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Aim. To study the pharmacological treatment of patients with acute stroke (AS) within the prospective outpatient registries. Material and methods. In the pilot phase of the study, conducting on the base of one of the out-patient clinic in Ryazan city, 200 and 115 patients were included into the outpatient registry of patients with AS history of any remoteness (AS-AR registry), and outpatient registry of the first apply (AS-FA registry) to the out-patient clinic after stroke, respectively. The correspondence of the prescribed and actually taken drug therapy to clinical recommendations, its continuity, and the adherence of patients to treatment were assessed during the prospective observation. Results . Most patients did not receive adequate therapy to reduce the risk of AS and other cardiovascular complications in the outpatient stage, especially in the period prior to the reference AS. Drugs with a proven beneficial effect on the prognosis in the post-stroke period were prescribed significantly (p and after 2 years – in the AS-FA registry, the frequency of the therapy was not significantly different from the frequency of prescribing at the stage of inclusion in the registers, with the exception of statins (they were taken 1.7 and 1.5 times less frequently). Prognostically significant prescriptions of the inclusion phase were performed in the long-term follow-up period in 49% and 70% of patients (on average 58%), respectively; however, the frequency of first-time therapy was 44% and 19% of the total number of prescriptions in this period, respectively. Adherence to treatment, according to the Morisky-Green questionnaire, was revealed in 17.7 and 51.7% of patients, respectively Conclusion. The results of the pilot phase of the REGION study (AS-AR and AS-FA outpatient registries) showed that the quality of the prescribed drug therapy of patients in out-patient clinic is inadequate. A comparison of the data of AS-AR and AS-FA registries allows to make a preliminary conclusion that over the 5-year period separating the remoteness of AS development in these registries, the quality of patient treatment has significantly improved, although not enough. The proportion of previously performed prognostically significant prescriptions averaged only about 60% at the stage of the further prospective follow-up. In general, during the observation period, taking into account newly made prescriptions, the frequency of adequate drug therapy during the observation period decreased only for statins. Most patients were not sufficiently committed to pharmacological treatment according to the Morisky-Green questionnaire.

Aim. To assess the clinical and anamnestic characteristics, the prescription rate of angiotensin converting enzyme inhibitors (ACEI)/angiotensin receptor blockers (ARB) and β-blockers in the outpatient practice, adherence to drug therapy in patients with a combination of chronic heart failure (CHF), hypertension (HT) and history of myocardial infarction (MI) in the frame of Cardiovascular Disease Registry (RECVASA). Material and methods. Data analysis in groups of patients with a combination of CHF, HT and the history of MI (n=406) and patients with a combination of CHF, HT and ischemic heart disease (IHD) without history of MI (n=1897) was performed in the frame of RECVASA registry. The structure of the associated cardiovascular and concomitant non-cardiac diseases, the severity of the clinical manifestations of CHF, IHD and HT, the prescription rate of the ACEI/ARB and β-blockers, the adherence to drug therapy (according to the Morisky-Green test) were studied in groups. Results. Patients with a combination of CHF, HT and IHD with or without MI history significantly differed in the proportion of men (47.8% vs 24.9%, respectively), prevalence of atrial fibrillation (25.9% vs 20.5%, respectively), diabetes mellitus (27.3% vs 15.7%, respectively) and the stroke history (17.2% vs 10.7%, respectively). The mean age (69.9±11.0 vs 70.3±11.0 years, respectively), as well as the prevalence of the history of respiratory diseases, chronic kidney disease, digestive diseases, obesity and anemia, did not differ significantly. Patients with a combination of CHF, HT and post-infarction cardiosclerosis (PICS) compared with patients without PICS significantly more often had CHF class 3-4 NYHA (62% vs 47.9%, respectively), HT of degree 3 (92.5% vs 84.2%, respectively), stable angina class 3-4 (84.4% vs 66.4%, respectively). Patients with PICS significantly (p

Aim. To study particularities of course and outcomes of acute cerebrovascular accident (ACVA), quality of examination and medical treatment within a framework of an outpatient register. Material and methods . Two outpatient registries were organized on the base of one of Ryazan outpatient clinics within a framework of the pilot phase of the REGION study: the register of patients who had experienced ACVA of any remoteness (ACVA-AR register, n=200) and the register of patients who had visited the outpatient clinic for the first time after cerebral stroke (ACVA-FV register, n=115). Particularities of ACVA development, concomitant cardiovascular diseases (CVD) and noncardiac diseases were analyzed. We estimated accordance of methods of examination and prescribed medical treatment with clinical guidelines. Long-term outcomes were also evaluated in the course of prospective follow-up. Results. Patients of both registers had concomitant CVD (on an average 3 diagnosis) and noncardiac comorbidity (on an average 1 diagnosis). Majority of patients at the outpatient phase received inadequate treatment for cardiovascular risk decrease, especially before reference ACVA. The ACVA-FV register patients as compared to the ACVA-AR ones (who had experienced ACVA on an average 4.8 years earlier) were more often (p

Aim To assess characteristics and patterns of cardiovascular (CV) and non-cardiovascular (non-CV) multimorbidity in patients with history of stroke (STR) without myocardial infarction (STRH), history of myocardial infarction (MI) without stroke (MIH), and their combination (STRH+MIH) on a basis of the hospital registry. Methods The hospital registry included 8954 patients with arterial hypertension (AH), ischemic heart disease, chronic heart failure (CHF), atrial fibrillation (AF) and their combinations hospitalized to the National Medical Research Center for Preventive Medicine (Moscow, Russia) from 01.04.13 to 31.03.17. 2020 (22.6%) patients had a MIH, 857 (9.6%) – a STRH and 318 (3.6%) had a combination of them. Results The age of patients with MIH was significantly less than in STRH and in the combined group (66.8±11.3 vs 70.8±10.9 and 71.6±9.9 years, p0.05). The average number of comorbid non-CV diseases (non-CVDs) was: 1.96±0.5 in MIH group; 2.03±0.3 in patients with STRH and 2.55±0.3 in STRH+MIH group (p Conclusions Patients with history of stroke and myocardial infarction had maximal number both of CVDs and non-CVDs compared with groups of only myocardial infarction or stroke history, i.e. they had the higher CV risk and the most unfavorable profile in hospital registry. So, the multidisciplinary approach for the treatment and prevention in this multimorbid group is most indicated. 70% of patients in combined group had primary MI earlier than primary stroke (on the average 3.8 years). This fact confirmed the suggestion that MI is the earlier part of cardiovascular continuum than stroke.

Introduction It is well known that high heart rate (HHR) is the independent risk factor for all cause and CVD mortality. Less known about HHR associations with various cause-relative deaths. Purpose to evaluate the impact of HHR in cause-specific mortality among Russian men and women. Methods The data were obtained from seven independent cross-sectional population surveys, conducted in 1975–2001 in Moscow and St Petersburg (Leningrad) in which a randomly selected population aged 35–74 years was studied at different periods of time. The total number of respondents was 20 045 (15107 men and 4938 women). The surveys were carried out using the single core protocol with the standard methods and criteria. Socio-demographic characteristics, smoking status, alcohol intake, body mass index (BMI), systolic and diastolic blood pressure (SBP and DBP), lipid levels [total cholesterol (TC), high density lipoproteins-cholesterol (HDL-C), triglycerides (TG)] and resting electrocardiogram (ECG) were measured. CHD status was defined as: angina pectoris (AP) assessed by Rose questionnaire and/or ECG disturbances by Minnesota code: Q-QS waves (Major QQS: 111–127; Minor QQS: 128, 13), ST-T ischemia (major ischemia: 41,2 an/or 51,2 without 31,33; Ischemia minor: 43,53). Heart rate was measurement on ECG record. HHR was defined as >80 beat/min. Follow-up period was more than 23.5 years. Hazard ratios (HR) and 95% confidence intervals (CI) for estimation the associations between HHR and cause specific mortality were evaluated by Cox regression, with adjustment for risk variables such as age, smoking status, alcohol consumption, blood pressure level, lipids disturbance and CHD. Results During the follow-up period 10648 deaths (8724 in men and 1924 in women) occurred. The other mortality events consisted of 3495 CHD deaths, 1641 stroke deaths, 5680 CVD and 4287 non CVD deaths for both sexes. Mean age of the sample was 46.5±0.01 b/min. After adjustment for age, risk factors, CHD status and education, the association between HHR and all-cause mortality was 1.25 ([1.16–1.34], p=0,0001) among men; 1.21 ([1.04–1.86], p=0.0102) – among women. For CVD deaths - 1.23 ([1.12–1.36], p=0.0001) and 1.19 ([0.97–1.45], p=0.0902) – among men and women, respectively. HHR was also associated with non-CVD mortality among men but not in women: 1.38 ([1.18–1.62], p=0.0001) and 1.28 ([0.93–1.77], p=0.1345), respectively. The same was found for stroke mortality: for men – 1.45 ([1.06–1.98], p=0,0183), for women - 1.28 ([0.93–1.77], p=1345). The HHR was associated with CHD mortality only in men in women this indicator was not even selected for model. Conclusions HHR is the independent risk factor for every cause-specific mortality even after adjustment for age, risk factors profile and CHD history among Russian men while among women the positive association was found only for all-cause mortality. Probably HHR can be considered at least in men as a marker of general health.

Background Masked hypertension (MH) is associated with cardiovascular complications and poor prognosis. Characteristics of untreated patients with reproducible MH are studied insufficiently. Purpose The aim of our study was to assess characteristics of ambulatory patients with reproducible MH in comparison to patients with non-reproducible MH in two visits. Methods The patients from the ambulatory BP monitoring (ABPM) database (>2000 patients) were selected according to the following criteria: absence of any antihypertensive treatment (AHT), availability of clinical BP (CBP) and ABPM records at two visits with the 6 months interval, CBP Results We selected 295 patients (men 43%, mean age 49.0±7.6 years, CBP 128.4±9.4/80.5±7.2 mm Hg, body mass index 27.6±4.3 kg/m2, 24h pulse wave velocity in aorta [PWV] 10.7±1.7 m/s). MH only at one visit was found in 168 patients (56.9%). Respectively, MH at both visits was in 127 patients (43.1%). The patients with reproducible MH were characterized by the presence of: mother's (p=0.011) or father's hypertension (p=0.025), mother's ischemic heart disease (p=0.015), mother's myocardial infarction (p=0.020), father's stroke (p=0.030), higher arterial stiffness (PWV 11.0±1.7 m/s vs. 10.5±1.8 m/s, p=0.022), and systolic BP in aorta (120.0±7.5 mmHg vs. 117.8±9.4 mm Hg). Conclusions The patients with reproducible MH (without AHT) are characterized most of all by the family history of hypertension and its complications. The correlation of stable MH with arterial stiffness confirms the importance of PWV and central aortic pressure measurement in patients with CBP

Currently, in the epidemiology of nutrition, methodological approaches to the empirical assessment of the diets of the population and their relationship to health indicators are actively using. In Russia, these approaches have been used in a number of cohort and regional studies, however, such studies are not available for the entire Russian population.

Aim: to elucidate predictors of high level of basal triglycerides (TG) in blood of children of persons with early (onset: men ≤55, women ≤60 years) ischemic heart disease (EIHD).Materials and methods. We examined 316 families: patients (probands) (n=295; 77.9 % after MI) with EIHD, their spouses (n=219; 83.1 % women) and native children of probands (n=413; 55.7 % men) aged 5–38 years. In children aged 5–17 and 18–38 years proband’s spouse was mother in 88 and 77 % of cases, respectively. Hypertriglyceridemia in children (HTG) was defined in persons aged 5–17 years as ≥90 percentile (Lipid Research Clinics), ≥18 years – ≥1.7 mmol / l or HTG drug treatment. Predictors of HTG were selected by binary logistical regression with adjustment for age, sex and drugs.Results. HTG was found in 31 / 158 children aged 5–17 years. Its independent predictors were systolic arterial pressure (odds ratio [OR] of top [>108] vs. two bottom [≤108 mm Hg] tertiles 3.85, 95 % confidence interval [CI] 1.38–10.7, р=0.010), heart rate (HR, OR of top [>78] vs. two bottom [≤78 bpm] tertiles 2.94, 95 % CI 1.20–7.23, р=0.019), and high density lipoprotein cholesterol (HDL–C, OR 0.35, 95 % CI 0.13–0.94; р=0.038) of their children; HR (OR of top [>72] vs. two bottom [≤72 bpm] tertiles 3.56, 95 % CI 1.38–9.11, р=0.008), low density lipoprotein cholesterol (OR 2.49, 95 % CI 1.12–5.52, p=0.025]), and type 2 diabetes (OR 25.9, 95 % CI 1.01–665.3; p=0.049) of the parent – proband’s consort. HTG was found in 35 / 255 children aged 18–38 years and was associated with own age (OR 1.10, 95 % CI 1.02–1.19, р=0.012) and male sex (OR 6.21, 95 % CI 2.45–15.8; р=0.000). HTG was independently associated with body mass index (OR top [>25.4] vs. two bottom [≤25.4 kg / m2] tertiles 4.94, 95 % CI 2.13–11.4, р=0.000); basal glycemia (OR top [5.1] vs. two bottom [≤5.1 mmol / l] tertiles 2.52, 95 % CI 1.17–5.43, р=0.019); HDL–C (OR 0.17, CI 0.04–0.81, 0.027); alcohol consumption (OR consuming more than once vs. once a week and less 2.27, 95 % CI 1.02–5.02, p=0.044) of these children; HDL–C (OR 0.19, 95 CI 0.04–0.94; p=0.041) of the proband-parent.Conclusions. HTG in children aged 5–38 years with parental early IHD was independently associated mainly with own characteristics, forming components of metabolic syndrome. Attention should be paid to the dominance of maternal transmission in children and adolescents (age group 5–17 years).

Purpose.Assessment of prevalence of arterial hypertension (AH), need for prescription of antihypertensive therapy (AHT), and efficacy of AHT in Russian population in accordance with novel guideline of the American College of Cardiology/American Heart Association (“American recommendations”) on diagnosis and treatment of AH (2017).Materials and methods. Epidemiological study ESSE-RF (ЭССЕ-РФ) was carried out in 12 regions of Russian Federation (RF) with different climatic-geographic characteristics. Number of examined residents of RF aged 25–65 years was 20 652. The sample was stratified by gender and age. Examination included anthropometry, laboratory tests, blood pressure (BP) measurement with the OMRON tonometer. The SCORE scale was used for evaluation of risk of development of cardiovascular diseases (CVD). In American recommendations AH was defined as follows: 1-st degree – systolic BP (SBP) 130–139 and/or diastolic BP (DBP) 80–89 mm Hg, 2-nd degree – BP ≥140/90 mm Hg and/or presence of AHT. In recommendations of the European Society of Cardiology (2013, 2018) (“European recommendations”) AH was defined as BP ≥140/90 mm Hg and/or presence of AHT.Results. We analyzed data of examination of 20 607 participants – 7806 men (37.9%) and 12 801 women (62.1%). According to European recommendations AH was diagnosed in 10 347 persons (50.2%) – 3987 men (51.1%) men and 6 360 women (49.7%). According to American recommendations AH was registered in 14 853 persons (72.1%) – 6 059 men (77.6%) and 8 794 women (68.7%). AHT received 6324 persons (61.1% of those with AH); according to American recommendations, the onset of AHT was indicated to additional 620 persons with 1-st degree AH because of high CVD risk. Among all participants with AH (on and without AHT) strengthening of AHT for achievement of target BP level was required in 77.8 and 92.6% of patients according to European and American recommendations, respectively.Conclusion. Application of novel criteria of AH diagnosis from 2017 ACC/AHA guideline to Russian population would increase prevalence of AH up to 72.1%. Onset of AHT would be indicated in 13.8% of patients with 1-st degree AH, while in 93% of patients receiving AHT its strengthening would be required.

Aim. To study the prevalence of ECG ischemic disorders assessed by theMinnesota code on a sample of people over 50 years, depending on gender, age and employment. Material and methods. The results of a survey of a representative sample of the unorganized population of 13 regions, participants of the ESSE-RF program in 2012-2014, were included into the study (n=8334 people; men - 2784, women - 5550). Analysis of the prevalence of ECG changes was carried out by the Minnesota code in groups of 50-54, 55-59 and 60-64 years old, depending on gender and employment (employed and unemployed). Results. Pathological changes were recorded on the ECG more often in men compared to women – Q(QS)-wave (5% vs 1.9%), atrial fibrillation (2.1% vs 0.8%; p

When appointing antihypertensive drugs to patients with stable mild to moderate arterial hypertension (AH) it is necessary to take into account the effect of treatment on the quality of life (QoL) of these patients. The aim of the study was to compare the effect of prolonged use of antihypertensive drugs from the main treatment groups on QoL of patients with stable AH in 5 controlled trials. The results of monotherapy efficacy were assessed by 24-hour blood pressure monitoring and QoL patients were studied before and after long-term monotherapy according to the results of a database analysis of 5 studies performed in our center for the last 4 years. After the period of withdrawal of antihypertensive therapy, patients underwent 24-hour blood pressure monitoring, QoL was evaluated. According to 24-hour blood pressure monitoring, diltiazem had an antihypertensive effect, comparable to the effect of enalapril. Both drugs had no effect on the circadian rhythm of arterial pressure and the outpatient heart rate. Long-term use of none of the antihypertensive drugs (diltiazem, amlodipine, enalapril, metoprolol, telmisartan) did not worsen QoL. The greatest impact on QoL was provided by the group of angiotensin-converting enzyme inhibitors, enalapril, significantly improving QoL.

Nitric oxide (NO) is an important functional regulator that contributes to progression of various cardiovascular diseases. We studied associations between nitric oxide metabolites, nitrite and nitrate (NOx), and cardiovascular mortality in a prospective 3-year follow-up cohort study in 1,869 elderly patients aged over 55 years. The Cox proportional hazard regression model was adjusted for multiple factors including sex, age, risk corresponding to preexisting cardiovascular conditions, and serum inflammatory markers (C-reactive protein, interleukin-6, fibrinogen, and leucocytes count). During the follow-up period, there were a total of 348 deaths including 216 deaths unrelated to cardiovascular events and 132 cardiovascular deaths. Cox regression adjusted for factors related to cardiovascular disease risks and inflammatory markers showed a significant association between high levels of serum nitric oxide metabolites, NOx, and increased cardiovascular mortality (hazard ratio 2.21; 95% confidence interval 1.13-4.31) but there was no association with non-cardiovascular mortality. Analysis of adjusted hazard ratios demonstrates that association of serum nitric oxide metabolites with cardiovascular mortality was independent of levels of inflammatory markers. Thus, elevated concentrations of serum nitric oxide metabolites are a predictor of cardiovascular mortality and may be used as an integral marker of cardiovascular death. © 2016 BioFactors, 43(1):82-89, 2017.

Purpose To elaborate a risk score for prognostication of long-term survival of patients with chronic ischemic heart disease (CIHD) using data of the PROGNOSIS-IHD Registry. Material and methods Participants of the PROGNOSIS-IHD Registry (n=641, 500 men, 141 women) were inhabitants of Moscow region consecutively admitted for planned hospitalization with diagnosis of IHD to the clinic of the Center of Preventive Medicine from 01.01.2004 to 31.12.2007. During hospitalization all patients underwent coronary angiography. Diagnosis of IHD was not confirmed in 100 of 641 patients. In 2010 vital status was determined in 551 patients (86%). Mean duration of observation was 3.9 years. Uni- and multi-factorial analysis was used for assessment of prognostic value of clinical-anamnestic and instrumental parameters. Results The following parameters which were included into the risk score were most significant for prediction of occurrence of a primary end point (fatal and nonfatal cardiovascular complications [CVC]): feeling of shortness of breath (relative risk [RR] 1.86 and 1 point in risk score); history of unstable IHD course (acute coronary syndrome, myocardial infarction, unstable angina) (RR 1.76 and 1 point); need in diuretics before hospitalization (RR 1.92 and 1 point); stenosis of a cardiac valve (RR 2.95 and 2 points); zones of abnormal contractility of left ventricular myocardium at echocardiography (RR 2 and 1 point). Risk of death and nonfatal CVC in patients with suspected IHD was considered very low, low, medium, and high at score values 0, 1 (RR 1.6), 2 (RR 2.4), and more or equal 3 (RR 6.1), respectively. Conclusion Novel scale has high prognostic significance relative to stratification of risk of death and nonfatal CVC in patients with suspected CIHD and can be used in wide clinical practice because of its informativeness, simplicity, and accessibility.

The aim of the present study was to identify the relationship between the quality of life of patients with arterial hypertension (AH) and the degree of seasonal fluctuations in blood pressure (BP) in the morning hours in these patients, as well as to trace the seasonal dynamics of the average morning levels of blood pressure in this group of patients. We analyzed the database of various studies carried out in our center between 1996 and 2011, which contained data 953 ambulatory BP monitoring (ABPM). ABPM data were analyzed in patients with hypertension, without serious comorbidities, who conducted blood pressure monitoring on a weekly background of antihypertensive therapy. Results of the study. It has been shown that diastolic blood pressure (DBP) in the morning (at) was the highest in winter (83.5±13.7 mm Hg), at the lowest - in summer (80.2±11.5 mm Hg), which was typical of the seasonal dynamics of blood pressure generally. The systolic blood pressure (SBP) was characterized by the highest level of the fall in blood pressure (133.3±18.7 mm Hg). The smallest - in the winter (131,8 B±17,6 mm Hg). The differences between the seasons are not reliable. When analyzing the results by using generalized linear models (Generalized Linear Models) and calculating the Fisher's exact test (F) The following patterns were identified. Intensity of seasonal increases in blood pressure (compared with the average level of blood pressure) was inversely related to the level of social support of friends, colleagues, relatives (Scale VI Quality of Life Questionnaire) (for F DBP was 4.29 (p

Aim. To study the relationships between clinical and functional features of chronic obstructive pulmonary disease (COPD) and status of cardiovascular system with focus on identifying factors associated with the atrial fibrillation (AF) in patients with COPD. Material and methods. Patients (n=94) with COPD out of exacerbation and airways obstruction of 2-4 degree (GOLD 2013) were examined. The spirometry, daily pulse oximetry, 24-hour ECG and blood pressure monitoring with vascular wall stiffness estimation, echocardiography were performed. Levels of high-sensitivity C-reactive protein (CRP) were also assessed. Results. AF paroxysms were found in 46 patients, including newly diagnosed ones in 22 patients. According to the results of multiple correlation analysis, the frequency of AF paroxysms correlated with forced expiratory volume in 1 sec (FEV1) (R=-0.348; p=0.013), minimum oxygen saturation of the blood (min%SpO2) (R=-0.356; p=0.011), CRP level (R=0.442; p=0.001), the sizes of both atria (p

The article presents data on the mortality trends in Russia during the last decade in comparison with other countries in Europe. It is shown that in spite the decline in death rates, Russia remains among the countries with the highest mortality rates from CVD. The specifics of mortality that distinguish Russia from other countries are described: a large variability between regions in mortality levels, differences between sexes, dependence on geographical location and socio-economic development of the regions, and late referral to a doctor in life-threatening conditions. The article emphasizes the role of risk factors and accessibility and quality of medical care to the population, as the two main components of the mechanism for changing mortality from CVD.В статье приводятся данные о динамике смертности от сердечно-сосудистых заболеваний (ССЗ) за последние годы в сравнении с другими странами Европы. Показано, что на фоне снижения смертности Россия остается в ряду стран с наиболее высокими показателями смертности от ССЗ. Отмечены отличия России от других стран: большая вариабельность между регионами в уровнях смертности, различия между полами, зависимость от географического положения и социально-экономического развития регионов, позднее обращение к врачу при угрожающих жизни состояниях. Подчеркивается роль факторов риска и доступности и качества оказания медицинской помощи населению как двух основных составляющих механизма изменения смертности от ССЗ.

to study associations between elevated blood plasma concentration of N-terminal pro-brain natriuretic peptide (NT-proBNP), risk factors and cardiovascular diseases (CVD) in samples of adult population of Russian Federation (RF) aged 25-64 years.We analyzed data of examination of representative samples of population of 5 regions of RF obtained within the framework of the multicenter ESSE-RF study (2012-2013). Number of examined subjects was 8 077 (3 176 men). Methods included use of standard questionnaire, measurements of height, body mass, blood pressure (BP), and plasma NT-proBNP level. The following CVD were included into analysis: arterial hypertension (AH), ischemic heart disease (IHD), atrial fibrillation (AF), and stroke.Women compared to men had higher NT-proBNT concentration was higher in women compared to men, in both genders it rose with age. Overall 17.9 % of examinees had elevated NT-proBNT levels (14.2 and 20.3 % among men and women, respectively). Elevated NTproBNP level was associated in men with age, myocardial infarction, angina pectoris, ischemic ECG changes, left ventricular hypertrophy, AF, bradycardia, smoking, in women with age, IHD, ischemic ECG changes, AF, bradycardia, heart rate ≥80 bpm, BP ≥160/95 mm Hg.In studied RF population elevated NT-proBNP level was significantly associated with gender, age, smoking, and CVD.

Aim. To determine the value of different blood pressure (BP) measurement methods for arterial hypertension (HT) chronotherapy efficacy assessment. Material and methods. Two similar open, randomized, cross-over studies (morning vs evening intake) were carried out. Duration of the initial wash-out period was 2 weeks; duration of both treatment courses — 3 weeks; the interval between courses — 1 week. Only patients with stable HT (mean day-time BP>135/85 mm Hg) were included. Ambulatory BP monitoring (ABPM) was carried out prior to treatment and at the end of both treatment courses. The patients performed home BP monitoring (HBPM) throughout the study. Pharmacokinetics of verapamil (n=14, mean daily dose — 240.0±16.3 mg) was studied to assess compliance with verapamil therapy. In ramipril trial (n=30) its mean daily dose was 8.9±0.7 mg. The following main ABPM variables were analyzed: ABPM means and variability, maximal and minimal values, nocturnal BP fall, parameters of Fourier transformation and smoothness index. The morning and evening BP means and morning BP surge (morning – evening BP) were assessed by HBPM. Student’s t-value and Mahalanobis distance were used to evaluate individual value of each variable (“morning” vs “evening” effect). This analysis was first done separately for each trial. After that, combined data were analyzed. Results. Overall antihypertensive effect was more intense with morning ramipril (p

Aim. To compare influence of amlodipine and spirapril on ambulatory blood pressure profile, including antihypertensive effect smoothness in patients with arterial hypertension (HT).Methods. 39 patients (aged 53,7±10,0 y.o.) with HT were included in the open, randomized, cross-over study, 30 patients completed study. The duration of every therapies was 4 weeks, initial control period and wash-out period between therapies lasted 1 week. The initial daily dose of amlodipine was 5 mg, standard dose of spirapril (6 mg/daily) was not changed during the trial. After 1-2 weeks of treatment amlodipine dose was increased up to 10 mg/daily as well as dihydrochlorothiazide was added, if necessary. Ambulatory blood pressure monitoring (ABPM) was performed initially and at the end of both therapies.Results. Both drugs demonstrated good antihypertensive effect according to ABPM data. Decrease of systolic/diastolic blood pressure was 11,2±1,8/7,6±1,2 mm Hg in amlodipine therapy and 10,0±1,8/7,1±1,2 in spirapril therapy (pConclusion. Amlodipine has prominent as well as smooth antihypertensive effect, that gives it advantages in the long-term antihypertensive therapy.

Aim. To study therapeutic equivalence (efficacy, safety and tolerability) of original clopidogrel (Plavix) and its generic (Egitromb) in patients of high cardiovascular risk. Material and methods. Thirty one patients with coronary heart disease and indications for clopidogrel therapy were involved into the randomized cross-over blind study. Half of the patients received original clopidogrel (75 mg daily) during the first 2 weeks and then they received generic clopidogrel in the same dose during next 2 weeks. Another half of the patients received the drugs in reverse order. Antiplatelet activity of Plavix and Egitromb was estimated by effects on ADP-induced platelet aggregation initially and after 2 weeks of treatment with each drug. Study blinding was provided by the following approach: doctors of cardiology clinic performed clinical monitoring and drug distribution; coded blood samples for platelet aggregation assessment were studied in independent laboratory of thrombosis; statistical data analysis was performed by biostatistics expert in other research center. Results. 2-week therapy with each drug led to a significant decrease of ADP-induced platelet aggregation which remained low after switching from original drug to generic and vice versa. Aggregation dynamics did not depend on the first administered drug. There were no significant differences between aggregation changes as a result of treatment with original or generic drug. No one adverse event was observed in association with both drugs therapy. Conclusion. Generic drug Egitromb (Egis, Hungary) and original clopidogrel Plavix (Sanofi-Aventis, France) have equivalent antiplatelet effect.

Aim. To study effect of antihypertensive drugs on quality of life (QoL) of patients with stable arterial hypertension (HT).Material and methods. Results of some studies with similar design involving totally 170 patients with HT, aged 57,2±8,8 y.o., were analyzed. HT duration was 11,2±8,3 years. Patients received antihypertensive monotherapy with diltiazem, amlodipine, enalapril, lisinopril, metoprolol and telmisartan during 1-3 months. 24-hour blood pressure (BP) monitoring, QoL was performed before and after treatment.Results. All antihypertensive drugs significantly reduced systolic and diastolic BP and did not affect QoL. ACE inhibitors similarly improved QoL.Conclusion. Antihypertensive drugs (diltiazem, amlodipine, enalapril, lisinnopril, metoprolol, telmisartan) do not worsen QoL of patients with HT.

Aim. Тo compare the cost-effectiveness of antihypertensive therapy based on a generic and original drugs of amlodipine in patients with arterial hypertension (HT) degree 1-2 in NORST study. Material and methods. Patients (n=60) with HT degree 1-2 were involved in NORST study. After wash-out period they were randomized to receive generic (Group 1) or original (Group 2) amlodipine in the initial dose of 5 mg daily. In case of insufficient antihypertensive effect dose of amlodipine was increased to 10 mg per day and then successively lisinopril 10 mg daily and hydrochlorothiazide 12.5 mg one time per day were added. The total duration of treatment was 10 weeks (70 days). Achieving target blood pressure (BP) (

Aim. To compare two therapies based on carvedilol or metoprolol in hypertensive patients with overweight and obesity.Material and methods. 320 patients with arterial hypertension (1-2 degree) were involved in the study. 160 patients received carvedilol and 160 patients – metoprolol. Both randomized groups were comparable on the main clinical characteristics.Results. By the end of the study both systolic and diastolic blood pressure (SBP, DBP) reduced in both groups рConclusion. The results of open, randomized CAMELLIA trial confirmed antihypertensive effect and good tolerability of carvedilol in common clinical practice as well as demonstrated some its advantages in patients with metabolic syndrome. Carvedilol has positive metabolic effects on lipid, glucose and uric acid levels. Carvedilol therapy is more preferable in patients with arterial hypertension and metabolic risk factors.

Aim. To compare the efficacy and safety of carvedilol in men and women with mild to moderate arterial hypertension, associated with obesity and/or compensated diabetes type 2. Material and methods. Hypertensive patients (n=592, 176 men and 416 women) with obesity and/or diabetes were involved into randomized comparative open-label study in parallel groups. Patients were randomized into two groups. Patients of group A (n=291: 90 men and 201 women) kept on to receive previous antihypertensive drugs except beta-blockers which were withdrawn and replaced with carvedilol (Acridilole®, PLC “Akrikhin”, Russia). Patients of control group (n=301: 86 men and 215 women) kept on to receive only previous antihypertensive drugs. Efficacy of antihypertensive therapy was assessed at every 2-week visits during 24-week observation. Biochemical parameters of glucose and lipid metabolism, 12-lead ECG were evaluated at baseline and at the end of the study. Target blood pressure (BP) achievement and safety was assessed in 24 weeks of treatment. Results. Women had more severe metabolic abnormalities compared with men. By the 24th week of treatment significant reduction in systolic BP , diastolic BP , and heart rate was found in the both groups of patients regardless of gender , intergroup differences were significant (p

Principles and fundamentals of proper presentation of observational epidemiological study results are focused. Principles of observational study publication developed by expert epidemiologists (STROBE statement) are explained in detail.

Aim. To study efficacy and safety of beta-blocker with vasodilating properties carvedilol (Acridilole, Akrihin, Russia) as a part of the combined therapy of patients with arterial hypertension (HT) and diabetes mellitus 2 type (DM2) and/or obesity.Material and methods. 592 patients: 176 men (29,7%) and 416 women (70,3%) with HT were examined. 194 patients had D2 and 398 patients had obesity. Patients were randomized for carvedilol therapy (n=291) or control group (n=301). Carvedilol was prescribed additionally to current therapy in dose of 6,25 mg BID, in 2 weeks the dose was increased to 12,5 mg BID if it was necessary. Blood pressure (BP) and heart rate, number of angina attacks were registered at visits. ECG, laboratory analysis (plasma lipide profile, serum glucose, glycolised haemoglobin, serum K+ and Na+), evaluation of depression and anxiety status (according to special questionnaires) were performed on the first and the last visits.Results. 582 patients completed the study. 7 patients dropped out from carvedilol group and 3 patients - from control group. The levels of systolic BP (SBP) and diastolic BP (DBP) were decreased during study, more significantly in carvedilol group (рConclusion. High antihypertensive efficacy of carvedilol is confirmed in hypertensive patients with DM2 and/or obesity. Good tolerability and metabolic neutrality of carvedilol is also observed.

Aim. To estimate influence of thrombosis associated genetic factors on cardiovascular complications (CVC) occurrence in patients with stable ischemic heart disease (IHD) on the base of 5-year prospective survey. Material and methods. A total of 503 patients with the mean age of 59.4 years were enrolled into the study. The follow-up period was 5.4 years. Composite endpoint included the following cases of fatal and nonfatal CVC: death, acute coronary syndrome, ischemic stroke/transient ischemic attack, peripheral arterial thrombosis and revascularization of affected vascular system. We determined prevalence and prognostic value of mutations and polymorphisms in genes that encode blood clotting factors (factor V Leiden G1691A, prothrombin G20210A, ß-fibrinogen 455G> A), platelet GPIIIa receptor (C1565T) and enzymes involved in homocysteine metabolism (methylentetrahydrofolate reductase (C667 T MTHFR) and A1298C, methionine synthase (MTR) A2756G, methionine synthase-reductase (MTRR) A66G and transcobalamin (TCN) C776G). Results. Overall incidence rate of vascular events made up 31.0%. MTHFR and TCN polymorphisms proved to be significant in regard to cardiovascular risk among all studied genetic indices. Carriage of at least C667 T one MTHFR polymorphic allele increased risk of CVC 1.64 times (95% confidence interval (CI) 1.2-2.3, p=0.003). Homozygous carriage of MTHFR 1298 AА and TCN 776 СС “wild” genotypes increased risk of CVC 1.63 times (95% CI 1.2-2.3, р=0.006) and 1.37 times (95% CI 1.001-1.89, р=0.04), respectively. Such genetic variants as MTHFR C667 T/СТ and 1298 AА impacted prognosis only given concomitant decrease in plasma folate level, which was observed in 56.1% of the patients. Conclusion. It can be recommended to test the presence of MTHFR C667 T, MTHFR 1298 AА and TCN 776 СС, and to simultaneously assess folate level in IHD patients in order to clarify risk of unfavorable cardiovascular events.

Aim. To compare enalapril (E) and diltiazem (D) efficacy in menopausal women with arterial hypertension (AH) using three methods of blood pressure (BP) measurement.Material and methods. There was a cross-over randomised study with E and D included 22 menopausal women with AH. E was given at a daily dose of 5-20 mg and D – at a daily dose of 180-360 mg. At baseline and at the end of each treatment period ambulatory blood pressure monitoring (ABPM) was carried out. Self blood pressure measurement (SBPM) was performed during all study period. To assess a steadiness of antihypertensive effect we calculated smoothness index and trough-to-peak ratio based on ABPM data.Results. Ambulatory 24-h systolic BP and diastolic BP were decreased in the E group (-15.2/-9.6 mm Hg) and in the D group (-10.9/-6.0 mm Hg). E demonstrated a greater antihypertensive effect on SBPM results in the evening. Values of smoothness index on E treatment were slightly higher than on D treatment (0.86±0.15/0.64±0.13 vs 0.67±0.17/0.62±0.15). Trough-to-peak ratio was inconclusive in this study.Conclusions. Results of the study have shown some advantages of antihypertensive therapy with E compared with these of D in slow release formulation (both drugs at a single daily dose) in menopausal women. A sustained antihypertensive effect without negative influence on circadian BP profile allows to consider E as one of perspective agents for the AH treatment in this type of patients.

Aim. To study the incidence of comorbidities and their impact on the prognosis in patients with ischemic heart disease (IHD) included into the PROGNOZ IBS Register.Material and methods. Data from the PROGNOZ IBS register of patients diagnosed with IHD using coronary angiography during the reference hospitalization (n=541; 432 male and 109 female) was included in the analysis. 504 (93%) patients were included in the survival analysis. Risk factors of cardiovascular diseases, associated with atherosclerosis, or those that were complications of IHD were considered as comorbidities as well as not cardiovascular diseases – chronic obstructive pulmonary disease, bronchial asthma andchronic kidney disease (CKD).Results. The average duration of follow-up was 7.3±2.19 years. The average number of comorbidities in patients with IHD was 1.83. Comorbidities worsened the prognosis of life: the presence of diabetes mellitus (DM) increased the relative risk (RR) of primary endpoint occurrence by 1.7 times, the combination of DM with hypertension – by 2.4 times, a history of stroke – by 2.3 times (pConclusion. Prognosis of life in IHD patients is worsened by the presence of several comorbidities: risk factors of cardiovascular disease (DM and hypertension), cardiovascular diseases associated with atherosclerosis or those that are complications of IHD, chronic lung diseases and CKD.

Aim. Tto study efficiency and safety of new combined drug of enalapril maleate and hydrochlorothiazide “Renipril HT: in patients with mild to moderate arterial hypertension (AH) in comparison with the original combined drug with the same substances – “Co-renitec”, possibility of reaching target blood pressure (BP) level with separate treatment with each drug, and in combination with atenolol if necessary.Material and methods. 30 patients (11 men and 19 women) with mild to moderate AH took part in randomized, open, cross over study. 10-14 days before the study started, previous antihypertensive treatment had been canceled for all the patients. Each patient by turns was treated during 6 weeks with Renipril HT (RH) and Co-renitec (CR). Efficiency of antihypertensive therapy was assessed at visits to physician every 2 weeks within the whole period of study. Within first 2 weeks patients were treated with RH 10/12,5 mg daily or CR 10/6,25 mg daily. Within next 2 weeks doses of drugs were doubled if target BP level (Results. After 6-week treatment with RH average level of systolic BP reduced by 21,8 mmHg compared to the initial level, after 6-week treatment with CR – by 23,8 mmHg. Average level of diastolic BP reduced by 10,8 and 13,5 mmHg respectively (differences between drugs in BP decrease are not significant). By the end of 6-week treatment with RH target BP level was reached in 74% of patients, with CR - in 64% of patients. Bigger number of side-effects was registered in treatment with RH (p=0,03), but most part of them were not severe and didn’t demand therapy correction.Conclusion. New combined drug of enalapril maleate and hydrochlorothiazide – RH is an efficient and safe antihypertensive drug with all advantages of combined drugs. It has no less efficiency than the original drug with the same active components – CR in patients with mild to moderate hypertension. Convenience of taking – once per day – provides high compliance with treatment with this drug.

Aim. To prove the advantage of the long-term controlled antihypertensive therapy compared with the real usual standard therapy in patients with mild to moderate arterial hypertension.Material and methods. It was multicenter, randomized, prospective parallel-group study in patients with mild to moderate hypertension. One part of patients (treatment group) received the strongly regulated stepped antihypertensive therapy based on ACE-inhibitor spirapril, the second one (control group) continued their usual standard therapy prescribed by doctors of polyclinics or other patient care institutions. The study lasted one year.Results. 1742 patients were enrolled in the study, 854 patients were included in the treatment group and 888 – in the control group. 220 patients dropped out of the study by different reasons, and 1552 patients finished the study. There were 651 (37,6%) men and 1081 (62,4%) women. It was substantial decrease in blood pressure in both group, but distinctions between systolic and diastolic blood pressure in the treatment and control group during the study were significant.The target levels of blood pressure (systolic < 140 mm Hg and diastolic < 90 mm Hg) were registered substantially more frequent in the patients of treatment group than in control group (69,4% и 39,3% after three months and 83,6% и 66,9% after 12 months of the treatment correspondingly).Conclusion. Controlled stepped antihypertensive therapy resulted into more significant decrease in systolic and diastolic blood pressure and more frequent achievement of target levels of blood pressure in comparison with control group. It supposes better prognosis of patients.

Aim. To study influence of mildronate (M) on treatment efficiency of patients with ischemic heart disease (IHD), receiving standard antianginal therapy (AAT)Materials and methods. Double-blind, randomized, placebo-controlled study was carried out in parallel groups. All patients continued the earlier prescribed AAT without changes. After control period (10-14 days) was over, randomization of patients either to the treatment group (M 500mg twice per day), or to the control group (placebo (Pl) twice per day) was made for 6 weeks therapy. Criterion of treatment efficiency: increase in duration of trial with burden on treadmill (TB), decrease in angina attack frequency (AA) and reduction in nitroglycerin taking (NTT). TB was carried out at the beginning (TB-1), at the end of the control period (TB-2), and at the end of the treatment (TB-3).Results. TB-1 and TB-2 had good reproducibility, their duration didn’t differ. At the end of the treatment additionally with M, growth in duration of TB-3 (p=0,002) was registered, while there was no growth of TB duration with the Pl treatment (p=0,07). During the treatment decrease in AA number both with M (p=0,002), and with Pl (p=0,02) was noted. With M treatment decrease in NTT treatment (p=0.02) was observed, while NTT with Pl didn’t change (p=0,7). Number of side effects, registered with M and Pl, didn’t differ.Conclusion. Mildronate provides additional benefits for patients with IHD with stable burden angina, when they do not reach desired effect with the prescribed AAT.

Aim. To assess the real rate of dual antiplatelet therapy (DAT, acetylsalicylic acid + clopidogrel) use in patients having appropriate indications according to current clinical guidelines and to study the possibility of prescription rate improvement by education activity directed to doctors. Material and methods. The study consisted of 3 parts. Parts I and II present the results of two questionnaire surveys of patients with acute myocardial infarction, or stenting, who needed in DAT according to current clinical guidelines. The real use of the DAT was assessed in part III on the basis of the multicenter study conducted in different regions of Russia (ROMB study) in a large sample of patients having DAT indications. Results. Part I - PROGNOZ-IBS study. According to the questionnaire survey only 112 out of 239 patients (47%) having an absolute indications, received DOT. Part II - phone survey of patients with acute myocardial infarction in two towns of Lyubertsy and Podolsk. 28 of 71 patients (39%) took the DAT (from some days to 6 months) and 35 patients (49%) — did not take it. Part III - ROMB study. 519 patients did not take DAT, at that 259 (50%) in hospital and 260 (50%) - in out-patient clinic. 521 patients took DAT according to indications, at that 238 (46%) in hospital and 283 (54%) - in out-patient clinic. Conclusion. Less than 50% of patients, having direct indications, received DAT in the real clinical practice. The prescription rate can be improved due to education activity directed to doctors and increase in clopidogrel drugs affordability.

Aim. To compare information value of antihypertensive effect equability parameters for two drug formulations of nifedipine: long-acting one (nifedipine-XL) and short-acting one (nifedipine-sa).Material and methods. 147 patients with arterial hypertension (age 53,8±12,5 years) were included into multicenter, cross over design study. Duration of wash-out period was 2 weeks; duration of each treatment course – 4 weeks; interval between courses – 1 week. The following doses of drugs were used: nifedipine-XL – 30-60 mg once daily, nifedipine-sa – 10-20 mg three times a day. Daily blood pressure monitoring (DBPM – Schiller BR-102) was made initially, at the end of each treatment course and at the end of interval between courses. To assess the equability of drug antihypertensive effect “smoothness index” (SI) and coefficient trough effect/peak effect were used (COTP). Information value of these indexes (treatment vs. initial) was assessed by the logical regress analysis.Results. Nifedipine-XL and nifedipine-sa had significant antihypertensive effect according to DBPM data and clinical measurements. Equability of both drugs was similar. χ2 Wald range was 14,7-18,7 (pConclusion. Similar information value of SI and COTP can be explained by the homogeneity of studied patients. Usage both of these indexes for estimation of antihypertensive effect equability is connected with same methodical limits.

Objective This study assessed the value of modern medical treatment (MMT) with and without carotid endarterectomy (CEA) in patients with asymptomatic severe carotid artery stenosis. Methods We conducted a randomized trial involving 55 patients with 70% to 79% carotid stenosis at three Russian centers. Between 2009 and 2013, 31 patients were randomized to undergo CEA with MMT (CEA group) and 24 to receive MMT alone. The primary end point was nonfatal ipsilateral stroke or death from any cause during a follow-up period of 5.0 years. The secondary end point was any nonfatal stroke, carotid revascularization, or death from any cause during follow-up. Results The trial was stopped after a median follow-up of 3.3 years (maximum, 5.0 years). There were two primary events in the CEA group and nine events in the MMT group. The 3.3-year cumulative primary event rates were 6.5% in the CEA group and 37.5% in the MMT group (hazard ratio for the MMT group, 5.06; 95% confidence interval, 1.53-16.79; P = .008). The 3.3-year cumulative secondary end point was 12.9% in the CEA group and 50.0% in the MMT group (hazard ratio for the MMT group, 4.23; 95% confidence interval, 1.55-11.53; P = .0048). Conclusions CEA as an initial management strategy could reduce the risk of death and major cerebrovascular events when added to MMT.

Aim. To study the prevalence of hyperuricemia in the Russian regions, depending on the climatic, geographical, socio-demographic characteristics and some cardiometabolic risk factors.Material and methods. Data from the ESSE-RF study from 10 regions of theRussian Federationare presented. All study participants were examined according to a uniform protocol. Measurements were standardized, biochemical tests were carried out in three Federal centers using the same methodology. The study was approved by independent Ethics committees, and all participants signed informed consent.Results. The prevalence of hyperuricemia was 16.8% (25.3% in men and 11.3% in women; pConclusion. Prevalence of hyperuricemia inRussiais defined; regions with the highest and lowest prevalence are identified. Associations of hyperuricemia with some social and demographic characteristics as well as cardiovascular risk factors are revealed.

Aim. To develop a method for the assessment of quality of medical prevention of recurrent stroke and its’ testing using the results of the LIS-2 register (Lyubertsy study of mortality in patients after stroke).Material and methods. The scale evaluation of the quality of therapy for the prevention of recurrent stroke developed in accordance with the modern clinical practice guidelines, as well as the recurrent stroke prevention index (RSPI) for this assessment were elaborated. The analysis of the therapy was performed in patients after stroke in LIS-2 registers (n=219). The assessment of the quality of treatment was performed using RSPI, the influence of the index results on the in-hospital mortality was studied.Results. Two groups of patients [with RSPI=0 (n=137) and RSPI>0 (n=82)] were formed on the basis of the results evaluation via RSPI. Significant differences between groups were not found. At the same time higher in-hospital mortality (p=0.014; χ2 Pearson) was detected in patients with RSPI=0; relative risk of in-hospital death (after adjustment for sex and age) was 2.04 [1.07-3.91] (p=0.031). Analysis of the length of survival and duration of hospital stay was performed in both groups using the Kaplan-Meier method. In-hospital mortality was significantly higher in patients with RSPI=0, which was confirmed by the log-rank test (p=0.032).Conclusion. The results of the quality of medical care assessment in accordance with the developed method are significantly related to the outcomes during the stay in a hospital. The developed method, based on current clinical recommendations, can serve as an example of the implementation of evidence-based medicine in actual practice.

Aim. To provide final data on the three-year period of the inclusion of patients; to give most accurate "portrait" of patients hospitalized with a brain stroke within the framework of the LIS-2 register (Lyubertsy study of mortality in patients after stroke).Material and methods. All patients (n=960) admitted to the Lyubertsy district hospital №2 with stroke for the period from 01.2009 to 12.2011 were included into the study.Results. Men accounted for 37.5%, women - 62.5%, mean age was 71.1±9.8 years. The history of hypertension was present in 833 patients (86.8%), atrial fibrillation in 252 (26.8%) patients, 199 (20.7%) patients had previously undergone stroke. In-hospital mortality was 21.6% (207 patients had died; mean age 72.9±9.8 years). Low frequency of the antihypertensive therapy (34.5%), lipid-lowering therapy (0.7%), antiplatelet agents (5.7%), anticoagulation therapy prescription in patients with atrial fibrillation was detected.Conclusion. Insufficient assignment of drugs with a proven effect on the prognosis in patients with risk factors prior to the development of the reference stroke draws attention. High incidence of recurrent strokes indicates an underactive secondary prevention.

Aim. To evaluate the frequency of the prescription of cardiovascular drugs in patients before the reference acute myocardial infarction (AMI) based on the register "LIS-1" (Lubertsy mortality study of patients after myocardial infarction).Material and methods. Stage 1: development of the Register of patients with AMI admitted to cardiology departments of hospitals in Luberets district, Moscow region (2005-2007) and discharged for outpatient treatment. Median follow-up – 1.6 years (1.0, 2.4). The primary endpoint – total mortality. Stage 2: the continuation of register "LIS-1" (2011-2012).Results.1133 patients (mean age of men 60.1±0.5, women – 71.4±0.4 years) were included in the 1st stage of the study; 172 (15.2%) died in the hospital. Before the reference hospitalization 21.4% of patients had been receiving b-blockers, 35.3% - renin-angiotensin-aldosterone system (RAAS) inhibitors, 15.7% - antiplatelet agents, 1.9% - statins, 13% of patients - diuretics. Statistically significant (adjusted for sex and age) positive impact on hospital mortality reduction had a treatment with b-blockers [OR=0.542, CI=0.357-0.824, p=0.004] and RAAS inhibitors [OR=0.710; CI=0.512-0.986, p=0.040] prior to the development of acute myocardial infarction. As the number of patients receiving statins and antiplatelet agents was small, the contribution these drugs intake on hospital mortality was not identified. 272 patients (mean age 63.6±12.6 years) were included on the second phase of the study. The information about the received therapy before reference hospitalization was reported by 173 patients: 39% of patients used b-blockers, 47% - RAAS inhibitors, 37% - antiplatelet agents, 15% - statins, 15% of patients - diuretics. Positive changes in the frequency of the prescription of essential drugs were observed in 5 years: a significant increase in number of patients with b-blockers (pConclusion. The Register "LIS-1" (Lubertsy study of mortality in patients after myocardial infarction) allowed not only to assess data on clinical practice at a certain period, but also to evaluate the changes in drug therapy of patients with high and very high cardiovascular risk.

Aim. To study the conformity of preventative therapy prescribed to patients during a hospital stay and at a discharge to clinical guidelines using a special algorithm, and to assess the impact of the results on a long-term mortality based on the LIS-2 register (Lyubertsy study of mortality in patients after cerebral stroke).Material and methods. The scales to assess the quality of cardiovascular care for the prevention of recurrent stroke along with the prevention of recurrent ischemic attacks index (PRIA index) for this assessment were developed according to current clinical guidelines. Analysis of the therapy was performed using PRIA index on survived hospital patients from LIS-2 register (N=753). The impact of PRIA index results on a long-term mortality (Me=2.3 years) was studied.Results. Based upon the results of the assessment obtained with PRIA index, higher treatment conformity to clinical guidelines resulted in a significantly better long-term survival. Non-conformity to clinical guidelines was due to the lack of prescription of drugs with proven efficacy and irrational choice of preventive therapy. Median of treatment quality assessment was 44.4% (22.2; 44.4).Conclusion. Low conformity of preventive therapy to clinical guidelines is found in the LIS-2 register. The algorithm for the assessment of preventive cardiovascular therapy quality allows identifying limitations in the prevention of recurrent stroke, and can serve as an example of implementation of evidence-based medicine in clinical practice.

We present in this review data on home blood pressure variability (HBPV) with consideration of its definition and threshold values. We also present own classification and discuss analysis of results of HBPV and their interpretation in observational and clinical studies, including own data. Experience in this area accumulated during last 30 years, information on pathophysiological mechanisms, prognostic properties of HBPV may be useful for a physician from practical point of view.

The aim of the study is to investigate the epidemiological situation regarding chronic respiratory diseases in populations that inhabit different climatic–geographical regions of Russia, and to develop targeted programs for prevention of these diseases. Methods: (1) a comparative analysis of the standardized mortality data in Russia and other selected regions of the Russian North using the European standard for respiratory diseases, in a population aged 25–64; and (2) data from a randomized cross-sectional epidemiological study, with subjects from three different climatic-geographical regions of Russia. Results: (1) the respiratory disease-related mortality rates in the majority of Russian Northern regions were much higher compared to the national average. Although death rates from chronic lower respiratory diseases were higher among the Northern regions and in the whole of Russia relative to the countries of European Union (EU), the cause of death in the populations of the Northern regions tend to be lower respiratory infections and pneumonia; and (2) despite the absence of any significant differences in the prevalence of smoking, the prevalence of chronic respiratory diseases (COPD) is significantly higher in Far North Yakutsk compared to the other two regions in this study—Chelyabinsk and Vologda. The status of hyperborean had the highest chance of a significant contribution to COPD and cardiorespiratory pathology among all other risk factors. The results revealed a need for effective targeted strategies for primary and secondary prevention of chronic respiratory diseases for the populations of the Northern regions of Russia. Conclusions: The revealed regional distinctions regarding the prevalence of, and mortality from, chronic respiratory diseases should be taken into consideration when designing integrated programs for chronic non-communicable disease prevention in these regions.

im of the study - to evaluate the possibility of increasing the effectiveness of antihypertensive therapy by simplifying regimens, improving knowledge and practical skills of the doctors on the use of modern tactical approaches to treatment as well as patients education methods of measuring blood pressure (BP), the principles of a healthy lifestyle and explain the need to follow the prescribing physician.Post-marketing observational discovery program FORSAZH held in 29 cities of the Russian Federation. Participation in the program received 442 physician (internists and general practitioners), which included 1969 patients with prior failure of combination antihypertensive therapy. Patients in 86% of cases took the free combination, 14% - fixed combinations of drugs. The change of the treatment on reception of a preparation containing a fixed combination of perindopril/indapamide (10 mg/2.5 mg) after 3 months led to decrease in systolic blood pressure by an average of 39.5 mm Hg, diastolic - 18.7 per mm Hg. The frequency of achieving the target BP140 mm Hg and 90 it was 76%. Marked reduction in BP and frequency to achieve the target BP is not dependent on additional training of physicians and patients, the use of prior therapy in free or fixed combination, but depended on the initial degree of increase in BP and duration of therapy. Predictors of failure to achieve target BP were age, male gender, low initial adherence, good health, a higher baseline BP, elevated cholesterol levels, body weight, heart rate and decreased glomerular filtration rate. Adherence to therapy patients (on a scale of Morisky-Green) and health assessment on a visual analog scale significantly increased. This tactic has been a change of therapy is not only effective but also safe. Adverse events were reported in 28 patients (1.4% of the total number of observed cases) and only 1 case required dose reduction due to development of clinically manifested hypotension.In enhancing the effectiveness of the treatment of patients with hypertension was decisive simplification of drug therapy through the use of a fixed combination of perindopril A/indapamide.

AIM to elucidate contribution of atrial fibrillation (AF) to mortality from various causes among men and women in Russia. MATERIAL AND METHODS We analyzed data from samples of population of Moscow and Petersburg (Leningrad) aged 35-74 years examined in different years. Total number of subjects was 20045 (15107 men), response rate was 75%. Examination was carried out according to unified protocol incorporating collection of standard information on social and demographic parameters, smoking status and alcohol consumption, history.