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Aim: To evaluate changes in parameters of orthogonal ECG in hypertensive patients on trandolapril+verapamil combination., Material and Methods: Eighteen patients before and after 8-week therapy were examined using orthogonal ECG and 24-h monitoring of blood pressure. Computer processing of orthogonal ECG was made with calculation of some vectorcardiography (VCG) and d mapping parameters. Also, 24-h blood pressure monitoring was made., Results: 8-week therapy significantly reduced mean diurnal and nocturnal systolic and diastolic blood pressure (SBP, DBP), improved their variability. In patients with VCG signs of left ventricular hypertrophy the treatment significantly diminished some VCG parameters. A direct correlation was found between initial diurnal SBP variability and SQRSxyz, SQRSxz; dynamics of nocturnal SBP variability and dynamics of SQRSxyz, SQRSxz and Rx+Sz (r = 0.7; p < 0.05). A direct correlation was between dynamics of SBP and IADI (r = 0.7; p < 0.05)., Conclusion: Hypertensive patients treated with a fixed combination trandolapril/verapamil exhibit a positive trend not only in parameters of 24-h monitoring of blood pressure but also in parameters of orthogonal ECG.

Aim: To study structural and functional changes in left ventricular myocardium (LVM) of patients with mild and moderate arterial hypertension (AH) with application of tissue myocardial dopplerechocardiography (TMD), correlation between these changes and parameters of electrophysiological remodeling and circadian profile of blood pressure., Material and Methods: Forty-give hypertensive patients were divided into two groups: the study group 2A consisted of 28 patients with mild AH (144.2 +/- 5.8/89.4 +/- 6.6 mm Hg), group 2B - of 17 patients with moderate AH (160.5 +/- 9.1/101.3 +/- 10.2 mm Hg). The control group consisted of 10 normotensive subjects. All the patients were examined using standard echocardiography with assessment of transmitral blood flow, tissue doppler investigation, circadian monitoring of blood pressure, electro-, vector- and decartocardiography., Results: No significant differences in standard doppler, electro- and vectorcardiographic parameters between the patients with mild and moderate hypertension were found. LVM mass index and LV wall relative thickness significantly increased both in 2A and 2B groups vs controls (p < 0.05). Most patients of group 2A and 50% patients of group 2B had no alterations in LV geometry. Lower blood pressure was associated with LV concentric remodeling, higher - with concentric and excentric hypertrophy. In the presence of LV remodeling hypertensive patients developed more pronounced disorders of diastolic function according to TMD compared to hypertensive patients with normal LV geometry (p < 0.05). TMD detected LV diastolic disorders in 82% patients of group 2A and in 94% - of group 2B, while transmitral doppler study detected diastolic dysfunction only in 14 and 29% patients, respectively. A significant difference by Em/Am was registered between patients with mild and moderate AH only in the area of the mitral ring at the side of LV posterior wall (p < 0.05)., Conclusion: TMD is able to detect earleast structural-functional myocardial changes in hypertensive patients and to determine significant differences in LV diastolic disorders in patients with mild and moderate AH. No significant differences in LVM mass, standard doppler, electro- and vector-cardiographic parameters were found between AH patients' groups.

Memory impairment, headaches and vertigo are considered as initial appearances of chronic cerebral vascular disorder in patients with arterial hypertension (AH). The complex analysis of complaints, cognitive functioning, emotional state and MRI data was conducted in 60 patients with AH, mean age 58,4+/-7,8 years, without a history of stroke and 30 controls matched for age, sex and education. Impairment of cognitive functioning was assessed by the Psychiatric Status Scale (a short version), the Clock Drawing Test, tests of auditory and verbal memory, attention concentration, speed of test performance, speech fluency and spatial orientation. The deterioration effect of systolic arterial pressure on cognitive functioning was found. The lesions of white matter (subcortical and/or periventricular leucoaraiosis) were observed in 76% of patients and single asymptomatic lacunar infarctions--in 20%. Cerebral vascular lesions were correlated with cognitive impairment. Anxiety and anxiety-depressive disorders which were not associated with the cerebral vascular lesion but related in large to the patient's complaints on headaches and vertigo were revealed in 62% of cases. The results of the study suggest that cognitive dysfunction proves to be the early and reliable predictor of chronic cerebral vascular disorder in patients with arterial hypertension.

Objective: To study an independent role of the obstructive sleep apnea syndrome (OSAS) in patients with arterial hypertension (AH) according to the data of a retrospective observation., Subjects and Methods: all patients underwent polysomnographic test (EMBLA Flaga, Iceland) and the frequency of unfavorable events (stroke, myocardial infarction, chronic heart failure, atrial fibrillation, intermittent claudication, or death) was determined during the case-control observational longitudinal retrospective study. The diagnosis of OSAS was made when the apnea-hypopnea index (AHI) of more than 15 events per hour of sleep; the patients with an AHI of less than 15 formed a control group., Results: Among 120 enrolled patients, 64 (53%) had OSAS. In the patients with OSAS, the baseline AHI was 50.9 +/- 23 events per hour whereas in the control group it was 8.9 +/- 5.2 per hours. Both groups were comparable in age, height, weight, body mass index, snore duration, drowsiness, and respiratory standstill during sleep, blood pressure, total cholesterol, and creatine. While analyzing OSAS, there was no change in the risk for a combined end point (all-cause death, stroke, myocardial infarction, chronic heart failure, atrial fibrillation, or intermittent claudication). Our study was retrospective, the patients were few and AH is itself an important cardiovascular risk factor which should be borne in interpreting the results of our study. We consider that the study of the independent role of OSAS should be continued within a well-designed prospective observation.

Nonspecific aortoarteritis (NAA) is a chronic inflammatory disease that affects the aorta and its branches. The clinical manifestations of this disease are of a great variety and depend on the site of a lesion and the stage of the disease. A wide range of highly informative noninvasive imaging techniques, such as duplex scanning (DS), magnetic resonance imaging (MRI), and computed tomography (CT) of the aorta and its branches, are used to make a more accurate diagnosis and to determine the site and extent of a vascular bed lesion. The given clinical example suggests that CT angiography of the aorta and its branches is a high-precision technique in determining the site of vascular bed lesion in patients with NAA and the pattern and extent of arterial involvement and that it may be used for both the diagnosis of the disease at its developmental stages and the monitoring of the vessels during pathogenetic therapy.

Combined antihypertensive therapy based on 2.5-5 mg of cilazapril (an angiotensin-converting enzyme inhibitor) to normalize arterial pressure (ABP) was studied in 22 patients (12 male, 10 female) aged 49-74 years (mean 63 +/- 7 years) with stroke (18 patients) or transient ischemic attacks (three patients). Magnetic resonance tomography (MRT) including perfusion studies, along with neuropsychological studies and assessment of emotional status (Beck depression inventory, Spielberger anxiety scale), were performed before and after treatment. After six months of treatment, patients showed normalization of ABP (systolic pressure decreased from 154.7 +/- 12 to 128 +/- 23 mmHg, diastolic from 90.3 +/- 9.6 to 79.4 +/- 23 mmHg). There were no side effects and no patient experienced stroke. MRT revealed no signs of new foci and there were no significant changes in brain blood flow. By the end of treatment, improvements in cognitive functions were noted on the Mini Mental State Examination, the 10-word memory test, the Boston naming test, or the Wisconsin card-sorting test, though there were no changes in the patients' emotional status.

Thirty-six patients with arterial hypertension complicated with disturbances of carbohydrate metabolism (from changes of tolerance to glucose to diabetes mellitus type II), lipid metabolism (obesity of different degree) and depression have been studied. In 23 cases (main group), a combined therapy with somatotropic and psychotropic drugs was used while 13 patients were (control group) treated only with somatotropic medications. Citalopram, a selective inhibitor of serotonin reuptake, was the main psychopharmacological drug used in the treatment of the main group. In some cases other medications (neuroleptics, benzodiazepines) were used. Patient's state was assessed by the results of the somatic and psychopathological examination using psychometric scales and by a number of indices obtained in the instrumental and laboratory (biochemical etc) study. The results suggest the higher efficacy of the combined therapy by all parameters--arterial pressure, indices of carbohydrate and lipid metabolism, severity of affective disorders.

Aim: To evaluate a combination of the effects of non-drug measures and rozuvastatin on the lipid spectrum and blood pressure (BP) in patients with treated arterial hypertension (AH) concurrent with dyslipidemia., Materials and Methods: The multicenter open-labeled prospective program included 299 patients from 19 cities and towns of Russia. Two hundred and eighty-eight patients completed phase 1 of the program; out of them 279 patients (149 males and 130 females) aged 58-80 years (56.7 +/- 8.7 years) with a mean AH history of 10.3 +/- 8.4 years. Phase 1 of the program involved 3 visits and it was over 12 weeks after rozuvastatin therapy. Phase 2 (including a visit 12 weeks following the termination of Phase 1) is being continued., Results: Rozuvastatin therapy resulted in a reduction in the levels of total cholesterol (TC) by 2.5 +/- 0.8 mmol/l (p < 0.001), low-density lipoprotein (LDL) cholesterol by 2.2 +/- 0.8 mmol/l (p < 0.001), triglycerides (TG) by 0.8 +/- 0.9 mmol/l (p < 0.001), and atherogenicity index (AI) by 2.8 +/- 1.4 (p < 0.001) and an increase in the content of high-density lipoprotein (HDL) cholesterol by 0.2 +/- 0.2 mmol/l (p < 0.001), which produced the target levels of LDL cholesterol in 61% of the patients, HDL cholesterol in 70%, and TG in 73%. During unaltered antihypertensive therapy there were also decreases in body mass by 1.5 +/- 2.8 mmol/l (p < 0.001), body mass index by 0.5 +/- 1.0 kg/ m2 (p < 0.001), waist circumference by 1.0 +/- 3.2 cm (p < 0.001), and BP by 72 +/- 14.2/4.1 +/- 8.6 mm Hg (p < 0.001). There was an increase in the activity of aspartate aminotransferase and alanine aminotransferase, and creatine phosphokinase; however, this was clinically significant in none patients., Conclusion: Rozuvastatin significantly lowers the levels of TC, LDL cholesterol, TG, and AI and elevates the concentration of HDL cholesterol. In the majority (83%) of the patients, rozuvastatin used in a dose of 10 mg/day was sufficient to normalize the lipid profile, which makes it possible to recommend that rozuvastatin therapy should be started from this dose.

Aim: To evaluate telmisartan effects on 24-h blood pressure profile, sensitivity to insulin, carbohydrate and lipid metabolism in patients with metabolic syndrome (MS) and arterial hypertension (AH)., Material and Methods: Twenty patients with MS and AH of the degree I-II received telmisartan in a dose 80 mg/day. 24-h BP monitoring, tests for total cholesterol, HDLP, LDLP cholesterol, triglycerides, glucose, glucose tolerance test were made before and 24 weeks after the treatment., Results: Telmisartan reduced all the study parameters of blood pressure, body mass, fasting and post-prandial hyperglycemia, postprandial hyperinsulinemia. Telmisartan raised peripheral tissue sensitivity to insulin, normalized phases of insulin secretion. Total cholesterol, LDLP cholesterol diminished while HDLP went up., Conclusion: Telmisartan has a specific ability to partially activate receptors stimulating proliferation of peroxisomes and improve regulation of carbohydrate and lipid metabolism, to reduce body mass.

Aim: To confirm or reject effects of CPAP on sleep asystole and to elucidate possible dependence on correction of respiratory disorders., Material and Methods: Thirteen patients (11 males and 2 females aged 19 to 66 years) with bradyarrhythmia (BA) arising in sleep participated in the study. BA was caused by transient atrioventricular block of the degree II-III in 9 cases (69%), episodes of sinus node arrest and/or synoatrial block in 6 (46%) cases. Two (15%) patients had combination of BA forms. To diagnose sleep respiratory disorders, polysomnography (PSG) was made. Diagnostic criteria of sleep obstructive apnea syndrome (SOAS) were apnea/hypopnea index (AHI) more than 5 episodes for 1 hour sleep. The patients were divided into two groups. Individual selection of therapeutic pressure under PSG control was performed in SOAS patients (the study group). CPAP-therapy was effective in AHI < 5. In the control group (AHI < 5) such selection was made too. CPAP-therapy was effective in the controls if episodes of apnea/hypopnea were not registered through the night of monitoring., Results: In the study group CPAP-therapy was effective. The AHI decreased from 73.2 to 4.4, oxygen saturation of arterial blood increased from 74 to 85%, mean duration of asystoles fell from 5.2 to 1.3 s, pauses with duration more than 2 s disappeared. In the control group sleep apnea/hypopnea episodes disappeared but in asystole CPAP was uneffective., Conclusion: CPAP-therapy is effective and pathogenetically sound method of treating patients with nocturnal bradyarrhythmia associated with sleep respiratory disorders.

Aim: To develop a universal method of metabolic syndrome (MS) diagnosis which is valid irrespective of the version in patients with documented arterial hypertension (AH) and obesity., Material and Methods: MS was diagnosed according to two versions (WHO and ATPIII) in 517 males and 1041 females aged 20 to 75 years. All the patients had documented obesity and hypertension., Results: Two versions used (WHO and ATPIII) provided the same results only in 44% patients: MS was confirmed in 16% and rejected in 28%. The rest 56% patients had MS only by one of the versions. A computer program has been created for making decision about MS presence in obese patients with hypertension., Conclusion: A diagnostic rule has been elaborated for MS diagnosis by associated disorders with accuracy of 94% even in the absence of information about such key components of MS as HDLP and triglycerides.

Aim: To study effects of body mass loss due to orlistat on carbohydrate and lipid metabolism, insulin resistance, 24-h profile of arterial pressure (AP), left ventricular myocardial hypertrophy, brain perfusion in patients with metabolic syndrome (MS)., Material and Methods: Thirty middle-aged patients with MS entered the trial. They received orlistat in a dose 120 mg twice a day for 24 weeks. Before and after the treatment the patients' carbohydrate and lipid metabolism, insulin resistance were studied, 24-h monitoring of arterial pressure, echo-cardiography were made. Brain perfusion was studied with single-photon emission computed tomography in 18 patients. Results. All the patients lost much weight. This was accompanied with improved indices of AP profile, metabolism of carbohydrates and lipids, insulin resistance, left ventricular hypertrophy, brain perfusion. Conclusion. Orlistat treatment weakens basic factors of cardiovascular risk.

Aim: To study effects of antihypertensive therapy with bisoprolol and actovegin on cerebral perfusion in patients with metabolic syndrome., Material and Methods: Thirty patients (18 women and 12 men) with metabolic syndrome and mild arterial hypertension took bisoprolol alone in a dose 5-10 mg/day, and fifteen patients received combined therapy (bisoprolol and actovegin) for 12 weeks. Before the study and 12 weeks later measurements were made of carbohydrate and lipid metabolism, single photon emission computed tomography investigated brain perfusion., Results: Improvement of brain perfusion was observed after both monotherapy with bisoprolol and its combination with actovegin., Conclusion: Monotherapy with bisoprolol and bisoprolol combination with actovegin improved brain perfusion but the combination was more effective.

Aim: To study the condition of the sympathico-adrenal system (SAS), synthesis of cAMP dependent on beta2-adrenoreceptors and parameters of free radical oxidation in patients with primary pulmonary hypertension (PPH); to examine efficacy of non-selective beta- and alpha1-adrenoblocker carvedilol in PPH patients., Material and Methods: Twenty patients with PPH had 6-minute walk test, ECG monitoring with assessment of heart rhythm variability (HRV). Tests for noradrenalin and adrenalin concentration in blood plasma, cAMP synthesis by blood lymphocytes in basal conditions and under stimulation with isoproterenol and forskolin, free radical oxidation were made initially, 1 and 6 months later. Ten patients received carvedilol in addition to standard therapy, 10 patients served control., Results: PPH patients had higher NA in the blood, low cAMP synthesis, high malonic aldehyde, low activity of glutathionperoxidase, increased activity of superoxidedismutase and catalase of erythrocytes. The most pronounced changes in the above parameters were observed in patients with PPH FC III-IV. HRV declined in progression of cardiac failure. 6-months of combined treatment with carvedilol increased the distance of 6-min walk. Carvedilol had no effect on HRV, it reduced NA, stimulated cAMP synthesis, demonstrated no antioxidant activity., Conclusion: In PPH there is activation of SAS and desensitization of beta2-AR cells, oxidative stress develops. Addition of carvedilol to standard therapy with PPH improves clinical condition due to adrenoblocking properties of the drug.

To normalize arterial pressure (AP), combined antihypertensive therapy, basing on intake of 2,5-5 mg cilazapril, inhibitor of angiotensin-converting enzyme (IACE), was administered to 22 patients, 12 men, 10 women, aged from 49 to 74 years, mean age 63 +/- 7 years, who survived stroke (18 patients) or transitory ischemic attack (3 patients). Magnetic resonance tomography (MRT), i.e. perfusion regime, neuropsychological study and assessment of emotional state (Beck depression inventory and Spilberger anxiety scale) were conducted before and at the end of the treatment. During 6 months therapy, systolic blood pressure decreased from 154,7 +/- 12 to 128 +/- 23 mm HG and diastolic pressure from 90,3 +/- 9,6 to 79,4 +/- 23 mm Hg in all patients, without side-effects and development of stroke. There were neither new foci registered by MRT, no significant changes of cerebral blood flow. At the end of the treatment, cognitive functions were improved on the Mini Mental State Examination, on short-term memory test, Boston naming test and Wisconsin Card Sorting Test but no changes were found in emotional state of patients.

Aim: To elucidate associations between location and extent of lesions of arterial vascular bed in patients with nonspecific aortoarteritis and presence of various alleles of DRB1 gene of HLA class II in patients of Russian ethnicity., Material and Methods: Ultrasonography, magnetic resonance imaging and computed tomography were used for examination of arteries in 25 patients aged 22-69 years. Genotyping of HLA-DRB1 locus was carried out in all patients and in a group of practically healthy subjects of the same ethnic group (controls)., Results and Conclusion: Patients compared with controls had significantly higher frequency of class II alleles of HLA-DRB1 gene which corresponded to serological specificity DR1. Subgroup of patients carriers of DR1 allele had significantly less extensive involvement of arterial vasculature compared with subgroup of carriers of other alleles. The revealed clinical-genetic relationship reflects special features of aortoarteritis in Russian population and evidence for genetic heterogeneity of this disease.

Cerebral perfusion was studied in patients with arterial hypertension combined with metabolic syndrome and diabetes mellitus type II. The data is compared to the results obtained for patients with a single disorder--metabolic syndrome, diabetes mellitus type II and arterial hypertension without metabolic alterations. It is shown that patients with disregulation of carbohydrate and lipid metabolism are more vulnerable to cerebral blood supply alterations. A level of perfusion was the same in patients with metabolic syndrome and diabetes mellitus type II. Besides, an acetazolamide application revealed that patients with metabolic syndrome had reduced cerebral vascular autoregulation.

Aim: To design a mathematical express model of expected lifespan of patients with primary pulmonary hypertension (PPH)., Material and Methods: A retrospective analysis of 418 case histories of 132 PPH patients (81 females, 51 males, age 16-57 years). Ninety one of them were hospitalized at least twice. The following characteristics of the patients were registered: a PPH form, age at onset, gender, morphological structure of the lung, date of the first visit to doctor. Relationship of these factors with lifespan was analysed and the express formula of expected lifespan was calculated using the multifactorial analysis of variance with standard computer statistical programs., Results: Lifespan was studied for dependence on static factors free of therapy effects (gender, age, form of PPH). The presence of a factor named "duration of the disease development" (DDD) is suggested. A correlation was found between DDD and lifespan in PPH patients explaining survival by 84.5%. The formula of the prognosis was derived for patients with known morphological structure of the lung in whom the above dependence explains survival by 93.5%., Conclusion: Among effect modifiers, of significance for survival are age, PPH form, morphological structure of the lung. An artificial index DDD was used for deriving a formula for prognosis of survival for a newly hospitalized PPH patient.

Aim: To study the effect of co-renitek monotherapy for 16 weeks on parameters of 24-h monitoring of arterial pressure, carbohydrate, lipid, purin metabolism in patients with mild and moderate arterial hypertension (AH) and diabetes mellitus (DM) type 2., Material and Methods: 20 patients with DM type 2, mild or moderate AH received co-renitek (1-2 tablets a day) for 16 weeks. Before the treatment and 16 weeks later the patients were examined (24-h AH monitoring, carbohydrate, lipid, purin, electrolyte metabolism)., Results: Co-renitek treatment of DM type 2 patients with hypertension led to a significant lowering of mean systolic and diastolic pressure, improvement of 24-h AP profile and reduction of fasting glucose level. Co-renitek proved to be metabolically neutral in relation to lipid, purin and electrolyte metabolism., Conclusion: Co-renitek is effective and safe antihypertensive drug for treatment of arterial hypertension in patients with diabetes mellitus type 2.

Prevalence of pulmonary heart among patients with cardiovascular pathology is 5%. Clinical picture of pulmonary heart comprises symptoms of underlying disease and signs of pulmonary and cardiac failure. The following instrumental methods of investigation are very helpful for diagnosis of pulmonary heart: chest roentgenography, electrocardiography, echocardiography, pulmonary function testing, computer tomography. Pulmonary heart should be diagnosed during ambulatory examination. Hospitalization of patients with pulmonary heart is dictated by severity of clinical condition or presence of diagnostic problems. Radionuclide pulmonary scintigraphy, pulmonary angiography, right heart catheterization, lung biopsy can be carried out in hospital. Treatment should be directed at underlying disease, lowering of pulmonary artery pressure, alleviation of respiratory and cardiac failure.

There is a pathogenetic interrelationship between obesity and hypertension. Moreover it has become evident that the use of most modern and active antihypertensive drugs can not be effective without concomitant treatment of obesity. This study was conducted in 18 cities of Russian Federation in order to demonstrate influences of lifestyle changes on hypertension and levels of cardiovascular risk factors. The objective was to attract attention of physicians and patients to the problem of obesity and hypertension and to their inherent dangers.

Aim: To compare brain perfusion in hypertensive patients with diabetes mellitus type 2 (DM2) or metabolic (MS) syndrome and hypertensive patients without clinicobiochemical signs of DM2 or MS; to study enoxaparin effects on brain perfusion in DM2 and arterial hypertension (AH)., Material and Methods: Seventy patients included in the study were divided into three groups: 30 patients with DM2 and AH (group 1), 30 patients with MS and AH (group 2) and 10 AH patients without manifestations of MS or DM2 (group 3). All the patients have undergone single-photon emission computed tomography (SPECT) of the brain, carbohydrate and lipid metabolism were examined., Results: Deterioration of brain perfusion was more prominent in DM2 and MS patients with AH than in hypertensive patients with normal metabolism. Stress test with acetasolamide revealed defective autoregulation of cerebral blood flow in hypertensive patients with DM2. A 6-week therapy with enoxaparin significantly improved brain perfusion in hypertensive patients with DM2., Conclusion: Enoxaparin treatment of hypertensive DM2 and MS patients with abnormal perfusion of the brain can be used for prevention of cerebrovascular complications.

Fifty-five patients (mean age 42.3) with clinical signs of metabolic syndrome were investigated. The peroral glucose-tolerance and insulin-modified intravenous glucose-tolerance tests were used in the diagnosis of insulin-resistance. According to the SI index, a lower tissue sensitivity to insulin was detected in 48 (87%) of patients; it is noteworthy, that a low SI index was registered in some of them, when indirect signs of insulin-resistance, like hyperglycemia, hyperinsulinemia, were absent.

Electrocardiograms from 30 patients with congenital atrial septal defect operated upon in adult age were analyzed. One of frequent variants of QRS configuration in standard leads was SIqIII type. It was observed in 50% of patients. Most frequent (in 67% of patients) variants of QRS configuration in lead V1 were rSr' and rSR'. Signs of right ventricular hypertrophy were most often found in a group of patients with high pulmonary hypertension. Changes of terminal portion of ventricular complex such as negative or biphasic T waves were found in 29 of 30 patients (in 63% of cases these changes were localized in leads V1-V3).

Twenty four hour blood pressure (BP) monitoring was carried out and structural state of left ventricular myocardium assessed in 20 patients with mild and moderate hypertension before and after 24 weeks of therapy with Hyzaar - fixed dose combination of losartan (50 mg) and hydrochlorothiazide (12.5 mg). According to data of 24-hour BP monitoring the use of Hyzaar was associated with lowering of diurnal (by 26.9/17.2+/-3/2 mm Hg, p<0.001), nocturnal (by 32.6/18.9+/-3/2 mm Hg, p<0.001), pulse (p<0.001) BP, and rate of morning systolic BP rise (p<0.05), decrease of nocturnal systolic and diastolic BP variability, and improvement of 24-hour BP rhythm. Trough/peak coefficients for systolic and diastolic BP (70 and 76%, respectively) reflected sufficient and steady hypotensive effect throughout 24 hours after single dose of Hyzaar. Target BP level was achieved in 70% of patients. At the background of 24-week treatment with Hyzaar left ventricular myocardial mass index significantly decreased (from 120.1+/-3.5 to 108.6+/-3.1 g/m2, D=11.5+/-1.0, p<0.001) and became normal in 60% of patients. Correlation analysis revealed independence of cardioprotective action of therapy from its hypotensive activity. Thus therapy with Hyzaar produced hypotensive and cardioprotective effects which were independent from each other.

Effect of transition from multiple administration of short acting nitrates to once daily use of isosorbide-5-mononitrate on angina class and quality of life was studied in 280 patients with stable angina pectoris. Transition to isosorbide-5-mononitrate was associated with increases of (in units) exercise tolerance (Delta=-6.6+/-0.35, p<0.001), satisfaction from treatment (Delta=-2.1+/-0.12, p<0.001), degree of psychological discomfort (Delta=-2.8+/-0.21, p<0.001), decreases of numbers of attacks of angina (Delta=-4.0+/-0.22, p<0.001) and side effects (Delta=-4.1+/-0.29, p<0.001), increase of average distance of walking without chest pain or dyspnea (from 372.1+/-415.1 to 586+/-663.5 m), shortening of duration of episodes of angina (from 4.7+/-4.0 to 4.1+/-7.2 min), significant lowering of angina class (p<0.0001). Thus in patients with ischemic heart disease long acting formulation of isosorbide-5-mononitrate provided rapid onset and stability of therapeutic action what eventually resulted in effective prevention of attacks of angina and improvement of quality of life.

Aim: To evaluate efficacy and tolerance of a compound drug co-renitec combining an ACE inhibitor enalapril maleate and diuretic hydrochlorothiazide co-renitec taken for 16 weeks in essential hypertension (EH)., Material and Methods: 28 patients with EH (16 males and 12 females aged 47-74 years) of mean duration 13.1 +/- 1.6 years. Blood pressure (BP) was monitored for 24 hours with the device SL 90207 (SpaceLabs Medical, USA). Microalbuminuria (MAU) was estimated with the use of immunoturbodimetric test., Results: By 24-hour monitoring, co-renitec reduced day BP by 14.9/8.9 +/- 3/2 mm Hg, nocturnal BP lowered by 18.6/11.4 +/- 3/2 mmHg, pulse pressure also fell. Coefficient T/P was 53.5% for systolic BP (SBP) and 59.6% for diastolic BP (DBP). The target SBP was reached in 77% patients, target DBP--in 69%. Co-renitec significantly decreased MAU, albumines excretion normalized in 46% patients., Conclusion: Co-renitec lowers both day and nocturnal blood pressure, improves 24-h rhythm of BP, has a positive effect on the kidneys. This allows its recommendation as a first-line drug in patients with moderate and severe EH.

We studied the role of oxidative stress in the pathogenesis of primary pulmonary hypertension. In patients with primary pulmonary hypertension the content of malonic dialdehyde in the plasma was higher than in healthy volunteers (5.18 0.46 and 2.95 0.14 nmol/liter, respectively, p<0.01). However, glutathione peroxidase activity in the plasma decreased in these patients (0.50 0.17 vs. 1.19 0.14 U/ml in the control, p<0.05). By contrast, glutathione peroxidase activity in erythrocytes from patients surpassed the control (6.13 0.39 and 4.63 0.45 U/h hemoglobin). The increase in malonic dialdehyde content in the plasma and glutathione peroxidase activity in erythrocytes and the decrease in glutathione peroxidase activity in the plasma were most pronounced in patients with severe cardiac insufficiency and pulmonary hypertension. Our results indicate that antioxidant preparations improve the prognosis in patients with primary pulmonary hypertension.

Aim: To evaluate carvedilol effect on clinical state, norepinephrine (NE) and epinephrine (E) plasma concentration and lymphocyte beta 2-adrenoreceptor dependent cAMP synthesis in patients with primary pulmonary hypertension (PPH)., Material and Methods: 14 patients with PPH were included in the study; 9 patients were treated by carvedilol; 5 patients were in the control group. The primary efficiency parameters were submaximal exercise measured by 60 min walk test, systolic pulmonary artery pressure (SPAP) measured by Doppler echocardiography, heart rate (HR) measured by 24-hour ECG-monitoring., Results: One month carvedilol treatment of PPH patients resulted in a significant HR reduction. There was a tendency to SPAP decrease, the 6-minute walk test results improved in IIINYHA patients., Conclusion: Carvedilol therapy improves clinical state and evoked lymphocyte beta 2-adrenoceptor resensitization in PPH patients.

Aim: To evaluate norepinephrine (NE) and epinephrine (E) plasma concentration and lymphocyte beta-2-adrenoceptor dependent cAMP synthesis in primary pulmonary hypertension (PPH) patients in comparison with healthy controls., Material and Methods: Seven volunteers and fifteen patients with PPH were included in the study. NE and E plasma levels were measured by high performance liquid chromatography. Basal and stimulated (isoproterenol and forskolin) adenylyl cyclase activity in lymphocytes was measured by cAMP production using an enzyme immunoassay (Biotrak, Amersham UK)., Results: There was a 110% (p = 0.001) NE level increase in PPH patients. In systolic pulmonary artery pressure (SPAP) > 95 mm Hg lymphocyte cAMP production associated with adenylyl cyclase catalytic subunit was decreased by 170% and 70% vs PPH patients with SPAP < 95 mm Hg and healthy controls, respectively (p < 0.05). A significant negative correlation between forskolin cAMP production by lymphocytes and SPAP level was observed in PPH patients (k = -0.810, p = 0.011 by Kendell; k = -0.893, p = 0.007 by Spirman). Heart failure progressing from I-II to III NYHA functional classes was accompanied by plasma NE enhance and lymphocyte beta-2-adrenoreceptor-activated cAMP production decrease., Conclusion: The data demonstrate sympathoadrenal system activation and lymphocyte beta-2-adrenoceptor desensitization in PPH patients.

Aim: To evaluate the effect of arifon-retard (Servie, France) in patients with isolated systolic arterial hypertension (ISAH)., Material and Methods: The efficiency of 12-week monotherapy with indapamid (arifon-retard) in a daily dose of 1.5 mg on systolic, diastolic, and pulse arterial pressure (SAP, DAP, and PAP, respectively) was studied in 20 patients with ISAH., Results: SAP decreased by 25.1 +/- 1.8, (p < 0.00009), DAP by 4.2 +/- 0.9 (p < 0.0008), and PAP by 20.9 +/- 2.1 mm Hg (p < 0.00009). Antihypertensive effect was observed in all patients, AP normalized in 30% after 4 weeks of therapy and in 70% after 12 weeks, DAP not decreasing below 70 mm Hg in any of the patients. Antihypertensive effect of indapamid on SAP and PAP additionally increased from week 4 to week 12. With sufficient antihypertensive effect on SAP, the drug did not induce an excessive decrease of DAP and did not affect heart rate and blood biochemistry. The drug was well tolerated, no side effects were observed.

Pulmonary artery pressure (PAP) was monitored for 24-48 hours in 10 and 8 patients with primary and secondary pulmonary hypertension, respectively. The data obtained were compared with results of prolonged PAP monitoring in 2 healthy volunteers. Variability of mean PAP was 7.43-/+3.1, 5.78-/+1.64, and 3.4-/+0.63 mm Hg, coefficient of variability - 10.39-/+3.68, 13.04-/+6.01 and 22.73-/+8.03% in patients with primary and secondary pulmonary hypertension and healthy subjects, respectively. After surgery in patients with secondary pulmonary hypertension coefficient of variability rose from 13.04-/+6.01 to 16.7-/+12.8%, while variability decreased from 5.78-/+1.64 to 4.3-/+1.65 mm Hg. Level of spontaneous fluctuations of PAP was the highest in healthy subjects (71.4%) and the lowest - in patients with primary pulmonary hypertension (34.9%). Thus PAP variability is a widespread phenomenon which should be taken into consideration during right heart catheterization and acute pharmacological tests.

Arterial hypertension in line with atrial fibrillation, diabetes mellitus, smoking and alcohol abuse is an important modifying factor of stroke risk. If the diastolic arterial pressure increases by 5 mm the stroke risk increases by 30%. The cooperative study of prevention of arterial hypertension that had been conducted in our country 20 years ago ascertained correlation between arterial hypertension and stroke morbidity. Recently terminated multicenter studies showed the necessity to strengthen the arterial pressure control in order to decrease amount of cardiovascular complications and strokes, in particular the recommended blood pressure both for young and middle age groups as well as for patients with diabetes mellitus is 130/85 mm Hg. In elderly the recommended level is < or = 140/90 mm Hg. It is fairly achievable to conduct up-to-date medication and non medication hypotensive treatment. There is no data about what medications are preferable for secondary stroke prevention. To fill this gap PROGRESS study of perindiprol and MOSES study of eprosartan were designed.

Aim: To elucidate mechanisms underlying arterial hypertension (AH) in patients with hyperprolactinemia, prolactin-secreting adenoma of the anterior lobe of the hypothesis, in particular., Material and Methods: 9 females with microprolactin-secreting and 4 females with macroprolactin-secreting adenoma of the anterior lobe of the hypophysis (mean age 33.8 +/- 3.7 years) were examined using radioimmunoassay of the hormones, computed tomography, MR-tomography of the adrenals and brain., Results: Humoral regulation of the hypothalamic-hypophyseal-adrenal axis was found different in patients with microadenoma due to dopaminergic insufficiency of the hypothalamus and in patients with macroadenoma--tumor of the hypophyseal genesis. Patients with microadenoma were diagnosed to have low-renin diastolic arterial hypertension with clinical symptoms of hyperaldosteronism and high levels of plasma aldosterone. Patients with macroadenoma had normal arterial pressure, aldosterone levels and plasma renin activity. Treatment with parlodel, agonist of dopaminergic receptors, reduced arterial pressure, prolactin level, plasma aldosterone and raised plasma renin activity in patients with microadenoma. Such changes were not observed in patients with macroadenoma., Conclusion: It is suggested that one of the causes of AH in patients with microprolactin-secreting hypophyseal adenoma lies in hyperaldosteronemia which develops as a result of dopaminergic insufficiency of the hypothalamus and hyperprolactinemia.

Aim: A comparative analysis of the content of the soluble form of cell adhesion protein P-selectin in the blood plasma of patients with acute myocardial infarction (AMI), massive atherosclerosis (MA) and primary pulmonary hypertension (PPH), investigation of the relationship between plasma content of P-selectin and known markers of platelets and endothelial cells activation, preliminary assessment of the prognostic value of P-selectin determination., Materials and Methods: This study included 16 patients with AMI, 20 patients with MA, 21 patients with PPH and 18 healthy donors. The follow-up was 1-5 years. End-points in the group of patients with AMI were recurrent acute coronary syndrome and coronary artery by-pass operation, in the group with MA--thrombotic complications (acute coronary syndrome, ischemic stroke) and in the group with PPH--death. P-selectin was measured by ELISA and platelet factor 4 (PF4), thromboxane B2 (TXB2), endothelin-I and stable prostacyclin metabolite 6-keto-prostaglandin F1 alpha (6-keto-PGF1 alpha) by means of commercial ELISA kits., Results: Mean level of P-selectin in blood plasma of patients with AMI (1 day) (361 +/- 18 ng/ml), MA (410 +/- 31 ng/ml) and PPH (627 +/- 83 ng/ml) was increased in comparison with the group of healthy donors (269 +/- 12 ng/ml) (everywhere p < 0.001). In AMI, P-selectin was increased on day 1 only, on days 2, 3 and 10-14 of the disease the level of P-selectin was significantly lower than on day 1 and did not differ from the control level in the group of donors. In patients with MA a significant correlation was detected between plasma content of P-selectin and platelet activation marker PF4 (r = 0.606, P = 0.007) and in patients with PPH between the content of P-selectin and another platelet activation marker TXB2 (r = 0.622, p = 0.013). However, no correlation was found in PPH patients between the content of P-selectin and markers of endothelial activation and/or damage (endothelin-1 and 6-keto-PGF1 alpha). Difference in the concentration of P-selectin in patients with or without end-points during the follow-up period was detected in patients with AMI (353 +/- 14 ng/ml and 451 +/- 24 ng/ml, p = 0.009) and PPH (477 +/- 58 ng/ml and 927 +/- 184 ng/ml, p = 0.017) but not with MA (426 +/- 37 ng/ml and 361 +/- 24 ng/ml, p = 0.295)., Conclusion: The level of P-selectin in plasma was increased in patients with acute thrombosis (AMI, 1 day) as well as in patients without clinical signs of thrombosis but with a massive injury of the vasculature (MA and PPH). The increase of P-selectin was, presumably, caused by its secretion from activated platelets since its concentration in plasma correlated with platelet concentration but not endothelial activation markers. Preliminary data indicate that blood plasma soluble P-selectin may be considered as a potential prognostic marker in AMI and PPH.

The respiratory section of lung biopsies from patients with primary pulmonary hypertension (PPH) was studied by electron transmission microscopy. The alterations found allow to suggest the presence of apoptotic degeneration of cells of the capillary endothelium and lung epithelium, this being confirmed also by an alveolar macrophages increase. The role of apoptosis in the PPH pathogenesis is discussed.

Aim: To investigate aspirin efficacy in patients with primary pulmonary hypertension (PPH) after a course of prostaglandin E-1 (PE) treatment., Materials and Methods: 12 PPH patients (mean age 35.7 +/- 2.5 years) having the disease for 6.7 +/- 1.1 years were assigned to a 6-month course of aspirin treatment in a dose 100 mg/day in combination with calcium antagonist isradipin. All the patients have previously undergone 21-day PE treatment (vasaprostan). Before and after the treatment, the patients were examined clinically and biochemically., Results: As shown by ECG, chest x-ray, bicycle exercise, aspirin used in combination with isradipin led to stabilization of the disease. Platelet aggregation also remained stable, thromboxan B2 and endothelin-1 levels went down. Low doses of aspirin allowed to avoid side effects typical for this drug., Conclusion: Use of aspirin in a dose 100 mg/day in combination with calcium antagonists to treat primary pulmonary hypertension is justified.

Aim: Assessment of RAAS and vasopressin in patients with primary pulmonary hypertension (PPH)., Materials and Methods: Activity of plasma renin (APR), angiotensin-converting enzyme (ACE), plasma levels of angiotensin II (AII) and vasopressin (VP), serum concentration of aldosteron (AS) were measured by radioimmunoassay and enzyme immunoassay in 21 PPH patients with circulatory failure (age 34.7 +/- 2.1 years), 11 patients with NYHA functional class II-III, 10 with class IV, and 10 control subjects (age 29.8 +/- 1.5 years)., Results: Compared to controls, 21 PPH patients had elevated RAAS parameters: APR up to 3.52 ng/ml/h (p < 0.05), activity of ACE up to 43.13 units, AII level up to 33.93 ng/ml (p < 0.01), AS up to 468.86 ng/ml (p < 0.01), VP up to 5.26 ng/ml (p < 0.001). Circulatory failure progression resulted in activation of all the RAAS components. This and VP activation was the greatest in PPH patients with ACE > 5 ng/ml/h. PPH patients with mean pressure in the pulmonary artery higher than 60 mm Hg demonstrated higher ARP, AS, VP, AII, ACE than those who had this pressure under 60 mm Hg., Conclusion: PPH patients display a noticeable activation of RAAS and VP. This activation seems to be secondary as the changes increase with elevation of the pressure in the pulmonary artery and aggravation of circulatory insufficiency. Plasma renin activity determines the degree of RAAS activation as a whole. The discovered activation of RAAS in PPH gives grounds for doubts in the validity of using ACE inhibitors in the treatment of PPH.