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To elucidate the role of nitrous oxide (NO) in development of severe primary arterial hypertension (AH) including malignant hypertension and concomitant ischemic heart disease (IHD).Patients with diagnosis of primary 1-3 degree AH (n=62, 21 men, 41 women aged 39-87 years, mean age 63.7+/-2.7 years) and 28 subjects with normal arterial pressure (AP) (n=28, 13 men, 15 women aged 30-85 years, mean age 57.5+/-7.8 years). Blood serum levels of NO stable metabolites (nitrates and nitrites) were measured by reaction of their reduction in the presence of vanadium chloride and by reaction of diazotization of sulfanilamide by generated nitrite (modification by R.M.Miranda et al., 2001).NO level (level of its stable metabolites) was substantially elevated in patients with various severity of AH compared with subjects with normal AP. Severe and malignant course of AH was not associated with substantial lowering of NO level in blood serum. Relation between NO level and age found in subjects with normal AP, was not observed in patients with labile and stable course of AH. In patients with AH, normal serum NO level and signs of chronic involvement of cardiovascular system the disease was several times more often associated with atrial fibrillation and class II-III angina than in patients with high NO levels. Patients with AH combined with IHD more often had signs of heart failure and history of myocardial infarction.

Coronary bypass grafting with the use of cardiopulmonary bypass was performed in 119 patients (age 41-75 years) with stable angina. In addition to standard therapy in pre and post operative periods patients of group 1 (n=40) received mildronate (750 mg/day for 3 days then 750 mg twice weekly), patients of group 2 (n=41) received trimetazidine (70 mg/day). Patients of group 3 (n=38) received no "metabolic" drugs. The use of cardioprotectors mildronate and trimetazidine facilitated improvement of total and local myocardial contractility both before and after surgery, and caused limitation of development of myocardial stunning, associated with derangement of local contractility in post operative period.

To assess effects of hypertension and obesity on blood plasma levels of sex hormones and gonadotropins in fertile and postmenopausal women.We assessed endocrinological status and measured levels of sex hormones and gonadotropins in 228 women with grade I-III hypertension (WHO, 1999) and 114 normotensive women of fertile and postmenopausal ages (17 to 74 years). There was a definite relationship between obesity and levels of sex hormones which did not depend on blood pressure level. The authors regarded this relationship as an endocrinological consequence of obesity. Severity of hypertension was associated with elevation of luteinizing and follicle-stimulating hormones and lowering of progesterone level in fertile women and with elevated levels of sex hormones in blood plasma in menopausal women. The authors interpreted the latter phenomenon as a sign of adrenal gland hyperfunction.

As shown by the study of 27 patients with non-obstructive form of hypertrophic cardiomyopathy (HC), this disease is associated with a significant rise in the production of active oxygen forms by leukocytes, significant changes in the activity of enzyme antioxidant defense, unchanged lipid peroxidation, high total antioxidant activity of blood plasma. The patients received a complex of natural antioxidants varying by mechanism of action and glutaminic acid. Antioxidants produced a subjective clinical response, reduced incidence of cardiac arrhythmia, improved exercise tolerance. The response becomes still better in combination of antioxidants with conventional therapeutic tools.

Plasmosorption and enterosorption were assigned to 35 acute myocardial infarction (AMI) patients. Plasmosorption was performed within an hour since AMI onset followed by a 5-day course of enterosorption (enterosorbent YO-A in a dose 30 g/day). The above combination produced a positive effect on hemodynamics and blood rheology resultant from a reduction in hematocrit value, plasma levels of fibrinogen and its derivatives, plasma viscosity and platelet aggregation. Ibustrin (200 mg) combined with heparin (100000 U) introduced into extracorporeal circulation effectively prevents thrombogenesis. AMI patients treatment with enterosorption plus plasmosorption enhances the response to nitroglycerin, reduces the rate of complications and lethal outcomes.

Infrared laser therapy using an arsenide-gallium laser was used in 54 patients aged 30-75 years who suffered from coronary heart disease. A positive clinical effect was achieved in 47 (87%) of 54 patients, as evidenced by the reduced number of nitroglycerin tablets used and improved bicycle ergometric, echo- and electrocardiographic parameters in the patients.

Overall 146 females suffering from essential hypertension (borderline, stage I and II according to WHO, 1980) were examined for basal concentrations of estradiol, estriol, progesterone, testosterone, cortisol, ACTH, prolactin in plasma, LH and FSH in blood and urine. The patients and 69 control normotensive females were reproductive, premenopausal, menopausal, postmenopausal, postcastration. Latent hypertension was elicited at bicycle exercise. It was found that relationships between sex hormones and gonadotropins both in hypertensive and normotensive women did not differ noticeably in reproductive period and in menopause. Hormone defects due to primary and secondary infertility, castration, menopause did not raise the risk of arterial hypertension onset. An-Unfavorable course of hypertension was observed in premenopause, following operative castration, in climacteric syndrome. The severity of AH at reproductive age was associated with hyposecretion of progesterone, estrogens and gonadotropins LH, FSH. This relationship was absent in menopausal women. A conclusion is proposed on miner significance of sex hormones imbalance and gonadotropins in the onset of arterial hypertension in females varying by generative activity.

Na+/H+ turnover rate in the erythrocyte membranes were measured in 20 patients with Stages II and III essential hypertension, 11 patients with renal hypertension and 10 healthy subjects. The patients with essential hypertension showed a two-fold increase in Na+/H+ turnover rate as compared to the controls. Those with renal hypertension displayed no changes in the rate. The rate of Na+/H+ turnover was not associated with the patients' sex and was the same in Stages II and III essential hypertension. Measuring the Na+/H+ exchange rate was proposed to be an additional diagnostic tool for the differential diagnosis of arterial hypertension.

Monitoring the sodium-lithium counter transport, the authors examined the membrane permeability of red cells for sodium in 70 females and 127 males aged 20 to 70 years. In subjects with normal arterial pressure, the membrane permeability of the red cells showed no age-specific changes or differences in males and females at the age of 20 to 31 years and those over 40 years. Arterial hypertension (AH) according to the WHO criteria was diagnosed in 31% of those studied. The individuals with an increased permeability of the red cell membrane for sodium, exhibited AH twice as frequently as the individuals with the normal or decreased permeability. The rate of AH was found to rise (from 46 to 68%) with age in the subjects with the elevated permeability of the red cell membrane whilst there was no such tendency in the individuals with normal and decreased permeability of the red cell membrane.

A new antiarrhythmic drug, prolecofen (class Ic), was used in 74 patients with various forms of coronary heart disease, involving heart rhythm disorders. The drug's clinical efficiency and effects on platelet activity, lipid peroxidation, blood prostacyclin, thromboxane, cAMP and cGMP were assessed. Prolecofen is shown to be an effective agent for the treatment of ventricular and supraventricular arrhythmias in coronary patients. It contributes to the inhibition of platelet activity, a drop of cAMP and cGMP levels and a rise of the cAMP/cGMP ratio.

To specify indications for isovolumic hemodilution, hemostatic parameters (fibrinogen, soluble fibrin, fibrin decomposition products, platelet aggregation, thromboelastograms) were compared with clinical manifestations of coronary heart diseases (CHD) and coronarographic and bicycle-ergometric findings in 41 coronary patients. The increased blood viscosity syndrome was found in 63% of the patients. Isovolumic hemodilution was performed to control the detected disorders in 17 patients. Hemodilution was shown to be an effective means of controlling hemostatic disorders in coronary patients, hemostatic normalization being accompanied with clinical improvement in part of the cases.

Sodium permeability of erythrocyte membranes was examined, using the recording of maximum rates of sodium-lithium countertransport, in patients with essential hypertension of stages II and III by the WHO classification, renal arterial hypertension, Itsenko-Cushing disease, pheochromocytoma, Conn's syndrome and in subjects with normal arterial pressure who made up a control group. Hypertensive patients demonstrated a more than 60% increase in erythrocyte membrane permeability, as compared to normotensive controls. In patients with pheochromocytoma, the permeability values were almost 40% as low as the control ones. No changes in sodium erythrocyte membrane permeability could be demonstrated in patients with renal hypertension, Itsenko-Cushing disease and Conn's syndrome. It is believed that the erythrocyte membrane permeability parameters can be used for the identification of essential hypertension in the differential diagnosis of hypertensions.

The effectiveness of streptokinase treatment of patients with myocardial infarction as compared to the control group and patients given anticoagulants is analysed. It is shown that the frequency of recurrent myocardial infarctions, congestive circulatory insufficiency, shock, and thromboembolic complications is lower in the group of patients treated with streptokinase than in the control group. Streptokinase improves the course of the disease and the prognosis in patients with preinfarction angina pectoris. The effect of streptokinase is higher in the first 3--6 hours after the development of myocardial infarction and in individuals under the age of 65. The effectiveness of the treatment does not diminish when the drug is injected for a short time and in small doses (300,000--750,000 U).

Ultrasonic scanning of the heart was carried out on days 1, 10, 20 and 30 of uncomplicated myocardial infarction (MI) in 46 patients whose total and segmental ejection fraction (EF) (5 segments by a two-chamber projection from the apex) were then calculated. Total left-ventricular EF was moderately reduced on day 1 (48.6 +/- 1.8%) and increased significantly by day 30 (55.4 +/- 2.3%, p less than 0.01). All patients showed impaired segmental contractility in infarcted areas. Segmental EF was essentially reduced in segments 3, 4 and 5 in anterior MI, and in segments 1 and 2 in posterior MI. Recovery was associated with increasing EF in asynergic segments, that nevertheless remained diminished on day 30, as compared to unaffected areas. The rise in left-ventricular total EF is attributed to better contractility of asynergic segments.

Hypotensive activity of labetalol therapy alone or in combination with the diuretic agent oxodolin or with low-sodium diet (about 110 mmol/day) and potassium cooking salt substitute "Sanasol" (60% sodium chloride, ammonium chloride, calcium gluconate, magnesium asparaginate, etc.) was studied in 67 patients with second- or third-stage essential hypertension and 14 patients with nephrogenic hypertension. Central hemodynamic changes were assessed by means of radiocardiography and tetrapolar rheography. Combined treatment had better hypotensive effect in moderate and severe hypertension (diastolic arterial BP above 110 mm Hg). The diuretic-labetalol combination made possible a 25-45% reduction in the adrenoblocker dose. The effect of combined hypotensive treatment was similar in patients with different central hemodynamic types. Low-sodium diet with potassium substitute was well tolerated by the patients.

Results of physical training in 37 patients with the ischaemic heart disease with angina of effort are given, 31 one them had had myocardial infarction. Training on bicycle ergometer lasted 2 1/2 to 10 months. After exercise 75% of patients showed enhanced threshold capability, the "double product" (the heart rate x systolic AP) decreased at the expense of the pulse deceleration and decrease of the systolic AP with the standard exercise of 50 W. The maximum size of the "double product" under exercise and also with the appearance of angina remained unchanged. The heart volume after exercises did not change. Changes in haemodynamics depended on the initial functional state of the myocardium, which was evaluated by the degree of rise of the diastolic pressure in the pulmonary artery (DPPA) with 50 W exercise and according to the functional curves of the left ventricle traced by comparing DPPA and the minute volume. In patients with "good" myocardial function (DPPA not lower than 30 mm Hg) after exercises the stroke and minute volumes increased with the threshold exercise, DPPA decreased with 50 W, functional curve of the left ventricle approached the functional curve of healthy individuals. Patients with "bad" function (DPPA over 30 mm Hg and higher did not show) changes in haemodynamics and in the functional curve of the left ventricle.

Salt sensitivity was measured in 38 patients with first- and second-stage essential hypertension. Patients with high salt sensitivity were identified, in whom moderately limited (to 6 or 5 g daily) dietary salt consumption produced a hypotensive effect. A combination of low-sodium diet and hypotensive drugs in salt-sensitive patients allows diminished dosage of medication. Moderately-limited dietary salt uptake was shown to increase exercise tolerance in patients with essential hypertension.

In 31 patients with ischaemic heart disease and different types of hyperlipoproteinemia the Takeda method was used for determining the duration of 125I-labelled fibrinogen circulation. The half-life period of labelled fibrinogen was found to be twice shorter in the patients than in the normal individuals. Two types of curves of plasma radioactivity reduction were distinguished in patients with ischaemic heart disease. The briefest circulataion period of the labelled fibrinogen was found in patients with type II hyperlioproteinemia. In patients with ischaemic heart disease and normal blood lipids content the period of circulation of the labelled fibrinogen comprised 2.07 +/- 0.27 days and was higher than in those with hyperlipoproteinemia.

Platelet-vascular hemostasis and cyclic nucleotide levels as well as the effects of mexitil, ritmilen and prolecofen on those were examined in 58 coronary patients with various heart rhythm disorders. The patients showed considerably increased platelet activity, low prostacyclin level and high thromboxane and cyclic nucleotides levels, particularly in patients with high-grade ventricular extrasystoles. Mexitil did not essentially affect the parameters in question. Ritmilen produced a significant increase in 6-keto-PGF1 alpha and a decrease of platelet activity. In prolecofen-treated patients, platelet activity decreased significantly, cAMP and cGMP dropped while the cAMP/cGMP ratio went up; prostacyclin and thromboxane changes were not significant. This may be a mechanism of prolecofen's antiarrhythmic action.

Urinary sodium excretion was assessed in women with essential hypertension as an indicator of dietary sodium consumption. Groups of individuals with low (below 120 mmol/day), medium and high (above 180 mmol/day) excretion were identified. Patients with high sodium excretion levels showed slower withdrawal rates, as well as high total peripheral resistance and low cardiac output values. At the labile hypertension stage, these patients demonstrated an increase in total metabolic sodium owing to its growing residual fraction, and expanded interstitial fluid volume. Changes in renin-angiotensin-aldosterone activity showed close correlation with changes in sodium balance. Urinary adrenaline and noradrenaline excretion decreased in patients with labile hypertension who had the highest sodium excretion levels, and increased considerably in stable hypertension. Hypertension was particularly severe in patients who excreted over 180 mmol sodium daily whereas patients who excreted less than 120 mmol in the presence of stable hypertension had normal values of total metabolic sodium and cardiac output, and moderately elevated peripheral vascular resistance.

Aggregation of erythrocytes was determined in 50 patients with angina pectoris and myocardial infarction and in 20 subjects of the control group by rheoscopy after Schmid-Schoenbein. It is shown that in patients with ischemic heart disease aggregation of erythrocytes is considerably increased and the hydrodynamic strength of the aggregates is greater. The erythrocyte aggregation curve is some patients with ischemic heart disease was of a biexponential character in distinction to that in subjects of the control group, which was of the monoexponential type. It was found that the increase in the strength of the erythrocyte aggregation and in the rate of aggregate formation was due to fibrinogen and its complex compounds with decomposition products.

Ischaemic heart disease (IHD) in patients after amputation of the limbs runs a course with little manifest clinical symptoms, but with high risk of development of myocardial infarction with a lethal outcome. In patients after amputation of limbs there is a decrease of the blood stroke volume, increase of the total peripheral resistance and also marked disorders of the blood rheology and the function of platelets. In patients with IHD after amputation of the limbs for obliterating diseases of the vessels such changes are manifest in disorders of the microrheological properties of the blood (the rate of aggregation of red cell and the stability of red cell aggregates). Physical rehabilitation and prostheses in patients of this groups must be realized under careful cardiological control.

The parameters of water-electrolyte metabolism and central hemodynamics were studied in 44 patients with essential hypertension (stage II-III) after 3-week treatment with sympatholytics and diuretics. Patients with hyperkinetic type of hemocirculation had a sodium lack at the stage of stable hypertension, therefore the diuretic treatment is not indicated for such patients. The treatment with the diuretic oxodolin was accompanied by the decrease in the peripheral resistance of blood vessels, in sodium metabolism and its extracellular fraction, and by the increase of the deposit sodium fraction. The elevation of the renin-angiotensin system activity due to the diuretic therapy did not influence the blood pressure level and the central hemodynamics parameters.

Sodium transport was investigated, using the isotope exchange method, in the erythrocyte membranes of normal subjects and patients with essential and symptomatic (renal) hypertension. In hypertensive patients, the constant of balanced Na/Na exchange rate was increased by more than 60%, and the balance concentration of erythrocytic sodium by 30%, as compared to the controls, in the presence of ouabain. These differences become far less pronounced if furosemide is added to the incubation medium. In patients with secondary (renal) hypertension, the Na/Na exchange rate and erythrocytic balance concentration of sodium are not affected by ouabain as compared to the controls. It is suggested that Na/Na-countertransport plays the principal role in the disruption of erythrocyte membrane permeability by sodium in essential hypertension.

One hundred and sixty-two patients with acute myocardial infarction, whose ages ranged from 36 to 65, were studied. The content of thyroid hormones was found to be reduced in the acute period of myocardial infarction. The triiodothyronine level was lower on the 2nd day of the disease, the thyroxine content decreased on the 10th day of the disease but became normal on the 20-25th day. An interrelation between the clinical course of the disease and the dynamics of changes in the cholesterol content, rate of erythrocyte aggregation, the content of fibrinogen degradation products, and the level of thyroid hormones was determined. Normalization of the values was determined. Normalization of the values studied occurred earlier in the group of patients with a more favourable course of the acute period of myocardial infarction than in those with severe myocardial infarction. The data obtained show a close interrelation between thyroid activity and values studied and the clinical course of the disease.