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On December 18, 2022, an interdisciplinary Expert Council was held in St. Pe­ter­sburg, dedicated to the debatable issues of anticoagulation in the prevention of venous thromboembolism in pregnant women with cardiovascular and systemic diseases, at which a number of proposals and guidelines were adopted, and the results of the Highlow study were considered. Leading experts from the Russian Society of Cardiology, the Russian Society of Obstetricians and Gynecologists, the National Association of Specialists in Thrombosis, Clinical Hemostaseology and Hemorheology took part in the Expert Council.

The main stages of the creative path of the scientist with a world-famous, professor, the Honored Worker of Science of the Russian Federation, Academician of the Russian Academy of Sciences Alexey Petrovich Golikov are presented in the article.

Aim. To evaluate the effectiveness and safety of telmisartan, used in monotherapy or in combination with hydrochlorothiazide or amlodipine, in real clinical practice in patients with diagnosed arterial hypertension who have not reached the target levels of blood pressure (BP).Material and methods. The study was a non-intervention, prospective, multicenter, comparative, observational, epidemiological program, which was carried out in Russian medical institutions. The total patient population in which the prescribed therapy was administered included 1933 people (758 men and 1175 women, mean age 57.0-59.3 years). Participants were followed-up for 12 weeks. The change in office BP was evaluated on the 4th and 12th week.Results. Significant (p

Anticoagulant therapy is widely used in all forms of acute coronary syndrome (ACS) to inhibit the formation of thrombin and/or to inhibit its activity to reduce the risk of thrombotic events (both in primary percutaneous coronary intervention and in the absence of revascularization). Of the entire range of anticoagulants offered by the domestic and foreign pharmaceutical industry, a limited number of drugs of this group are used in the treatment of ACS, in particular, unfractionated heparin and low molecular weight heparin – enoxaparin.Enoxaparin has a safety profile and clinical efficacy at least comparable to that of unfractionated heparin, and at the same time has a number of obvious advantages, such as a simpler protocol of administration and dosing, does not require routine monitoring of the parameters of the blood coagulation system. In patients with ACS with ST-segment elevation the routine administration of enoxaparin should be considered as an alternative to the standard regimen of unfractionated heparin therapy. In patients with ACS without ST-segment elevation enoxaparin should be used when fondaparinux is unavailable.

The study included 75 women with arterial hypertension, aged 48-51 years (Me 50,0 years [25%; 75%: 48,0; 52,0 years]), who according to the clinical laboratory and instrumental examination was diagnosed essential hypertension (EH) I–II stage of 1–2 degrees. The duration of arterial hypertension did not exceed 5 years (Me 1 year [25%; 75%: 1; 3 years]) and all women had moderate risk of cardiovascular complications on the SCORE scale. All patients were in the perimenopausal period, confirmed by laboratory of hormonal status. After 14 weeks of monotherapy losartan or ramipril or combination with one of RAAS blockers and bisoprolol with low-dose hydrochlorothiazide was achieved target blood pressure and improvement of endothelial and kidney function, which was manifested by decrease in the level of albuminuria and ADMA concentration, significantly exceeding the reference values in the initial state. More pronounced organoprotective effect was in the group of women, receiving combined antihypertensive therapy.

Aim. To define early echocardiographic markers of cardiovascular risk in women.Material and methods. In 76 females, of 1st degree of kinship, from 61 families, two groups were selected: 26 daughters, whose mothers have arterial hypertension (AH) — group 1; 41 daughters from normotensive mothers — group 2. Anamnesis was assessed, including registration of cardiovascular risk factors, heredity, anthropometry, bidimensional echocardiography (EchoCG), and tissue Doppler.Results. In women from group 1, waist circumference (WC) and waist/hip ratio were significantly higher than in group 2. In bidimensional EchoCG, structural and functional parameters of the left ventricle function (LV) were within the reference values, however left atrium volume index in group 1 was significantly higher in comparison with the daughters from normotensive mothers. Also, in the group 1, there were significant differences od tissue Doppler values that characterize diastolic LV function. Relation E/e’ on lateral and septal areas of the mitral valve did not reach pathological values in both groups, as the in groups almost healthy persons were included; in the group of daughters form hypertensive mothers though, these parameters were significantly higher than in the group 2.Conclusion. Early adverse factors of cardiovascular risk in women are inheritance for cardiovascular diseases and AH, markers of metabolic syndrome (increased WC and waist/hip ratio), and left atrium volume and E/e’ that represent diastolic function of the LV.

Cardiovascular diseases (CVD) remain the main cause of mortality in the world. [1] At the same time, arterial hypertension (AH) is one of the most common CV pathologies, which, according to foreign researchers, affects about 30–45% of the general population [2] and about 40–47% of the population according to Russian studies. [3] The experts forecast that by 2030 the prevalence of hypertension will increase by approximately 10%. [4]

By now there is a substantial evidence on the role of magnesium deficiency, which can occur during pregnancy even in healthy women in case of its insufficient intake through food, in the deterioration of the clinical condition and obstetric complications, especially in patients with cardiovascular disease. Therefore, complex preventive therapy which apart from treatment of hypertension and autonomic dysfunction with mitral valve prolapse, includes oral organic magnesium formulations (lactate, citrate, pidolate) in combination with pyridoxine to replenish magnesium deficiency in these patients has a pronounced positive effect both on the mother, the fetus, and the course of pregnancy.

The article is devoted to management of pregnant patients with obesity. Fat metabolism disorders are known to contribute to the development of gestational hypertension, preeclampsia, intrauterine hypoxia and fetal macrosomia, birth defects and other complications, including in the newborn. Hypertension plays an important role in the pathogenesis of those complications in pregnant women with obesity. Hypertension is at the same time a result of metabolic disorder and an exacerbating factor which adversely impacts the course and outcome of pregnancy. The article tells about rational combination therapy of hypertension during pregnancy.

84 women in perimenopause confirmed by medical history and hormonal status tests participated in the study; control group consisted of 64 patients with first or second degree hypertension and 20 apparently healthy women. Daily monitoring included blood pressure control, assessment of the functional status of sympathetic-adrenal system by the size of β-adrenoreceptors in erythrocyte membranes, test for microalbiminuria and glomerular filtration rate using Cockcroft-Gault formula. Group 1 included patients with first degree hypertension (23 women) which received losartan 50-100 mg/d monotherapy (Losarel, Sаndоz); group 2 patients (43 women) with second degree hypertension received combination therapy: losartan 100 mg/d and Lodoz (bisoporol 5 mg + hydrochlorothiazide 6.25 mg). Treatment lasted 12 weeks; patients were examined before inclusion in the study and after the study. Reduction in blood pressure to the target level was registered in all patients. There were no side or adverse effects. Initially elevated levels of β-adrenoreceptors in erythrocyte membranes significantly decreased in both groups, as a result of improved functional status of sympathetic-adrenal system. Renal excretion of nitrogen evaluated by glomerular filtration rate was not impaired; microalbiminuria increased manifold compared to reference values. After 12 weeks of treatment, microalbiminuria decreased in patients of all groups as a result of nephroprotective effect of antyheprtensive drug therapy.

The study covered 109 female patients with 1-2 degree hypertension in perimenopause and daily evaluated the results of 24-hour blood pressure monitoring, endothelial function using endothelium-dependent and endothelium-dependent vasodilation of the brachial artery, and endothelin-1 concentration in blood serum before treatment and after 12 weeks of monotherapy with ramipril ACE inhibitor (7 people), losartan angiotensin II receptor blocker (8 people) or combination of ramipril with Lodoz (45 people) and losartan with Lodoz (49 people). In all the observed groups, blood pressure decrease to recommended levels and an improvement of endothelial function were achieved; the latter was manifested in the positive decrease of endothelin-1 concentration in the serum which was high in comparison with reference values already in 1 degree AH, and in the improvement of vasodilator properties in the shoulder artery.

The study covered 140 women aged 45-60 (median age: 50 ± 7,2 years) in postmenopausal period the majority of who had stage II hypertension (120 women) and 20 were apparently healthy (control group). The function of the thyroid gland was examined; 78 patients were diagnosed with hypothyroidism, 30 with hyperthyroidism and 12 with euthyroidism. Evaluation of the size of β-adrenoceptors in erythrocyte membranes (β-APM) through the unique research method revealed a wide range of β-APM measures; all the patients were diagnosed with hypersympathicotonia. After the examination, treatment with Lodoz (bisoprolol 5 mg and hydrochlorothiazide 6.25 mg) once daily in the morning was initiated. Blood pressure and overall well-being of patients were checked once a week; if monotherapy with Lodoz proved to be ineffective, bisoprolol 5 mg in the evening was prescribed additionally; in case of failure to achieve required anti-hypertensive effect in patients, they were prescribed with enalapril 10-20 mg per day. 80 patients with hypertension taking Lodoz (5 of those in combination with bisoprolol) and 20 patients taking enalapril completed the treatment. After 12 weeks of antihypertensive therapy all patients who completed the study underwent 24-hour blood pressure monitoring; the results showed a good antihypertensive effect of Lodoz. No side-effects attributed to the therapy were observed.

Arterial hypertension (AH) in pregnancy is a heterogeneous pathology. It includes chronic AH (secondary AH and essential AH) which has been observed before pregnancy; gestational AH which develops approximately after 20 weeks of pregnancy and disappearing within 42 days after childbirth; pre-eclampsia (gestosis) which is a combination of AH and proteinuria; and unclassified AH which is diagnosed when blood pressure (BP) is first measured after 20 weeks of pregnancy, and elevated BP, with or without systemic signs and symptoms, is detected. AH in pregnancy increases the risk of complications both for the mother and the child, which points to the need for its active diagnostics and monitoring of the status of target organs and feto-placental complex. Pharmacotherapy of AH in pregnancy is based on the balance of its effectiveness and safety. Therefore, the first-choice medications are methyldopa, dihydropyridine calcium antagonists (nifedipine SR), and cardio-selective beta-blockers. AH in pregnancy is a risk factor of cardiovascular disease across life course stages in women.

Aim. To assess the pregnancy course and perinatal outcomes in women with congenital heart valve disease (CHVD).Material and methods. In total, 150 medical histories of pregnant women with corrected CHVD (CCHVD; n=61) and non-corrected CHVD (NCHVD; n=89) were retrospectively analysed. All women gave birth at the specialised maternity centre in Moscow and the perinatal centre in Khabarovsk.Results. The features of CHVD in pregnant women reflected the population patterns and were represented by interventricular and interatrial septal defects, aortal coarctation, open arterial duct, pulmonary artery stenosis, and corrected “blue” heart valve disease. Approximately 20% of the women learnt about their disease during the current pregnancy. In most women, the pregnancy course was uncomplicated, but in 9,8% (n=6) of CCHVD and 14,8% (n=13) of NCHVD women, heart failure (HF) symptoms developed and progressed at Weeks 28-32, when the hemodynamic load on cardiovascular system is maximal. Hospitalization and adequate treatment of these patients improved their clinical status and prolonged the pregnancy up to physiological terms. Over 50% of the women had cesarean delivery, despite no evidence of cardiovascular decompensation.Conclusion. The first delivery in most women with CCHVD and NCHVD took place at young age. Cardiovascular decompensation was registered at Weeks 28-32, when the hemodynamic load is maximal.

Aim. To study the episodes of acute heart rate variability (HRV) decrease in patients with coronary heart disease (CHD) and healthy people, at normal levels of physical stress (PS) – stairs climbing. Material and methods. The study included 30 patients with CHD, who underwent coronaroangiography, and 17 relatively healthy people (control group). Non-stop ECG monitoring was performed during stairs climbing at normal pace. Results. Episodes of acute HRV decrease were registered in 29 CHD patients and 12 healthy people. In CHD patients, the episodes developed at lower PS and HR levels, than in healthy subjects, regardless of compromised vessels’ number and stenosis severity. HR at the start of HRV decrease episode was 50% from submaximal HR in patients with unstable angina; 64% - in patients with stable angina, and 87% - in healthy individuals. Conclusion. Moderate PS test helped to identify, by registering episodes of acute HRV decrease, CHD patients and healthy people. Ratio “HR at the start of the episode” / “Submaximal HR” (HR LF

Aim. The principal objective of this randomized, comparative, open clinical trial PRESTIGE was to determine the time of achieving optimal therapeutic dozes of ACE inhibitors. The secondary goal was to assess dynamics of chronic heart failure (CHF) functional classes (FC) during the treatment. Material and methods. The study involved 125 patients with Q-wave acute myocardial infarction (MI): 68 males, 57 females; mean age 67 years. All participants were randomized into perindopril or captropril groups (n=63 and 62, respectively). In dose titration, starting doses were 2 mg/d and 18.75 mg/d, respectively. Recommended daily doses were 4-8 mg once per day for perindopril, and 75-150 mg, three times per day, for captropril. Treatment and follow-up period lasted for 6 months. ACE inhibitor efficacy was assessed by measuring brain natriuretic peptide (BNUP) levels - at baseline, Weeks 8 and 24. Quality of life (QoL) was assessed by two methods: by “health line” and standard Minnesota University Questionnaire for heart failure patients. Incidence of death and hospitalization due to cardiovascular causes was also registered. Results. At Week 8, there was a significant reduction in BNUP level (to 296.5±16.7 pmmol/l; or by 25.4%; р=0.004) in perindorpil group, and to 342.7±13.8 pmmol/ml (by 19.1%; NS; р=0.06) in captopril group. At 6 months, QoL improved in perindopril group (reduced total QoL score, 23.8; р=0.047), and did not change comparing to Week 3, in captopril group (31.4). Conclusion. MI patients with left ventricular dysfunction, early administered ACE inhibitors, achieved target dose of perindopril faster than that of captopril. That was associated with improved clinical course (CHF FC, QoL) in perindopril group.

A complex clinical, laboratory and instrumental examination of 234 patients found that hypertension occurs with equal frequency in men and women. Gender differences were determined by such most common risk factors as impaired fat metabolism and hypertriglyceridemia. Thickening of the intima-media complex greater than 1.3 mm and atherosclerotic plaques were found consistently more often in patients with hypertension, while their frequency was not linked to gender.

Введение: Гестоз занимает второе место в структуре причин материнской и перинатальной смертности. В литературе присутствуют разноречивые сведения о прогностической роли микроальбуминурии (МАУ) у беременных (Gonzalez LA, Барабашкина АВ). Ожирение также является одним из факторов риска развития артериальной гипертонии (АГ) и гестоза. Цель: оценить МАУ у беременных с избыточной массой тела и ее роль в прогнозе развития гестоза. Материалы и методы: Исследование проведено на 30 беременных на базе женской консультации 209 городской поликлиники Москвы. В исследование включались женщины без хронической АГ в возрасте от 18 до 35 лет в 1 триместре беременности. На настоящее время срок гестации наблюдаемых женщин 27-35 недель. 17 беременных с избыточной массой тела (индекс массы тела (ИМТ) > 25 кг/м 2), 13 - с нормальными значениями ИМТ. АГ исключалась проведением СМАД в 1 триместре беременности. В 1 и 2 триместре оценивались (З-адренорецепция эритроцитов ((ЗАРМ), МАУ, АД. Результаты: В группе с нормальными значениями ИМТ ни у одной беременной женщины не выявлялось повышения АД, МАУ и регистрировались значения ( АРМ=32±3,5 у. е. В группе с ожирением выявлено, что у беременных с ИМТ>30 кг/м 2 МАУ=105±63 мг/л встречается в 83% наблюдений (5 беременных из 6), а с ИМТ25 кг/м 2 выявляются нарушения функции почек в виде МАУ, повышения значений ( АРМ на фоне отсутствия подъемов артериального давления.

Введение: Микроальбуминурия является одним из предикторов развития гестоза. Однако, её влияние на перинатальные исходы недостаточно изучено. Цель: провести ретроспективный анализ перинатальных исходов у пациенток в зависимости от наличия микроальбуминурии (МАУ) в III триместре беременности. Материалы и методы: В ретроспективный анализ включено 57 историй родов пациенток на базе специализированного родильного дома при ГКБ № 67 для беременных с кардиоваскулярной патологией. Оценивались данные анамнеза, полного акушерско-гинекологического обследования, наличие и выраженность микроальбуминурии. Выраженность МАУ оценивали как: отсутствие белка (1 группа), наличие МАУ-до 300 мг/л (2 группа). Критерии включения: 1) беременные женщины в возрасте 18-47 лет; 2) женщины в третьем триместре беременности; 3) отсутствие экстрагенитальной патологии, влияющей на функцию почек. Статистическую обработку полученных данных осуществляли с помощью пакета прикладных программ «Statistica» версии 6.0 Результаты: В результате анализа все исследуемые пациентки были разделены на 2 группы: 1 группа - 21 наблюдение, 2 группа - 36 наблюдений. Средний возраст в группах составил 33±5, 30±6 лет. Средний рост 167±6, 165±5 см. Индекс массы тела 33±9, 31±9 кг/м2, частота встречаемости хронической артериальной гипертензии в группах 100% и 51,4% соответственно. При анализе перинатальных исходов получены следующие данные: масса новорожденных 3270,5±236,6 и 3289,3±490,5 г, рост новорожденных 50,2±1,25 и 50,5±2,12 см, оценка по шкале Апгар на 1 минуте жизни 7,75±0,55 и 7,66±0,64, Апгар на 5 минуте 7,95±0,39 и 7,66± 0,64, гипоксия плода 14,3 и 42,9%, задержка развития 0 и 22,9%, гипотрофия плода 0 и 11,5%, симптом угнетения 4,76 и 17,1%, поражение ЦНС 4,76 и 20% соответственно. Выводы: наличие микроальбуминурии в III триместре беременности увеличивает частоту преждевременных родов, а также отрицательно влияет на перинатальные исходы, при этом, не влияя на антропометрические показатели плода.

The Aim of the BEREG Registry was to analyze the prevalence and structure of cardiovascular diseases, associated comorbid conditions and assess their effects on pregnancy and perinatal outcomes in real clinical practice.In Tula city regional perinatal center the observation study named "Assessment of the clinical condition of the pregnant women with cardiovascular disease during gestation, at child delivery, at the early postpartum period and at twelve months after childbirth and assesment of perinatal outcomes, condition of the fetus and the newborn and the quality of treatment of these patients groups.All eligibly pregnant women hospitalized in 2014 to "Tula regional perinatal center" have been recruited in the Registry. Clinical and demographic data at admission, obstetric history, laboratory and instrumental examination data, previous medical history have been investigated. The following endpoints were evaluated: maternal mortality, death of the fetus and newborn baby; preeclampsia or/and eclampsia, heart failure, arrhythmia, thromboembolism events.Statistical processing of obtained data was carried out using the software package STATISTICA10.0 (StatSoft, USA).The study included 3214 women delivered babies in the perinatal center in 2014, of which 691 (21,4%) were diagnosed with cardiovascular disease (CVD) in most cases (451 women, 65,9%) - these were different clinical variants of arterial hypertension (AH). Five women (0.7%) had acquired and 23 women ( 3.3%,) congenital heart defect, non-significant heart development abnormities were found in 80 subjects, (11.6%). and Cardiac arrhythmias and conductivity disturbance have beenrevealed in 116 and 16 cases (16.8% and 2.3%) correspondingly.Patients with CVD were significantly older than women without CVD and more often had a variety of disorders of carbohydrate metabolism, overweight, obesity and chronic varicose disease of the lower extremities. Pregnancy in women with CVD significantly more often was complicated by the threat of interruption, placental insufficiency, preterm and operative babies delivery.Arterial hypertension as well as obesity, placental insufficiency and threatened miscarriage became prognostically unfavorable conditions that contributed of premature birth and fetal death. Fetal death or newborn babies death took place in 1,3% of all the subjects enrolled. In this cohort antenatal death have been registered in 43,2%, intrapartum one in 2.3% and neonatal death in 54.5%.Negative rognostic factors for low birth-weight babies were: placental insufficiency, various clinical variants of AH, obesity and infectious diseases; less input had endocrine diseases and risk of abortion.Adverse factors for the fetus death or newborn death were different clinical variants of arterial hypertension and the risk of abortion in any trimestre of pregnancy.