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The main goal in the arterial hypertension (AH) management is the target blood pressure (BP) achievement, as it leads to the cardiovascular risk reduction. At the same time, proper BP is achieved less than in 50% of all cases. In addition, there are two types of truly uncontrolled AH in population, such as resistant (RAH) and refractory (RFH) AH. Recent research suggests that RAH may be associated with changes in the renin-angiotensin-aldosterone system, while RFH appears to be more closely associated with sympathetic hyperactivation. These pathophysiological mechanisms are also active in patients with obstructive sleep apnea (OSA). Therefore, the prevalence of OSA in patients with RAH and RFH is very high, and treatment with continuous positive airway pressure (PAP-therapy) can reduce BP levels in such patients. The latter allows us to consider PAP-therapy as an additional method for the target BP achievement in patients with uncontrolled AH and OSA.

Aim. To study the frequency of clinical and radiological signs of reperfusion pulmonary edema and compare them with the volume of endovascular intervention after balloon pulmonary angioplasty (BPA) in patients with chronic thromboembolic pulmonary hypertension (CTEPH).Materials and methods. The study included 50 patients with CTEPH, who underwent stage 1 PLA. To prevent severe reperfusion edema, the number of segmental arteries planned for angioplasty was taken into account, the Pulmonary Edema Predictive Scoring Index (PEPSI) was determined, and after the intervention, noninvasive ventilation was performed in the Continuous positive airway pressure (СPAP) mode for 24 hours. Clinical manifestations of reperfusion edema were assessed 1, 24, 48 and 72 hours after BPA. Radiological signs of edema were considered based on the results of multislice computed tomography (MSCT) or chest x-ray.Results. Angioplasty was performed on 97 segmental, 6 lobar pulmonary arteries, incl. by 45 (46,4%) – with occlusive lesions. The number of arteries undergoing angioplasty ranged from 1 to 7 in each patient, on average 1,9 ± 1,4, change in pulmonary flow grade (ΔPFG) – 4,3 ± 3,4, PEPSI 58,4 ± 51,0, which exceeded the recommended value of 35,5. During the 72-hour observation period, 28 (56%) patients had grade 1 edema, grade 2 reperfusion edema was observed in 15 (30%), grade 3 – in 5 (10%), grade 4 – in 2 (4%) patients. Patients with grade 2-4 edema had higher baseline mPAP (p = 0,015) and PEPSI (p = 0,046). All manifestations of reperfusion edema of 2-4 degrees were stopped due to the prolonged regimen of CPAP therapy for 3 ± 2 days. None of the patients reached grade 5 edema, and there were no deaths. Clinical manifestations of reperfusion injury were observed in 25 (50%) patients, their highest frequency was observed after 24 hoursConclusion. Balloon pulmonary angioplasty of the pulmonary arteries is a safe method for the treatment of inoperable patients with chronic thromboembolic pulmonary hypertension, provided that recommendations for the prevention of reperfusion pulmonary edema are observed. CPAP therapy can successfully prevent and stop the development of severe reperfusion injuries after BPA even when the risk index for reperfusion pulmonary edema is exceeded.

Aim. To assess the impact of adherence and effectiveness of long-term positive airway pressure therapy (PAP-therapy) on the clinical and psychological characteristics of patients with obstructive sleep apnea syndrome. Materials and methods. The study included 80 patients who were examined in the sleep apnea laboratory of the Myasnikov Institute of Clinical Cardiology of the National Medical Research Center for Cardiology and who have been on PAP-therapy for more than 12 months. The average age of the patients was 65.0 years [59.0; 71.0], body mass index 35.0 kg/m2 [31.0; 38.0], sleep apnea-hypopnea index (AHI) 39.5/h [31.0; 62.6]. The average duration of PAP therapy was 3.5 years [2.0; 6.0], while the minimum use was 1 year, the maximum 15 years. In the sample of patients who came in person, the percentage of days using PAP-therapy was 87.5% [62.0; 98.0] and the average usage time 6.3 hours [5.2; 7.3]. Results. On long-term PAP-therapy a persistent decrease in AHI was seen on average from 39.5/h [31.0; 62.6] to 2.7/h [1.2; 6.2], p=0,000. The criteria for good adherence to PAP-therapy (use 4 hours/night, more than 70% of nights) were met by the percentage of days of use by 67.5% of patients, the average time of use by 87.5% of patients. Both criteria for good adherence to PAP-therapy was met by 64.8% of patients. With long-term PAP-therapy, 71.7% of patients met the criteria of effectiveness (AHI5/h), AHI remained 5/h in 22.9% of patients and the average residual AHI was 10/h in 5.4% of patients. Correlation analysis showed associations between the PAP-therapy usage parameters and the severity of obstructive sleep apnea syndrome, and sleep quality: percentage of days of use and AHI (r=0.374, p=0.001), average time of use and PSQI (r=-0.438, p=0.000). Patients with a lower adherence to PAP-therapy (63.0% of days [22.0; 96.0] and 3.6 hours [2.4; 4.5] of use) did not differ in daytime sleepiness (ESS 5.0 points [2.0; 9.0] and 5.0 points [3.0; 8.0 ], p=0.891), but had a significantly lower quality of sleep (PSQI): 18.0 points [14.0; 20.0] versus 10.0 points [7.0; 18.0], p=0.004 compared with patients with high adherence to PAP-therapy (98.0% of the days [92.0; 99.0] and 7.9 hours [7.5; 8.2] of use). Conclusions. Patients with the higher adherence to PAP-therapy had significantly better sleep quality. But even the use of PAP-therapy for less than 4 hours is associated with a decrease in daytime sleepiness severity.

Obstructive sleep apnea - is a socially significant disease that leads to an increased risk of developing cardiovascular complications and dramatically worsens the patient's quality of life. For a long time, the disease was considered exclusively male, however, the results of recent epidemiological studies reflect a decrease in the difference of the incidence between men and women. These changes are due to a more targeted study of the manifestations and clinical course of the disease, as well as new approaches in the diagnosis of obstructive sleep apnea syndrome. The review is focused on the analysis of recent data on gender differences in the prevalence, pathophysiology of obstructive sleep apnea, diagnostic approaches and clinical manifestation of the disease. It also considers the impact of gender on the quality of life and sleep. The obtained results can help better explain the mechanisms of gender differences, as well as form new trends in the development of clinical trials.

The aim of the study was to evaluate blood pressure (BP) level and vessel wall stiffness parameters role in antihypertensive therapy (AHT) escape phenomena development on the background of primarily effective AHT use. Materials and methods. Data from 102 patients with arterial hypertension level 1-3, stage I-II were analyzed. All patients underwent individual AHT adjustment for 2-3 weeks (adjustment period). At the end of the adjustment period the therapy effectiveness was evaluated with clinical BP measurement (target BP values less than 140/90 mm hg) and 24-hour BP monitoring (target daily BP values less than 130/80 mm hg). The study included only those patients who reached target clinical and daily BP values on the background of 2-3 antihypertensive drugs use at the end of the adjustment period. At the beginning of the observation period after effective AHT was used carotid-femoral pulse wave velocity was evaluated with applanation tonometry. For the purpose of timely escape phenomena diagnosis clinical BP measurement and 24-hour BP monitoring were performed in 1, 3, and 6 months after the trial start in all patients. Results. After 6 months of observation patients were divided in 2 groups: group 1 included 34 patients with AHT escape phenomena, group 2 - 68 patients with stable, controlled AH. In group 1 on the background of effective AHT use at the beginning of observation higher levels of following measures were observed: clinical systolic BP - SBP (125.2±11.3 mm hg vs 119.7±11.7 mm hg, p=0.021), daily SBP (128.0±3.3 mm hg vs 121.2±7.4 mm hg, p=0.000), daily average SBP (131.6±4.9 mm hg vs 125.3±8.5 mm hg, р=0.000), night average SBP (120.4±8.5 mm hg vs 111.8±8.6 mm hg, р=0.000), daily pulse BP 50.2±4.8 mm hg vs 44.2±7.6 mm hg, p=0.000), daily mean brachial artery stiffness index - ASI (161.9±28.3 mm hg vs 142.2±24.5 mm p=0.000), carotid-femoral pulse wave velocity (11.6±2.5 m/s vs 10.5±2.3 m/s, p=0.029). In single-factor logistic regression models all these measures were shown to have predictive value in AHT escape phenomena development. According to multifactor logistic regression analysis that included carotid-femoral pulse wave velocity more than 10.8 m/s, daily mean ASI>137, daily SBP>124 mm hg, and daily pulse BP>46 mm hg, the only independent predictor on the background of effective AHT at the beginning of the observation was daily SBP>124 mm hg (odds ratio 19.1, 95% confidence interval 3.6-101.8; p=0.0004). Conclusion. BP level and artery stiffness index measured on the background of effective AHT at the beginning of the observation are predictors for escape phenomena development and can be used for effectiveness and required frequency of therapy management prognosis.

To evaluate the influence of cardiovascular risk factors on antihypertensive therapy (AHT) efficiency escape (EE).Data on 59 patients with grades 1-3 hypertension (Stages I-II) were analyzed. During chosen AHT, 24-hour blood pressure monitoring was done at baseline, 1 and 3 months after beginning the observation to identify/rule out the AHT EE phenomenon.The AHT EE group (Group 1) as compared with the group that needed no therapy correction within 3 months (Group 2) was observed to have the following: elevated fasting blood glucose levels (FBGL) (5.8±0.8 vs 5.3±0.7 mmol/l; p=0.008) and higher impaired glucose tolerance (IGT) rates (8 (27.6%) vs 4 (13.3%) cases (p=0.03)); a more number of smoking patients (8 (27.6%) vs 3 (10%) cases; p=0.02); a larger number of patients with a compromised family history of cardiovascular diseases (17 (58.6%) vs 11 (36%); p=0.02). Furthermore, in Group 1 baseline average systolic blood pressure during 24 hours (SBP-24) proved to be higher than that in Group 2 (127.4±4.2 vs 122.4±6.8 mm Hg; p=0.002). Odds ratio (OR) for developing the EE phenomenon increased by 60% with a rise of 0.5 mmol in FBGL (OR, 1.60; 95% confidence interval (CI), 1.06 to 2.4; p=0.02) and by 18% with an increase of 1 mm Hg in baseline SBP-24 (OR, 1.18; 95% CI, 1.05 to 1.33; p=0.004). Multivariate analysis indicated that the independent predictors of AHT EE were a compromised family history (OR, 3.7; 95% CI, 1.1 to 12.1; p=0.03) and IGT (OR, 4.1; 95% CI, 1.02 to 16.4; p=0.04).AHT EE was influenced by FBGL, IGT, smoking, a compromised family history, and baseline SBP-24 level.Цель исследования. Оценка влияния факторов риска развития сердечно-сосудистых осложнений (ССО) на 'ускользание' эффективности (УЭ) антигипертензивной терапии (АГТ). Материалы и методы. Проанализировали данные 59 больных гипертонической болезнью 1-3-й степени, I-II стадии. На фоне подобранной АГТ проводили суточное мониторирование артериального давления исходно, через 1 и 3 мес после начала наблюдения с целью выявления/исключения феномена УЭ АГТ. Результаты. В группе больных с УЭ АГТ (1-я группа) по сравнению с группой больных, не нуждавшихся в коррекции терапии в течение 3 мес (2-я группа), наблюдали следующее: более высокий уровень глюкозы в крови натощак - УГКН (5,8±0,8 ммоль/л против 5,3±0,7 ммоль/л; p=0,008) и более высокая частота нарушений толерантности к глюкозе (НТГ) - 8 (27,6%) случаев против 4 (13,3%) случаев (p=0,03); больше курящих больных - 8 (27,6%) против 3 (10%; p=0,02); большее число больных с отягощенной сердечно-сосудистыми заболеваниями наследственностью - 17 (58,6%) против 11 (36%; p=0,02). Кроме того, в 1-й группе исходный уровень среднесуточного систолического артериального давления (САД-24), оказался выше, чем во 2-й группе (127,4±4,2 мм рт.ст. против 122,4±6,8 мм рт.ст.; p=0,002). Отношение шансов (ОШ) развития феномена УЭ увеличивалось на 60% - с ростом УГКН на 0,5 ммоль/л (ОШ 1,60 при 95% доверительном интервале - ДИ от 1,06 до 2,4; p=0,02) и на 18% с ростом исходного САД-24 на 1 мм рт.ст. (ОШ 1,18 при 95% ДИ от 1,05 до 1,33; p=0,004). При многофакторном анализе независимыми предикторами УЭ АГТ являлись отягощенный семейный анамнез (ОШ 3,7 при 95% ДИ от 1,1 до 12,1; p=0,03) и НТГ (ОШ 4,1 при 95% ДИ от 1,02 до 16,4; р=0,04). Заключение. На УЭ АГТ повлияли УГКН, НТГ, курение, отягощенный семейный анамнез, исходный уровень САД-24.

Objective. To determine the dynamics of the clinical and psychological characteristics on the background of 1 month of CPAP therapy in patients with obstructive sleep apnea syndrome (OSA) and arterial hypertension (AH), both adherent and non-adherent to the treatment. Methods. The study included 180 patients with OSA and AH. Upon enrollment, anthropometric data, the results of polysomnography and cardiorespiratory studies, Beck depression scale, Spielberger personal and situational anxiety scale, Epworth daytime sleepiness scale, Pittsburgh sleep quality questionnaire and Quality of Life (WHO QOL-100) questionnaire were analysed. Out of 40 patients undergoing CPAP therapy, 30 patients were adherent to the treatment within a month. The adherence criterion was considered to be the usage of the CPAP device more than 4 hours per night, more than 5 days a week. In this article, the dynamics of the questionnaire scales is given only for those who were adherent to CPAP therapy. Results. Patients with OSA and AH adherent to CPAP therapy showed a statistically significant reduction in daytime sleepiness and depression, as well as improved quality of sleep and quality of life in the physical domain within 1 month of using CPAP therapy. Conclusion. Even short-term use of CPAP therapy in patients with OSA and AH leads to a reduction in daytime sleepiness and depression, improved quality of sleep and quality of life in the physical domain.

The study had two phases: the first phase of exploring the possibility of a computer pulse oximetry as a screening method for the diagnosis of respiratory disorders during sleep in patients with cardiac profile in steady-state conditions, the second - a screening study of prevalence of obstructive sleep apnea in the same category of patients. In a comparative study of two methods: cardiorespiratory monitoring (4 channels, held monitoring device «Kardiotekhnika-07», «Incart», Russian, and computer pulse oximetry device PulseOx 7500, SPO medical, Israel) included 70 patients (70% men and 30% of women), mean age 55,5±11,2 years. The sensitivity of the computed pulse oximetry in detecting disorders of breathing during sleep (number of episodes of more than 5 per hour, reducing the saturation of more than 3%) was 94,4%; specificity - 79,2%; positive predictive value - 91,1%; negative - 86,4%; accuracy - 87,7%. In a screening study included every fifth patient entering the Russian Cardiology Research and Production Complex MH of the Russian Federation. Patients of the departments of cardiovascular surgery, emergency cardiology department of chronic heart failure, patients with respiratory diseases COPD, asthma were excluded. Statistical analysis included 206 patients. Median age was 68,4±13,7 years, BMI - 32,9±5,5 kg/m2, 43,6% of men and 56,3% of women. From 5 to 15 events per hour was observed in 31,1% of patients, from 15 to 30 events/h - 31,1% and more than 30 events per hour - 23,9%. Thus, respiratory disorders of varying severity were in 77,4% randomly sampled in the study patients.