenic reflexia; also used were Eysenck's psychotism scale, hospital anxiety and depression scale, the perceived stress scale (PSS), and moral potential of personality development scale.It was shown that the profile of psychological protection mechanisms is dominated by primitive reactions, such as projection, protection, and negation. Most subjects from the sample formed the pathogenic type of reflexia (inability to resolve a problem situation based on the cognitive components of the patient's mental state). Mathematical treatment of the so-called "simple cross-tabulation" with unification of all negative PPM revealed the highly significant relationship of LSI (not norm) with most previous somatic diseases (p0.001), i.e. the history of myocardial infarction, angina of effort, cardiovascular syndromes, diabetes, hypertension, chronic broncho-pulmonary, hepatic, gastrointestinal, urogynecological, oncological, and psychic diseases. (p0.007).Pyschological changes have greater influence than somatic ones on physiological parameters determining the population health status which suggests the necessity of taking them into account when planning health promotion measures.

Need for update of guidelines of the Joint National Committee (USA) on Prevention, Diagnosis and Management of Hypertension was based on necessity to adopt changes based on results of recent studies as well as creation of more simple and convenient variant for practical physicians. Compared with JNC VI most important changes concerned classification of blood pressure (BP) levels and approaches to drug therapy. New category "prehypertension" was introduced and 2 stages of hypertension distinguished: stage I - systolic BP 140-159 mm Hg or diastolic 90-99 mm Hg, stage II - systolic BP 160 mm Hg or higher, diastolic BP 100 mm Hg or higher. Diuretics were recommended as drugs of first choice and wider use of drug combinations encouraged. Some statements of JNC VII report have been criticized by some hypertension authorities.

Prospective monitoring of fatal and nonfatal myocardial infarctions and strokes was carried out in a population of workers with professional exposure to vibration. Duration of monitoring was 15 years. In the end of this period implementation of a program of preventive intervention was associated with lowering of rates of cerebral and coronary events (3.0 vs. 5.2% among nonparticipants in this program). In 5 years after cessation of the program an increase of risk of cardiovascular complications especially that of strokes occurred. Changes of rates of events in a group of workers not subjected to special intervention were less pronounced. Negative dynamics of event rates in the group of active prevention could be attributed to continuing action of unfavorable occupational factor.

According to epidemiological surveys arterial hypertension increases the risk of death of coronary heart disease 3-hold, of hemorrhagic and ischemic strokes--6-fold. Treatment of arterial hypertension leads to a significant fall in the risk of strokes and ischemic heart disease. The PROGRESS trial demonstrates that antihypertensive therapy of patients with the history of acute cerebral circulation disorder with ACE inhibitor perindopril is effective in secondary prophylaxis in such patients.

To study hemodynamic effects of replacement hormone therapy (RHT) with trisecvens, beta-blocker betaksolol and their combination in perimenopausal and menopausal women with hypertension.The study was made of 60 menopausal women aged 45-60 with mild and moderate arterial hypertension (AH). The women had no contraindications to either RHT or beta-blockers. They were randomized into three groups: group 1 received trisekvens, group 2--trisekvens plus betaksolol in a dose 10-20 mg/day, group 3--betaksolol. Arterial pressure (AP) and heart rate (HR) were measured before the treatment, in one month and each three months for a year. ECG and echo-CG were registered before treatment and each 3 months of the therapy. AP monitoring covered 50% of the patients of each group before the treatment and after 1 and 3 months of it. The data were analysed according to SAS system.Group 1 patients showed no significant changes in AP and HR. Group 2 and 3 patients' AP lowered, in group 2 the fall of systolic AP being more pronounced. 12-month therapy brought about a 10.3% decrease in left ventricular myocardial mass index in group 2.RHT with trisekvens in combination with beta-blocker in long-term use potentiates the effect on systolic AP and reduced hypertrophy of the left ventricle. RHT does not produce a significant effect on AP in women with AH recorded before the menopause.

The development of arterial hypertension is accompanied by impairment of the normal ratio of the "ACE-depending" and of the sympathetic nervous system, correlates with the action on the main pharmacological "targets": I-I-imidazoline receptors (moxonidine) or the ACE activity (enalapril). The aim of the present investigation was to determine the hypotensive and metabolic effects of moxonidine and enalapril depending on the basal ACE activity in patients with arterial hypertension, complicated with the metabolic syndrome. Effectiveness of moxonidine and enalapril administration (during 24 weeks) depended on the basal ACE activity in the hypertensive patients: (a) in the group of patients with low basal ACE activity moxonidine very effectively decreased systolic and diastolic blood pressure, compared with the group of patients with high basal ACE activity; (b) influence of enalapril on the level of arterial blood pressure was more pronounced with high basal ACE activity.choosing a hypotensive treatment for patients with the metabolic syndrome, it is advisable to take into account the basal ACE activity levels.

The study of hypotensive efficacy of high-cardioselective beta-blocker betaxolol, its effects on lipid and carbohydrate metabolism, menopausal syndrome in females with mild and moderate arterial hypertension.20 postmenopausal 45-59-year-old women entered the trial of betaxolol. They had diastolic blood pressure 90-114 mm Hg. Beta-blockers were not contraindicated. Arterial pressure, heart rate, body mass, blood lipid spectrum, glucose and insulin levels were evaluated before the treatment, 1, 3 and 6 months after it.Betaxolol safely and effectively lowered blood pressure. Blood lipid spectrum remained unchanged. A transitory rise in fasting insulin levels did not worsen glucose tolerance despite a small gain in body mass. Menopausal syndrome relieved due to good effect of betaxolol on vasomotor disorders.Betaxolol has a good hypotensive effect in the absence of adverse effects on lipid and carbohydrate metabolism. A reduction of menopausal syndrome was also achieved.

A relationship between erythrocyte Na+/Li(+)-countertransport activity and blood pressure was studied in a randomly selected sample (95 subjects) with full range of blood pressure, from a representative group of inhabitants of one of Moscow's districts. The mean rate of erythrocyte Na+/Li(+)- countertransport activity was higher (p0.01 or less) in the groups of subjects with both borderline (BH) and moderate essential hypertension (EH) as compared with the group of normotensives (NT). A positive correlation was found between the erythrocyte Na+/Li(+)- countertransport rate and age and body weight in the entire selected group. The total contribution of these confounding parameters is responsible for 20.4% of the interindividual variability of the Na+/Li(+)- countertransport activity. The individual Na+/Li(+)- countertransport values remained unchanged during at least 2 years of follow-up. A nonlinear relationship between erythrocyte Na+/Li(+)- countertransport activity and blood pressure was established in the entire group. No significant association between blood pressure and Na+/Li(+)- countertransport was seen at high and low values of these two parameters. A pronounced change in the erythrocyte Na+/Li(+)- countertransport values occurred within a narrow borderline blood pressure range.

A representative population sample was studied to elucidate relationships of arterial pressure (AR) with muscular performance (MP) and arterial hypertension risk factors. Power working capacity (PWCx) was measured by means of exercise tolerance test at rest, under physical loading and after the exercise. The findings were processed using a multivariate step-by-step regression analysis which established independent relations between exercise and postexercise MP and arterial hypertension. In normal and hypertensive males a rise in systolic pressure (SP) after the initial exercise (load 1) was dependent on PWC1 after more intensive exercise (load 2) on relations of MP with heart rate, SP and diastolic pressure (DP). In hypertensive males the SP elevation depended also on the age, B. W. index and heart rate. In normal AP males a DP rise depended on PWC2 and MP, the increment being limited by relationships between MP, DP, heart rate and SP. In hypertensive males the influence of PWC1 is defined through a SP rise after load 1. In normal AP and hypertensive females PWC1 is decisive for a SP rise. In normal AP females growth of DP after load 2 was dependent on PWC2 in relation to heart rate growth after load 2, while in hypertensive females PWC1 resulted in DP elevation after load 1. On comparison of the groups with normal and high AP the degree of AP increment under exercise depended on the relations of MP with heart rate, SP and DP.

A multivariate regression analysis including muscular performance, arterial pressure, age, heart rate, body-weight index permitted identification of independent relations between pressure and muscular performance. The latter accounts for 3% variability in initial systolic pressure in females and for 3% variability in males under physical loading. Initial systolic pressure accounts for 5% variability of muscular performance in females. The dependence between muscular performance and diastolic pressure is indirect, noticeable only in physical load with the help of double product.

In capable male population (age 20-59 years) developing oil and gas extraction in the Western Siberia the incidence of arterial hypertension reached 14.1%. Wide introduction of preventive programs in the extreme conditions of labour helped to normalize blood pressure in every second patient and to maintain health in migrants from other regions.

A programme on supplementary health education of medical staff from city polyclinics in the prevention and treatment of arterial hypertension was launched in one of the Moscow districts for 3 years. Another district was used as a comparison subject. Representative samples of residents aged 35-64 years from the two districts were screened before and after implementation of the programme. The WHO International MONICA programme was used to evaluate the efficiency of the programme proposed by the authors. The intervention district showed an improvement of hypertensives' awareness of the disease and a double increase in the number of patients with a high compliance. In the comparison district, these parameters remained unchanged. According to the criteria developed in the MONICA programme, there was a downward tendency in the incidence of myocardial infarction and stroke and these diseases-related deaths in the intervention district, whereas this was not observed in the district under comparison.

The routine protocol of general and neurological examinations and some special questionnaires were used to examine physical activity (FA) and physical working capacity (FWC) in a random population from one of the Moscow districts which included 1200 persons (males and females aged 30-64 years). The majority of the examinees were those who had slight and moderate exercises, mainly sitting work, did few or no physical exercises. The proportion of persons with low physical activity increased with age both among males and females. The ratios generally remained despite the presence of early signs of abnormal blood supply. Bicycle ergometer testings showed a significant reduction in the physical working capacity of the patients with abnormal brain blood supply, in a greater extent, in arterial hypertension. Decreased functional activity and functional working capacity may regarded as one of the risk factors for cerebrovascular disorders, in arterial hypertension in particular, and should be borne in mind in implementing preventive measures.

How two regimes of exercise training affect blood pressure changes was examined in 70 individuals with mild arterial hypertension. Prolonged controlled exercise training were shown to be an effective tool of non-drug correction of elevated blood pressure, the exercises aimed at developing aerobic tolerance being more beneficial. The magnitude of changes (increase) of working capacity may be an indicator for the effectiveness of exercise training programmes.

The relation of red blood cell Na+/Li+ countertransport rate to the prevalence of arterial hypertension (AH) and blood pressure was evaluated in 720 individuals aged 23-60 years. In all age groups, the rate of red blood cell Na+/Li+ countertransport was significantly higher in males than in females. Age, alcohol use, obesity in males and age, obesity, and Na+/Li+ countertransport rate in females are factors that predispose to AH, as evidenced by multivariate logistic analysis. The latter parameter is associated with obesity and diastolic blood pressure and unassociated with age, alcohol use, and smoke, as suggested by regression analysis. The distribution of Na+/Li+ countertransport rate values in the population after standardization for ruling out the impact of obesity is erroneous and shifted to the right. This allows it to be presented as a sum of two normal distributions. However, their analysis has failed to reveal statistically significant differences in blood pressure values of AH incidence. The rate of Na+/Li+ countertransport may be regarded as a biological population risk factor for AH, which is, however, less than such factors as age, obesity, and excessive alcohol use.

Whether the primary arterial hypertension prevention programme can be applied among employees of a Novosibirsk industrial enterprise within the framework of the second stage of the USSR Cooperative Study of Arterial Hypertension Control, is studied. For this, the authors used sodium-restricted diet concurrent with non-drug therapy (physio-, balneo-, reflexotherapy and acupuncture), and active sanitary education. The 2-year prospective follow-up showed a sufficiently high efficiency of health measures: the incidence of borderline hypertension was reduced by 10.5% at the end of the study, blood pressures could be maintained at the level of the borderline and subnormal values in most patients with persistent hypertension, the patients at risk developed no persistent hypertension, cases. In a 20% blind sample from the matched population, the changes in the frequency of various blood pressures were insignificant during this period.

The authors provide the results of the treatment of 15 patients with infectious bronchial asthma by plasmapheresis (PA). All the patients received PA in accordance with the techniques developed by the authors. These techniques simulate standard procedures using a plasticized container and a refrigerator centrifuge. As a result of the studies carried out, it has been concluded that the clinical efficacy of false PA is similar to that of routine PA as regards the clinical manifestations of bronchial asthma. Apparently, the elimination effect and the effect of red blood cells plasma withdrawal are of no material importance in the mechanism by which PA influences bronchial asthma. The psychosomatic causes, effects of temporary blood loss, blood contact with polymeric materials, and the influence of temporary blood cooling may be under discussion.

A 3-year prospective study was undertaken to evaluate the relation of red blood cell Na+/Li+ countertransport rates to the incidence of arterial hypertension. A total of 227 subjects (males and females aged 24-54 years)--a 20% representative sample of organized population--was followed up. The annual incidence of arterial hypertension was 4.3 among males and 2.7 among females. The baseline blood pressures and obesity in males and rates of Na+/Li+ countertransport in females were demonstrated to be factors associated with the incidence of arterial hypertension. The rate of red blood cell Na+/Li+ countertransport can be regarded as an independent biological risk factor for arterial hypertension.

The influence of three different modes of physical training (PT) on high arterial pressure was estimated in persons suffering from "mild" arterial hypertension. 154 men and women aged 35-54 years were entered into the study. In accordance with two different methods of estimating the initial physical work fitness (PWF), the test subjects were distributed into 4 groups. In these groups, the percentage of aerobic training aimed at the development of stamina was progressively raised. The dynamics of the initial PWF served as a criterion for the efficacy of PT. It has been demonstrated that firstly, both methods of estimating PWF are suitable enough for characterization of the dynamics of PWF, secondly, the decrease of arterial pressure is directly dependent on the effectiveness of the PT programs reflecting the dynamics of PWF, and, thirdly, PT aimed at the development of the general (aerobic) stamina is the most effective nonmedicamentous approach to the reduction of arterial hypertension.

The present work is concerned with the role of the velocity of Na+/Li(+)-countertransport of red blood cells (as an indicator of the function of cellular membranes) in the development of arterial hypertension under conditions of a populational study. A relationship is demonstrated between the velocity of Na+/Li(+)-countertransport and the sex, arterial pressure, body mass index, and blood serum triglycerides. The high velocity of Na+/Li(+)-countertransport is encountered in 25% of the population, being responsible for about 30% of all cases of arterial hypertension. Taking into consideration the modern multifactorial theory of the genesis of arterial hypertension, the high velocity of Na+/Li(+)-countertransport should be viewed as a definite disease pattern (one of several) and as a risk factor of arterial hypertension in women (the data of the prospective part of the study).

The quality of medical care provided especially to patients with arterial hypertension employed in three industrial plants (ZIL Automobile Works, Moscow, Mytishchi Machine Works, and Skoda Works, Plzen, Czechoslovakia) was investigated in random samples of male and female employees aged 35-64 years. The lowest prevalence of hypertension (AH) was found in Skoda Works (26.4 +/- 1.3%). A standardized cooperative epidemiological study detected a low percentage of treated AH cases and insufficient efficacy of treatment in all three plants, especially among young male hypertensives. The epidemiological status of AH in the ZIL and Mytishchi Works was less favourable compared with that in Skoda Works. Epidemiological data represent an indispensable basis for developing a scientific approach to primary and secondary prevention of AH.

A study was made of the relationship between Na-Li countertransport and arterial blood pressure in 95 persons selected at random from the representative sample (n = 1716) of the population of one of the districts of Moscow. Of these, 34 persons turned out to be normotensive, 15 had borderline hypertension, 44 stable essential hypertension, and 2 persons presented with secondary hypertension. A positive correlation was found between countertransport and age and weight, determining 20.4% of interindividual variability of countertransport values. The mean value of countertransport in the hypertension group appeared much higher than in the normotensive group, both without and with regard to the correlating parameters. Repeated examinations demonstrated that the countertransport value in each person remained unchanged for two years. A nonlinear correlation was discovered between countertransport and arterial blood pressure. The rate of countertransport is not related to arterial blood pressure (low and high values). A dramatic change in the countertransport values occurred within a narrow borderline range of arterial blood pressure.

A total of 5,555 workers from 6 industrial enterprises in Cheboksary were screened. The most prevalent cause of death appeared to be violent death which encompassed deaths caused by accidents, poisonings, injuries, suicides and comprised 35.4 percent of the overall pattern of mortality causes. In 76.8 percent of cases violent death was caused by alcohol abuse. Deaths from alcohol poisoning during a 9-year period comprised 11.3 percent of total causes of death. The second place by prevalence was given to ischemic heart disease, including sudden coronary death (20.9%) and moreover almost in each case death was developing as a result of alcohol abuse. In 1986 after the adoption of the Decree of the Central Committee of the CPSU in May 1985 "On the measures to combat heavy drinking and alcoholism", the incidence of violent deaths caused by alcohol abuse, as compared with midyear rates for previous 8 years decreased by 4.7 times (p less than 0.01) which contributed to the development of a marked trend towards the decline in general mortality rates by 31.4 percent. The results obtained showed that despite certain shortcomings, measures targeted to combat heavy drinking and alcohol abuse promoted the prevention of death among men of productive age.

The paper deals with methodological problems of electrolyte intake in clinical and population-based studies. Marked inter- and intraindividual fluctuations were found to substantially affect the reliability of assessing the intake of electrolytes, which should be borne in mind in practice. Specifically, individual-based reliable characteristics of electrolyte intake (excretion) may be obtained after examining at least 8 daily urinary collections. The adequate validity of group electrolyte intake may be attained when a group consists of at least 8 persons. It is shown that it is feasible to employ the definite urine amounts to gain an insight into electrolyte intake.

For successful control over the arterial hypertension among mass populationit is necessary to create the information system of automated register. In practice, its realization is possible on the basis of different polyclinical departments: prephysician examination, fluorography, and physician cabinets. A micro-computer installed in the polyclinic would be purposeful (and real) for operative decision of the automatic register's problems.

The study included 43,197 men aged 40-54 years, of whom 23,378 were in the intervention group and 19,819 in the comparison group; the number of man-years of follow-up totalled for the whole group 177,703. The study proved the efficacy of active, predominantly secondary prevention of arterial hypertension (AH), carried out in men aged 40-54 years over a period of 3-5 years in 12 centres within the framework of the cooperative programme. In comparison with the control group, the following changes were registered in the intervention group: 1) overall mortality decreased by 17.3%; 2) stroke mortality decreased by 48.4%; 3) non-lethal stroke morbidity decreased by 51.4%; 4) morbidity of non-fatal myocardial infarction decreased in the course of four years by 23.8%. In contrast to this, mortality due to ischaemic heart disease was in the intervention group and in the control group practically the same.

Cerebral circulation in relation to central hemodynamics was examined by means of rheoencephalography and chest rheography in 667 individuals with normal and elevated arterial blood pressure. Cardio-cerebral mechanisms are shown to be pathogenetically engaged since early stages of arterial hypertension. They are manifested as decreased cerebral stroke volume, smaller pulse inflow to cerebral arteries and increased vascular tonicity. Cerebral circulatory disorders grew more severe as the disease progressed.

A study was made of the peculiarities of the cerebral circulation with regard to the central hemodynamics in 326 men and 410 women aged 20 to 54 with normal and raised arterial pressure (AP) by the methods of bipolar rheoencephalography and tetrapolar chest rheography. In the groups with raised AP men (women) demonstrated a decrease in the blood pulse inflow in the cerebral arteries up to 57% (36%), in the stroke volume cerebral fraction up to 69% (53%), an increase in the vascular tone up to 137% (161%), an increase in the total blood-filling up to 157% (176%), inhibition of the rate of the maximum blood-filling up to 54% (37%) as compared to that in normal. With the transition of an AP borderline level to arterial hypertension the frequency and intensity of rheoencephalographic pathology was on an increase.

Questionnaire survey of 934 residents of various regions of the European part of the USSR and the results of the experimental impact of health education media under polyclinical conditions showed that awareness of alcohol-related risk could be achieved only due to doctor's assistance.