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Purpose: to study plasma renin activity (PRA) as a predictor of antihypertensive response to addition of diuretic to combination of angiotensin- converting enzyme inhibitor (ACEI) and calcium antagonist (CA)., Material and Methods: The study included 72 patients (39% men, mean age 62.0 ± 8.3 years) with uncontrolled despite use of ACEI and CA arterial hypertension (AH) without overt associated clinical conditions (AH criteria of national guidelines, 2010). After 4 weeks of therapy with ACE inhibitor (quadropril 6 mg/day) and CA (felodipine 5 mg/day) in all patients who did not reach target level of blood pressure (BP) (clinical BP≥140/90 mm Hg, daytime BP according to ambulatory BP monitoring [ABPM] >135/85 mm Hg) indapamide retard (1.5 mg/day) was added to combination therapy for 6 months. Examination included measurement of baseline and on treatment PRA and repetitive ABPM., Results: More pronounced antihypertensive response was observed in the group of patients with volume dependent AH. Baseline BP was 156.6 ± 14.1/86.7 ± 1.5 and 151.9 ± 17.1/78.0 ± 7.8 mm Hg, on treatment level of clinical BP - 126.2 ± 10.6/72.5 ± 11.6 and 132.2 ± 9.1/71.9 ± 7.2 mm Hg (p<0.05) in patients with volume dependent and renin dependent AH, respectively. Target clinical BP was achieved in 95 and 80% of patients, respectively (χ2= 10.3; p<0.05). According to ABPM both daytime and nighttime on treatment BP was lower in the group of patients with volume dependent AH (130.0 ± 11.0/74.1 ± 9.9 vs. 136.5 ± 7.3/78.8 ± 8.2 mm Hg, p<0.05; and 127.9 ± 15.8/71 ± 13.5 vs. 132.6 ± 13.0/74.5 ± 10.2 mm Hg, p<0.05)., Conclusion: PRA is an independent predictor of antihypertensive response to addition of a diuretic to combination therapy with ACEI and CA.

Unlabelled: Simultaneous inhibition of the renin-angiotensin-aldosterone system and the system of degradation of natriuretic peptides can potentially provide unique therapeutic effects in patients with chronic heart failure (CHF) with reduced ejection fraction (EF). Aim of this study was to assess tolerability of therapy with LCZ696--first representative of a class of inhibitors of angiotensin receptor and neutral endopeptidase neprilysin--and to study its pharmacodynamic effects., Methods: We included into open uncontrolled study 30 patients with stable functional class II-III CHF and EF ≤ 40%. After 24-hour run-in period during which angiotensin converting enzyme inhibitors (ACEI) were withdrawn the patients were given LCZ696 (100 mg/day for 7 days followed by 200 mg/day for 14 days). Other CHF therapy remained unchanged., Results: Transition from therapy with ACEI to LCZ696 was well tolerated. Three patients were excluded because of hyperkalemia ≥ 5mmol/l. After 21 days of treatment elevation of plasma biomarkers of inhibition of neprilysin and angiotensin receptors occurred: cyclic guanosine monophosphate, renin concentration and activity rose 1.38, 3.50, and 2.27 times from baseline level (p < 0.05 for all). After 7 and 21 days of LCZ696 administration we noted significant lowering of NT-proBNP; significant lowering of aldosterone and endothelin-1 in blood plasma, was observed on day 21., Conclusion: Administration of LCZ696 to patients with CHF with reduced ejection fraction (EF) was well tolerated and associated with potentially favorable for this category of patients dynamics of biomarkers.

The phenomenon of variability of blood pressure (BP) was studied for a long time, but recently it has received increased attention, with the focus shifted from short-term BP variability, estimated at daily monitoring for clinical blood pressure variability from visit to visit, which can be regarded as one of the indicators quality control of blood pressure with prolonged treatment. In light of the recent years of clinical data from visit to visit BP variability seems a promising new target for antihypertensive therapy.

The review presents modern data on interrelationships between sodium consumption, blood pressure level, and risk of cardiovascular complications. Phenomenon of salt sensitivity and methods of its detection are described. Results of epidemiological and interventional studies are used as a basis for formulation of populational strategy of limitation of sodium consumption. Possibilities of antihypertensive therapy with natriuretic effect are also presented.

Aim: To evaluate the efficiency and safety of an interchange of atenolol and ivabradine in patients who had stable angina pectoris without myocardial infarction in the history and left ventricular (LV) systolic dysfunction., Subjects and Methods: The trial enrolled 31 patients less than 70 years of age who had sinus rhythm, functional classes II-I angina on exertion without clinical signs of LV systolic dysfunction. At the first stage, 15 patients were randomized to ivabradine with its dose titration during 2 weeks; the other 16 patients were to atenolol. At the second stage, 10 patients were switched from ivabradine used at Stage 1 to atenolol 100 mg/day, other 10 patients who were on atenolol were switched to ivabradine 15 mg/day, and 11 patients received combination therapy with ivabradine + atenolol in half doses. All the patients underwent treadmill exercise testing and applanation tonometry., Results: Atenolol, unlike ivabradine, lowered brachial blood pressure and unchanged the central index of its increment, which was associated with LV systolic elongation. On the contrary, ivabradine decreased the central increment index and exerted no significant effect on the duration of LV systole. By comparatively lowering heart rate, ivabradine as well as atenolol reduced pulse wave propagation velocity., Conclusion: If ivabradine or atenolol is insufficiently effective or poorly tolerated, there may be an interchange of the drugs, as well as their combination in half doses without substantially affecting their therapeutic action in patients with stable angina pectoris without LV systolic dysfunction.

β-Adrenoblockers improve quality of life and in a number of cases life prognosis in patients with stable angina (SA). Dose of -adrenoblockers is considered optimal if at the background of treatment resting heart rate (rHR) is persistently decreased down to 55-60 bpm. But according to data of international registries rate of achievement of target rHR (trHR) in real clinical practice does not exceed 22%. Aim of this study was to determine what portion of patients with SA and arterial hypertension (AH) achieves trHR at the background of therapy with -adrenoblockers in routine practice in this country. Twenty centers in 6 towns in Russian Federation recruited 399 patients (mean age 64+/-10 years) with class I-III angina and concomitant primary AH. These patients for at least 2 months received any -adrenoblocker and did not change its dose during 4 weeks before inclusion into the program. Portion of patients with trHR was 15.5%. There were no significant differences between average daily doses of most frequently used -adrenoblockers (metoprolol, bisoprolol, carvediolol) in groups of patients who achieved and did not achieve trHR. Quality of life of patients who achieved was comparable with that of those who did not achieve trHR. Attainment of trHR was associated with significant decrease of short acting requirement nitrates. There was a significant direct correlation between attainment of trHR and target arterial pressure.

Purpose: To study elastic properties of carotid arteries in young men with arterial hypertension (AH)., Material and Methods: We examined men aged 18-25 years (mean 21.1+/-0.14 years): 36 with normal blood pressure (BP), 123 with stable and 51 with unstable AH. Parameters studied comprised intima-media thickness (IMT) of carotid arteries, their M-mode measured maximal systolic and minimal diastolic diameters (Ds and Dd), stiffness of common carotid artery (CCA) wall determined on the basis of analysis of elasticity and distensibility coefficients (CC and DC), Peterson's and Young's modules of elasticity (Ep and E), and index of flow deformation (CS)., Results: Compared with young men with normal BP and unstable AH patients with stable AH had abnormal elastic properties of CCA and increased IMT., Conclusions: Stable AH in young men is associated with signs of remodeling of CCA walls and increase of their rigidity.

In order to study structural functional characteristics of myocardium including parameters of myocardial fibrosis according echocardiography data in men with various levels of arterial pressure (AP) we examined 215 men aged 18-25 (mean 21.1+/-0,1) years with history of elevated AP at casual measurement. AP phenotype (normotension, stable arterial hypertension [AH], unstable AH) was determined on the basis of multiple measurements of clinical AP and 24 hour AP monitoring. At echocardiography we assessed presence of left ventricular (LV) hypertrophy (LVH), type of LV geometry, proportionality of LV myocardial mass (LVMM), diastolic function. Myocardial fibrosis was assessed by pixel density distribution range (PDDR) with the use of analysis of reflected signal. There were no manifestations of LV remodeling in subjects with normal AP. Concentric LV remodeling was found in 27.5 and 60.5% of patients with unstable and stable AH, respectively. Concentric LVH was found only in patients with stable AH (4.8%). Disproportionally high LVMM was found in 16.1% of subjects with stable AH. In a combined group with concentric LV remodeling and LVH rate of disproportionally high LVMM was 20.8%. We noted significant (p&lt;0.001) increase of PDDR in stable AH (181.4+/-2.2) compared with PDDR in normal AP (164.6+/-4.6) and unstable AH (160.1+/-2.7). In stable I degree AH PDDR (177.3+/-2.2) was insignificantly lower than in II degree AH (185.7+/-3.9). PDDR in concentric LV remodeling was 180.5+/-2.3, in concentric LVH- 166.8+/-13.2, in normal LV geometry - 168.4+/-2.5. PDDR in disproportionally high LVMM was higher than in proportional LVMM. Independent interrelationship was found between PDDR and body mass index (r=0.17; p=0.03), duration of AH (r=0.17; p=0.03), isovolumic relaxation time (r= 0.15; p=0.04). In young men LV remodeling can be detected at the stage of unstable AH. In stable AH degree of myocardial fibrosis was associated with higher AP level, concentric LV geometry, disproportionally high LVMM, lowering of diastolic function.

Efficacy and tolerability of fixed amlodipine/valsartan combination was studied in 86 patients with hypertensive disease hospitalized in departments of general internal medicine or cardiology. All patients had indications for antihypertensive therapy and were randomized either to fixed combination amlodipine/valsartan (n=43) or to therapy which corresponded to the hospital formulary (n=43). Correction of antihypertensive therapy was performed by treating physician at daily rounds. Self-control of blood pressure (BP) was performed by patients with the use of UA767PC apparatus. Results of BP self-control were compared with clinical measurements in order to detect concealed inefficacy of treatment. Results. Rate of achievement of target BP with fixed combination amlodipine/valsartan (93%) was comparable with that on traditional therapy (90%). But the use of fixed combination amlodipine/valsartan compared with traditional therapy was associated with lower clinical and self measured BP, quicker achievement of target BP (5.8+/-2.3 and 9.2+/-1.8 days, respectively, p&lt;0.05), lesser number of antihypertensive drugs (2.5+/-0.6 and 3.0+/-0.9 days, respectively), lower rate of concealed inefficacy of treatment (12 and 31%, respectively, p&lt;0.05). Conclusions. We have demonstrated appropriateness of inhospital administration of fixed amlodipine/valsartan combination as an approach allowing to achieve target BP in shorter time, with the use of fewer antihypertensive drugs, and diminishing concealed inefficacy of treatment.

Aim: To study effects of ivabradin on clinicohemodynamic and prognostic parameters in patients after myocardial infarction (MI) with systolic chronic cardiac failure (SCCF)., Material and Methods: A population-based randomized prospective trial enrolled 49 patients (40 males--81.6%, mean age 63.1 +/- 8.1 years) with sinus rhythm and a longer than 3 month history of MI. The patients were randomized into 2 groups: 23 patients of group 1 received standard treatment plus ivabradin, 26 patients of group 2 received standard treatment alone. Follow-up was 36.1 +/- 6.2 months. We analysed the trend in heart rate (HR), blood pressure (BP), parameters of echocardiography, ECG, levels of electrolytes, creatinin in blood plasma, frequency of hospitalizations, recurrent non-fatal MI and lethality (combined endpoint)., Results: In the end of the trial ivabradin significantly decreased HR from 71 to 64 b/m. Frequency of combined end point of efficacy was 30.4 and 50% in group 1 and 2, respectively. In group 1 primary end point in high baseline HR occurred more frequently than in HR < 70 b/m in 6 (50%) and 1 (9.1%) cases, respectively, but these differences were not significant (p = 0.068). In group 2 the differences were significant--9 (90%) and 4 (25%) cases, respectively (p = 0.004). By none of the parameters of ECG, plasma electrolytes, creatinine level significant intergroup differences were found., Conclusion: In the same trend in BP and ECG, group 1 patients showed significant and more pronounced HR lowering than group 2 patients. Addition of ivabradin to standard treatment of SCCF after MI promoted less frequency of hospitalizations, recurrent non-fatal MI, fatal cardiovascular events. This effect was especially strong in high baseline HR.

The review summarises data on statins efficacy in primary prophylaxis of cardiovascular complications. Main results of the JUPITER (Justification for the Use of statins in Prevention: an Intervention Trial Evaluating Rosuvastatin) trial are analysed in detail. Its role in possible changes in current recommendations on prophylaxis and treatment of atherosclerosis is shown. Statins are considered as drugs essential in the strategy of improvement of life quality.

Most important value of lowering of substantially elevated arterial pressure (AP) for improvement of outcomes in patients with arterial hypertension (AH) was convincingly confirmed by large truly placebo controlled randomized clinical trials (RCT) with the use of mainly diuretics, and/or beta-adrenoblockers in the 60-80ths. Later comparative RCT confirmed equal antihypertensive efficacy of 5 main drug classes relative to AP level in brachial artery. In this review we discuss merit of auxiliary class-specific properties of antihypertensive agents potentially affecting prognosis besides AP lowering. We also discuss problems related to decline of significance of quantitative criteria of AH and consideration of AP level in general context of cardiovascular risk; problems of external validity of RCT; extrapolation of RCT results obtained in patients with complicated AH and very high cardiovascular risk on young patients with uncomplicated AH; significance of hard and surrogate end points.

In 734 patients with arterial hypertension without established diseases of cardiovascular system (including 158 patients with diabetes mellitus) we compared various methods of assessment of functional state of the kidney (microalbuminuria, creatinine, calculation of creatinine clearance and glomerular filtration rate) for detection of subclinical renal involvement and assessment of cardiovascular risk. We showed that determination of microalbuminuria and calculation of glomerular filtration rate (MDRD equation) had independent and mutual complementary diagnostic value, and allowed to identify patients with pathogenetically different renal lesions, reflected proteinuric and nonpoteinuric mechanisms of progression of nephropathy in arterial hypertension with and without diabetes mellitus.

Impairment of renal function beginning from subclinical stages is independent risk factor of development of cardiovascular diseases and cardiovascular death. Cystatin C is considered in recent years as an alternative marker of functional state of the kidney and risk of development of cardiovascular diseases. Cystatin C is a protease inhibiting protein with low molecular mass which is characterized by free glomerular filtration and is not subjected to tubular secretion. Formulas are elaborated for calculation glomerular filtration rate basing on cystatin C level. In this review we consider potential advantages of cystatin C for assessment of early impairment of renal function. We also present data on interrelation between cystatin C, metabolic parameters, and markers of target organs damage, on prognostic value of cystatin C in various populations of patients.

In this work we compared parameters of central arterial pressure (AP) on the basis of analysis of pulse wave in young men in dependence of AP phenotype determined by repetitive clinical measurements and 24 hour AP monitoring (24HAPM). Comparison of characteristics of central pulse wave was carried out in 12 men with normal AP, 36 men with arterial hypertension (AH) according to clinical measurements and 24HAPM, and 17 men with white coat hypertension (WCH). Mean age was 21.0+/-2.1 years. Differences in levels of pulse pressure (PP) between groups with AH were revealed only at the level of the aorta. Studied patients with normal AP and 24HAPM did not differ by such characteristics as index of increment and reflected wave appearance time. Studied patients with AH confirmed by 24HAPM were characterized by significantly greater augmentation of central PP (100.0+/-12.6% vs 96.6+/-11.8% in persons with normal AP and 95.6+/-15.0% with WCH, p<0.05), earlier appearance of reflected wave (149.2+/-18.9 ms vs 160.6+/-16.2 and 160.3+/-28.6 ms, respectively, p<0.05), high rate of pulse wave propagation (8.6+/-1.2 m/s vs 7.2+/-1.2 and 7.0+/-1.7 m/s). Amplification was similar in three groups. The data obtained has shown that in men aged 18-25 years presence of AH, confirmed by 24HAPM) is associated with elevation of central systolic AP and PP and higher values of markers of both rigidity of the aorta and remodeling of peripheral vascular bed.

The review summarizes the current views on the pathogenesis of dementia and the significance of blood pressure levels for its development. The present status of the prevention of cognitive disorders and dementia is detailed in the use of antihypertensive therapy: there are the data of prospective cohort studies of the impact of antihypertensive therapy on the risk of dementia, the results of placebo-controlled studies in the groups of elderly and senile patients with a history of cerebrovascular complications, and the data of meta-analyses of studies. As for cognitive function, the effects of different classes of the currently available antihypertensive agents, such as diuretics, calcium antagonists, angiotensin-converting enzyme inhibitors, and angiotensin II type 1 receptor antagonists, are analyzed.

Hyperglycemia in patients with acute coronary syndrome (ACS) is one of main predictors of cardiovascular complications. Despite increasing number of proofs of prognostic value of elevated glycemia in patients with ACS and lowering of rate of clinical outcomes at the background of control of glycemia in patients with serious diseases there are no guidelines on diagnosis of the given state in patients hospitalized because of ACS and subsequent management of this category of patients. This can be explained by absence of reliable results of randomized clinical studies assessing interrelationship of parameters of glycemia, rates of early and remote cardiovascular and other complications as well as importance of achievement of adequate glycemic control and determination of target values of glycemia. Presented recommendations on management of patients with ACS in clinical practice require further confirmation and specification.

Aim: To study with the use of repetitive clinical measurements and 24-hour arterial pressure (AP) monitoring phenotypes of AP in young men aged 18-25 years with history of elevation of AP at accidental determination., Material and Methods: We examined 194 young men (mean age 21.1+/-2.1 years) because of detection of elevated AP at casual measurements. Clinical AP was assessed at repetitive determinations in sitting position at the same time on 5 consecutive days. 24-hour AP monitoring (24-HAPM) was carried out according to standard method. Classification of AP level and phenotype was made in accordance with recommendations of European Society of Arterial Hypertension (AH) (2007)., Results: Optimal clinical AP was found in 13 (6.7%), normal AP - in 20 (10.3%), high normal AP - in 24 (12,4%), stable AH - in 107 (55.2%) young men. Eighty one persons (41.8%) had I, 20 (10.3%) - II, and 6 (3.1%) - III degree AH. Among studied patients with stable elevation of clinical AP rate of isolated systolic AH (ISAH) was 65.4%, systole-diastolic AH - 6.1%, isolated diastolic AH - 8.4%. Comparison of levels of clinical AP and 24-HAPM showed that 34 young men (17.5%) had white coat hypertension, 73 (37.6%) - had true AH, 13 (6.7%) - concealed AH. The level of clinical SAP turned out to be the sole predictor of concealed AH. Among examined persons 40 (20.6%) had 1, 57 (29.4%) - 2, 34 (17.5%) - 3 or more additional risk factors. Sixty one subjects (31.4%) had metabolic syndrome. No association was established between number of risk factors, presence of metabolic syndrome, and AP phenotype. Left ventricular hypertrophy was revealed in 24.4% of patients with true AH and in 15.2% - with concealed AH., Conclusion: Dominating type of AH in young men is ISAH. The data obtained evidence for importance of 24-HAPM for establishment of AP phenotype in young men with normal and high normal clinical AP.

Arterial hypertension, insulin resistance, diabetes mellitus are associated with obesity. However exact mechanisms of this association have not been determined yet. Biologically active substances produced by adipose tissue participate in pathogenesis of cardiovascular diseases and complications. In this review we present data on the role of adiponectin -- adipocytokine with unique antiatherogenic, antiinflammatory, and insulin sensitizing properties. Hypoadiponectinemia is considered to be potentially modifiable cardiovascular risk factor and novel therapeutic target. Therapy with PPAR gamma agonists, blockers of renin-angiotensin and sympathetic nervous systems is associated with elevation of concentration of adiponectin.

Background: Increase of myocardial mass of left ventricle (MMLV) to a greater extent than required by hemodynamic load by elevated arterial pressure (AP) is reflected in concepts of " disproportionately " high (DH) MMLV and resistant to antihypertensive treatment LV hypertrophy (LVH)., Aim: To study in patients with arterial hypertension (AH) frequency of DH MMLV and factors associated with it., Material and Methods: Patients (n=170, 70 men, age 57.6+/-5.9 years) with previously untreated or irregularly treated uncontrollable AH. Proportionality of MMLV was assessed by coefficient of disproportionality (CD) defined as ratio of actual to expected MMLV., Results: DH MMLV was found in 140 patients (82.4%). Frequency of ECHOCG LVH among patients with DH MMLV was 49.3%. There were no cases of LVH among patients with proportional MMLV. Frequency of LVH depended on severity of disproportionality of MMLV elevation and was 18.9% at CD 128-155.9% and 82.2% at CD 184%. Patients with DH MMLV were characterized by greater body mass index, higher rate of disturbances of carbohydrate and lipid metabolism. Patients with DH MMLV without compared with those with LVH were characterized by significantly higher rate of concentric variant of LV geometry (66.2 vs 40.6%, p<0.05) and diastolic dysfunction (57.7 vs 36.2%, p<0.05), lower values of parameters of systolic LV function and higher rate of combination of concentric remodelling and diastolic LV dysfunction., Conclusion: DH MMLV is frequent among patients with previously untreated or irregularly treated uncontrollable AH. Calculation of disproportionality of MMLV allows to give additional characteristic of morphofunctional state of the myocardium in patients with AH. DH MMLV is associated with complex of subclinical structurally-functional disturbances of the myocardium and unfavourable changes of carbohydrate and lipid metabolism.

Arterial hypertension (AH) combined with diabetes mellitus accelerates development of damage of the kidney. Elevation of serum creatinine level, lowering of creatinine clearance or calculated glomerular filtration rate (GFR), microalbuminuria are independent prognostic factors of cardiovascular morbidity and mortality. Unfavorable outcomes of impaired renal function can be prevented or delayed with the help of appropriate interventions at early stages. There is an urgency to search for methods allowing to reveal in patients with cardiovascular diseases impairment of renal function at preclinical stages. In all patients with AH estimation of GFR using MDRD equation or creatinine clearance using Cockcroft-Gault formula as well as measurement of urinary protein excretion are necessary. The given article presents review of available literature data devoted to the problem of contemporary methods of early preclinical detection of renal damage.

Most of large controlled randomized trials have not revealed superiority of "new" over "old" antihypertensive drugs and posed a question of value of surrogate criteria for comparison of various treatment regimes. Data of ASCOT-CAFE trials allow to assume that estimation of central blood pressure (BP) opens novel perspectives in this direction. Most affordable methods of noninvasive measurement of central BP are radial artery applanation tonometry with subsequent computer transformation of peripheral to central pulse wave, and carotid artery applanation tonometry. Contrary to peripheral BP central BP level is modulated by elastic properties of major arteries and structural-functional state of medium caliber arteries and microcirculatory vascular bed, and thus is an index indirectly reflecting the state of the whole cardiovascular bed. Differences between central and peripheral BP levels are most clearly expressed in young age and diminish in the elderly. Effects of antihypertensive drugs on central BP may vary at the account of difference of points of application of their effects in vascular bed. Prognostic and clinical value of the central BP requires further investigation.

Immune inflammation is an important link in pathogenesis of chronic heart failure (CHF). It has been proven that hyperproduction of proinflammatory cytokines (TNFa, IL-6, IL-1, etc) with associated endothelial dysfunction and oxidative stress affect unfavorably clinico-hemodynamic parameters and prognosis of life of patients. However attempt to augment efficacy of treatment of CHF by means of inclusion of TNFa activity inhibitors in the complex of main remedies turned out unsuccessful. At present under discussion are perspectives of application in this category of patients of statins--lipid lowering drugs with pleiotropic properties most important of which is antiinflammatory action. Theoretical obstacles for the use of statins constitute available epidemiological data on reverse relationship between cholesterol level and mortality of patients with CHF in a framework of endotoxin-lipoprotein theory. At the same time preclinical and clinical experience has been accumulated evidencing for perspectiveness of such approach. Final solution of the problem of safety and feasibility of application of statins in CHF is expected after completion of prospective randomized trials GISSI-HF and CORONA.

Objective: To study the problems of physician-patient cooperation, patient- and physician related barrieres to target blood pressure (BP) achievement and to demonstrate improvement of BP control with indapamide SR 1.5 mg, when given to patients remaining uncontrolled while receiving antihypertensive therapy without thiazide diuretics (TD)., Methods: The trial Improvement of Arterial Hypertension Control in High-Risk Hypertensive Patients (ARGUS-2) run in 15 Russian centres during the year 2006. Retrospective analysis of medical notes of 684 outpatients and 575 inpatients with arterial hypertension. Validated questionnaires were used for interview of 373 physicians and 1298 patients. The study of Arifon retard efficacy was carried out in 1438 outpatients with difficult-to-control hypertension., Results: BP was above the goal level in 97.1% pts at the first analyzed visit to an outpatient department. Antihypertensive therapy was unchanged in 20.5% cases, the drug dose was increased in 46,6%, additional medication was administered in 36,8%. In 30.8% pts antihypertensive agent was substituted by another class drug. At the last analyzed visit target BP was found in 24.4% pts. BP control was poorer in pts with BP goal <130/80 mmHg (20.1%) than in those with higher target BP (25.9%). Achievement of BP goal was associated with combination therapy, higher rate of TD administration and with more frequent visits to physician. During hospitalization target BP <140/<90 mmHg was achieved in 87.1%,<130/<80 mmHg in. 76.2%. Arifon retard administration resulted in target BO achievement in 84.5% patients. Physicians percept low adherence to antihypertensive treatment, lack of patients knowledge about risk related to arterial hypertension, economical problems as main barriers to improvement of arterial hypertension management. Patients considered economical problems related to antihypertensive treatment more much less important than physicians did., Conclusion: The study results suggest the importance of therapeutic inertia overcome to improve arterial hypertension management in Russia. Low rate of multiple combination therapy and TD prescription are important features of therapeutic inertia. Polar perception of problems related to arterial hypertension by physicians and patients should be considered as influencing factors for educational programs development.