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The issues of diagnosis and treatment of hypertension (HTN), as well as the prevention of its complications, are an urgent problem in cardiology. On June 21, 2023, the Journal of Hypertension published guidelines on HTN from the European Society of Hypertension (ESH), which were first presented to the public at the annual European Hypertension Meetings on June 24, 2023 in Milan. This publication describes the highlights and key updates of the guidelines and outlines its clinical significance. Russian experts also discussed current problems of pathogenesis, diagnosis and treatment of HTN.

Aim. To evaluate the effect of blood concentrations of biomarkers of inflammation and fibrosis, obesity parameters, and parameters characterizing cardiac remodeling on the risk of recurrent atrial fibrillation (AF) within 6 months after elective electrical cardioversion (ECV) in patients with metabolic syndrome (MS).Materials and methods. The study included patients with AF and MS (n=60) and with AF without MS (n=41), who underwent elective ECV. Prospective observation was carried out for 6 months.Results. Arrhythmia recurrence within 6 months after ECV in patients with AF in combination with MS is higher than without MS (34/60 and 9/41, p = 0.003). Among echocardiographic parameters, left atrial volume and volume index, and epicardial adipose tissue thickness (EAT) are associated with arrhythmia resumption in patients with MS and AF. Blood concentrations of galectin-3 (17.4 (12.8-19.6) and 13.3 (5.1-14.9), p=0.0001), connective tissue growth factor (CTGF) (163, 1 (134.1-232.2) and 156.7 (104.7 - 189.1), p=0.002), growth differentiation factor 15 (GDF-15) (2343.9 (1206.1-3254.2 ) and 986.1 (812.5-1775.5), p=0.0001) and interleukin-6 (IL-6) (3.8 (2.3-7.3) and 2.3 (1, 3-3.4), p=0001) in patients with MS with recurrent arrhythmia is higher than without arrhythmia. According to the ROC analysis of EAT, the concentration of galectin-3 and IL-6 in the blood was most predictive of relapse of AF in MS; threshold values of the predictors were established: EAT more than 6.1 mm, IL-6 more than 2.8 pg/ml, galectin-3 more than 15.9 ng/ml.Conclusion. In patients with AF combined with MS, the frequency of maintaining sinus rhythm after effective ECV for 6 months is lower than in patients without MS. Epicardial adipose tissue thickness, high concentrations of galectin-3 and IL-6 are associated with relapse of AF in patients with MS.

The objective was to determine the concentrations of biomarkers of fibrosis and inflammation in the blood, parameters characterizing heart remodeling in patients with atrial fibrillation (AF) in combination with type 2 diabetes mellitus (T2DM).Methods and materials. The study included 231 examined patients aged 35 to 65 years: patients with DM (n=99), of which 49 patients with AF, and the comparison group consisted of patients with AF without T2DM (n=54) and healthy examined patients (n=78).Results. It was found that the concentration of profibrogenic biomarkers circulating in the blood of patients with AF and T2DM is higher than in patients with AF without T2DM: galectin-3 (13.4 (9.1–16.9) and 6.8 (4.6–12.8) ng/ml, p˂0.001), TGF-beta1 (3032.5 (2468.5–4283.5) and 2339.7 (1813.3–3368.8) pg/ml, p=0.01), GDF-15 (2359.3 (1234.3–3465.1) and 1256.7 (889.9–2083.7) pg/ml, p˂0.001), PINP (3625.4 (2462.1–4463.7) and 2451.3 (1842.0–2941.0) pg/ml, p˂0.001) and PIIINP (92.8 (68.6–122.4) and 67.6 (47.9–93.3) ng/ml, p˂0.001). Concentrations of proinflammatory cytokines CRP (3.5 (2.2–4.4) and 2.7 (1.4–7.1) mg/l, p=0.01) and CT-1 (1032.1 (667.6–1495.3) and 549.1 (411.9–960.1) pg/ml, p˂0.001) in patients with AF and T2DM is higher than in patients with T2DM without AF. The levels of TNF-alpha, IL-6 in patients with AF and T2DM are comparable to the concentrations of these biomarkers of inflammation in patients with T2DM without AF. According to the results of echocardiography, it was revealed that the thickness of the epicardial adipose tissue in patients with AF and T2DM is greater than in patients with AF without T2DM and greater than in patients with T2DM without AF (7.1±0.4, 4.5±0.3 and 5.1±0.3, respectively, p˂0.001). A strong positive correlation between GDF-15 and HbA1c was established according to the correlation analysis (r=0.617, p˂0.0001) and regression analysis (β=0.586, p˂0.0001). According to binomial logistic regression, it was found that T2DM in the examined cohort increased the risk of AF by 2.2 times (OR=2.2, 95 %CI 1.41–3.31, p=0.00004).Conclusion. The obtained new data on the increase in the concentration of profibrogenic factors in patients with AF in combination with T2DM indicate an important role of the formation of myocardial fibrosis in the development of this arrhythmia in these patients.

This publication discusses the relevance of the problem of blood pressure control in patients with resistance to drug therapy in real clinical practice. Data on the prevalence of true resistant arterial hypertension and clinical features of patients are presented. At the same time, taking into account the wider prevalence of patients with pseudo resistant arterial hypertension, special attention is paid to diagnostic algorithms in the publication, and the criteria for excluding pseudo resistant arterial hypertension are analyzed in detail. Presented are modern ideas about the most common secondary causes of arterial hypertension, such as obstructive sleep apnea syndrome, the possibility of correcting this condition and the choice of drug therapy. For this publication, modern recommendations were used in the strategy for choosing the optimal antihypertensive therapy, taking into account the pharmacokinetic properties and the possibility of personalized choice in various clinical situations. We analyzed data on the benefits of antihypertensive therapy using fixed combinations to increase adherence to therapy with a blood pressure control strategy and reduce the risk of cardiovascular risks. Various search engines were used to search for data and material: PubMed, Google Academy, Elsevier, information resources of the Russian Society of Cardiology and the European Society of Cardiology.

The objective was to study the factors associated with inappropriate reduced doses of non-vitamin K antagonist oral anticoagulants (NOACs) in patients with non-valvular atrial fibrillation (AF) in real outpatient practice.Methods and materials. 10663 case histories of patients hospitalized to the therapeutic clinic of the university for 5 years (2014 — 2018) were studied, 1307/10663 (12,3 %) case histories of patients with AF were selected. Factors associated with inappropriate low doses of anticoagulant therapy (ACT) with NOACs at prehospital treatment were studied.Results. NOACs received 57.7 % (384/665) of patients with AF at the outpatient stage: rivaroxaban — 180/384 (46.9 %) patients, dabigatran etexilate — 110/384 (28.6 %) patients, apixaban — 94/384 (24.5 %) patients. Inappropriate reduced doses of NOACs were revealed in 68/384 (17.7 %) patients: apixaban — 22/94 (23.4 %), dabigatran — 18/110 (16,4 %) and rivaroxaban — 28/180 (15.6 %) (p>0,05). Patients who received inappropriate reduced doses of NOACs as compared to those who received standard doses of NOACs had higher frequency of major bleedings in the past (7.4 and 1.0 %; p=0.014) and had higher risk of bleedings (HAS-BLED 1.7±1,1 and 1.2±1.0; p = 0.0002). Proportion of patients who had HAS-BLED≥3 in these groups were 19.1 % and 8.6 % (p=0.033). All patients who received inappropriate reduced doses of NOACs had modifiable risk factors of bleedings. 85.3 % of patients with AF who received inappropriate reduced doses of NOACs had high risk of stroke according to CHA2DS2-VASc scale.Conclusion. In real outpatient practice, NOACs were recommended to 57.7 % of patients with AF. 17.7 % of patients received NOACs s in inappropriate reduced doses. Frequency of major bleedings in the past and bleeding risk in AF patients with inappropriate reduced doses was higher than in patients with standard doses.

Aim. To determine the role of biomarkers in predicting atrial fibrillation (AF) recurrence within 12 months after radiofrequency ablation (RFA) in patients with metabolic syndrome (MS).Material and methods. The study included 245 patients with AF aged 35 to 65 years: patients without MS components (n=32), with 1-2 MS components (n=62) and patients with 3 or more MS components (n=153). All patients underwent a comprehensive clinical and anamnestic, anthropometric, laboratory and echocardiographic examinations. The prospective follow-up for 12 months included 135 patients with AF who underwent RFA.Results. It was found that the presence of 3 or more MS components increased the risk of AF recurrence by 4,1 times within 12 months after RFA (relative risk (RR) =4,1, 95% CI 2,19-7,65, p11,0 ng/ml (RR =3,43, 95% CI 1,79-6,58, p=0,0001), GDF-15 >1380,7 pg/ml (RR =2,84, 95% CI 1,81-4,46, p6,4 mm (RR =4,50, 95% CI 2,32-8,71, p

Aim. To study the frequency of administration of direct oral anticoagulant (DOACs) in doses recommended and not recommended by the instructions of the drugs in non-valve atrial fibrillation (AF) patients.Material and methods. 10663 case histories of patients hospitalized for 5 years (2014-2018) were studied, 1307/10663 (12,3%) case histories of patients with AF were selected. In patients with AF, the risk of stroke and systemic embolism, the risk of bleeding, the anticoagulant therapy (ACT) recommended at the prehospital stage and its adequacy was evaluated.Results. 1 261/1 307 (96,5%) patients had a non-valve AF. The risk of stroke and systemic embolism was 4,7±1,5 (CHA2DS2-VASс), 97,5% of patients with non-valve AF (1229/1261) needed ACT. Only 665/1229 (54.1%) patients with AF received ACT at the time of hospitalization and 578/1229 (47,0%) of patients did not receive ACT. Before hospitalization 281/665 (42,3%) patients received vitamin K antagonist (warfarin). The international normalized ratio in the target range (2,0-3,0) was in 111/281 (39,5%) patients. 57,7% (384/665) outpatients with AF received NOAC: rivaroxaban - 180/384 (46,9%) patients, dabigatran etexilate - 110/384 (28,6%) patients, apixaban - 94/384 (24,5%) patients. Inappropriate reduced doses of DOAC were revealed in 68/384 (17,7%) patients: apixaban - 23,4%, dabigatran - 16,4% and rivaroxaban - 15,6% (p>0,05).Conclusion. In real clinical practice 42,3% AF patients used warfarin, only 39,5% of them had INR in target values. DOAC in inappropriate reduced doses used 17,7% patients.

Epicardial adipose tissue (EAT) has unique properties due to its special anatomical structure, thermoregulation, and metabolic activity. Dysregulated EAT provokes the synthesis of pro-inflammatory cytokines, disorders in the metabolism of fats and glucose, as well as contributes to fatty degeneration of the myocardium and heart failure development. EAT may serve as a risk factor and biomarker for cardiovascular diseases, and is also a potential therapeutic target. The purpose of this review was to highlight current research data on EAT, secreted adipokines, their effect on target tissue metabolism, and to systematize the relationship between EAT and cardiovascular diseases. In particular, its function, role in heart failure, atrial fibrillation, as well as the prognostic value of various microRNAs determined in EAT are highlighted.

Review discusses the problem of non-vitamin K antagonist oral anticoagulants safety in patients with non-valvular atrial fibrillation. Bleeding risk assessment while applying anticoagulant therapy, preventive methods for major bleeding (intracranial, gastro-intestinal) during this therapy as well as the strategy of treating patients with bleedings occurring on direct oral anticoagulants intake are discussed in this review. Special attention is paid to the choice of direct oral anticoagulant, the importance of specific antagonist of dabigatran – idarucizumab and indications for its clinical application.

Aim. To determine the concentration of blood fibrotic and inflammatory biomarkers in patients with atrial fibrillation (AF) associated with metabolic syndrome (MS) components.Material and methods. The study included 646 patients aged 35-65 years: patients with AF and MS (n=142), those with AF and without MS (n=113), those with MS and without AF (n=175) and the control group consisted of healthy subjects without cardiovascular and metabolic diseases (n=107). All participants underwent anthropometric and laboratory investigations. Profibrogenic (aldosterone, galectin-3, TGF-beta1, CTGF) and proinflammatory (CT-1, IL-6) factors were determined in serum and plasma by ELISA. Statistical analysis was performed using IBM SPSS Statistics software (version 22.0).Results. The highest concentrations of fibrotic and inflammatory biomarkers were found in patients with AF in combination with MS. In MS patients without AF, the concentration of aldosterone, galectin-3, TGF-beta1, CTGF, CT-1, and IL-6 was also higher than in healthy subjects. The levels of aldosterone, CT-1 and IL-6 in patients with AF were higher in the presence of three or more MS components, while the highest values of these parameters were found in patients with five MS components. The lowest concentrations of galectin-3, CTGF, and CT-1 in patients with AF were found in patients without MS components, and in the presence of even 1 MS component, they were significantly higher. Correlation analysis made it possible to establish a stronger relationship between aldosterone and TGF-betal with systolic blood pressure (p=0,493, p

Aim. To determine the blood concentration of fibrosis biomarkers in patients with atrial fibrillation (AF) in combination with metabolic syndrome (MS) and to analyze the relationship with myocardial fibrosis.Material and methods. This cross-sectional case-control study included 547 patients aged 35 to 65 years: experimental group — patients with MS (n=373), of which 202 patients had AF; comparison group — AF patients without MS (n=110); healthy subjects without cardiovascular diseases and metabolic disorders (n=64). Patients with AF and MS who underwent electroanatomic mapping before pulmonary vein isolation (n=79) were assessed for left atrial (LA) fibrosis severity.Results. It was found that the blood concentration of circulating profibrogenic biomarkers in patients with AF and MS is higher than in patients with AF without MS: aldosterone (135,1 (80,7-224,1) and 90,1 (68,3-120,3) pg/ml, p

The aim of the study was to determine the prevalence of atrial fibrillation (AF) in patients hospitalized in the therapeutic and cardiology departments of the St. Petersburg hospital, and to analyze the prevalence of the number of components of the metabolic syndrome (MS) in patients with AF and anticoagulant therapy (ACT) assigned to outpatient stage to hospitalization. A retrospective analysis of 1760 case histories of patients hospitalized in the therapeutic and cardiology departments of the Therapy Clinic of the Faculty of Pavlov State Medical University named after IP Pavlov for 2017 was performed. It was established that AF was found in 16.5% (286) patients hospitalized in 2017. Among the causes of AF in patients, the number of components of MS was analyzed: 0 – 2.1% (6), 1 – 4.5% (13), 2 – 19.2% (55), 3 – 34.3% (98), 4 – 31.5% (90), 5 – 8.4% (24), thus MS with 3 or more components installed in 74.1% (212) surveyed in 2017. 58.7% (168) received ACT at the time of hospitalization, and 41.3% did not receive it (118). In 32,9% of patients with AF did not receive anticoagulant therapy at the prehospital stage, with no contraindications for administration. Among patients receiving ACT at the time of hospitalization, direct oral anticoagulants were prescribed 2 times more often than warfarin (69% and 31%, р = 0,01).

Aim. To determine the blood level of inflammatory markers, parameters characterizing obesity and cardiac remodeling in patients with atrial fibrillation (AF) in combination with metabolic syndrome (MS).Material and methods. This single-stage case-control study included 677 subjects aged 35 to 65 years: patients with MS (n=407), of which 128 patients with AF; comparison group — patients with AF without MS (n=75); control group — practically healthy subjects without cardiovascular diseases and metabolic disorders (n=195).Results. It was found that the blood concentration of circulating pro-inflammatory biomarkers in patients with AF and MS is higher than in patients with AF without MS: C-reactive protein (CRP) (4,43 (2,68-4,98) and 2,33 (1,08-4,7) mg/L, p

Aim. To study the incidence of nonvalvular atrial fibrillation (AF) in patients with a CHA2DS2VASc score of 1 in actual clinical practice, to determine the major and minor risk factors of thromboembolism and the frequency of oral anticoagulant therapy in these patients.Material and methods. We performed a retrospective analysis of 6575 medical records of patients hospitalized for five years in a therapeutic inpatient unit. To determine the stroke risk, major and minor modifying factors were assessed.Results. Of 1160 patients with nonvalvular AF, 93 (8,0%) patients had a CHA2DS2VASc score of 1: hypertension (87,1%), heart failure (4,3%), vascular diseases (4,3%), diabetes (2,15%) and age 65-74 years (2,2%); minor modifying factors were as follows: left atrial (LA) dilatation (81,7%), obesity (40,9%), persistent/permanent AF (37,6%), proteinuria (26,9%), chronic kidney disease (3,2%). A combination of minor risk factors was observed in 61,3%, the most common of which were obesity, LA dilatation, persistent/permanent AF. Anticoagulants were prescribed to 72% of patients with a CHA2DS2VASc score of 1.Conclusion. In actual clinical practice, patients with nonvalvular AF with a CHA2DS2VASc score of 1 are often found. The most common risk factors for stroke in these patients are hypertension, persistent or permanent AF, LA dilatation, and obesity. The use of anticoagulant therapy in these patients does not contradict current guidelines. However, further prospective follow-up is necessary to determine the effectiveness and safety of this therapy.

Aim. To evaluate the prominence of fibrosis of the left atrium myocardium and to define the value of transforming growth factor beta 1 (TGF-beta1) and galectin-3 in development of myocardial fibrosis in atrial fibrillation (AF) patients with metabolic syndrome (MS).Material and methods. Totally, 58 patients with AF included, of those 27 with MS. Controls were 50 almost healthy participants. Levels of galectin-3 and TGF-beta1 in blood serum were measured by immune enzyme assay. For fibrosis assessment, the anatomical and amplitude charts of the left atrium (LA) were built up with nonfluoroscopic system of electroanatomical charting CARTO3 (Biosense Webster, USA) and catheter measurement of the contact power with myocardium of LA (Smart Touch Thermocool, Biosense Webster, USA). In “off-line” regimen the evaluation performed of the zones of low voltage in amplitude specters 0,2-0,5 mV and 0,2-1,0 mV with the area measurement by navigation software function “area measurement”.Results. Volume of LA and volume index of LA in AF with MS were higher than in AF with no MS: 78,0±20,4 mL and 60,4±19,8 mL (p=0,005) and 37,8±9,5 mL/m2 and 30,4±9,0 mL/m2 (p=0,005), respectively. The percent of LA fibrosis area in AF with MS was higher than in AF with no MS (16,1 [12,8;20,5]% and 10,5 [7,3;16,2]%, respectively, p=0,028). The positive correlations revealed of the level of galectin-3 (r=0,410, р

Atrial fibrillation (AF) is a significant risk factor for stroke and systemic embolism. For prevention of these complications, most AF patients are indicated to take anticoagulants, that reduce the risk cardioembolic strokes, but increase the risk of bleedings, and the most prevalent are gastrointestinal (GIB).Aim. To assess the rate of pathological changes in esophagus, stomach and duodenum, predisposing for GID, in AF patient with higher risk of stroke and absolute indications for anticoagulation therapy.Material and methods. The analysis done, of case histories of hospitalized patients in the therapeutical university clinics, in the year 2016; of those — 263 with non-valvular AF. Among 222 patients with AF and higher risk of stroke, who had indications for anticoagulants, 103 underwent screening fibroesophagogastroduodenoscopy (FEGDS).Results. The FEGDS, performed in 103 patients with non-valvular AF and high risk of stroke, in 45,6% revealed diseases predisposing to GIB, including esophageal cancer — 1 (2,1%), gastric ulcer — 4 (8,5%), duodenal ulcer — 2 (4,3%), erosive esophagitis and reflux disease — 5 (10,6%), varicose veins of esophagus — 4 (8,5%), erosive gastritis — 31 (66,0%) and erosive duodenitis — 3 (6,4%). Combination of diseases was found in 10 (21,3%) patients.Conclusion. Patients with non-valvular AF and high stroke risk, before starting therapy with anticoagulants, it is aimworthy to perform FEGDS for on-time screening for esophageal, gastric, duodenal pathologies predisposing to GIB.

The aim of this study is determination of predictors of efficiency of radiofrequency ablation (RFA) in patients with atrial fibrillation (AF) and metabolic syndrome (MS). Material and methods. 98 patients with AF (78 patients with AF and MS (IDF, 2005) and 20 patients without MS) have been examined. Comparison groups included 50 patients with MS without arrhythmia and 50 practically healthy subjects. RFA was performed with Carto 3 navigation system. Follow-up period after RFA was 12 months. Epicardial fat thickness (EFT) was measured with help of echo-cardiography. Results: patients with AF relapse had more MS components than those with effective procedure (3.21±1.18 and 1.73±1.14, accordingly, p

Objective: to estimate contribution of C(-344)T version of aldosterone synthase CYP11B2 gene in risk of metabolic syndrome (MS) and atrial fibrillation (AF) for inhabitants of the Northwest region of Russia. Material and methods: 199 patients with MS, 103 from them with AF and 267 healthy persons. Identification of C-344T gene of CYP11B2 aldosterone sinthase has been performed by means of PCR method with restriction analysis. Results: in MS carriership of TT (-344) genotype met more often than in control: 33.2 % and 24.3 %, respectively (p = 0.04). Carriership of TT (-344) genotype increases risk of MS: OR = 1.54 (95 % CI 1.03-2.32) and was not associated with an increased risk of AF. Conclusion: association of TT(-344) genotype of CYP11B2 gene with risk of metabolic syndrome for inhabitants of the Northwest region ofRussia is revealed.

Objective. To evaluate the epicardial fat thickness (EFT) in patients with metabolic syndrome (MS), including paroxysmal and persistent atrial fibrillation (AF). To relate EFT to the fibroid heart marker, i.e. galectin 3. Materials and methods. We examined 100 patients with MS (50 with AF), and 50 healthy persons made the control group. Serum galectin 3 was measured by ELISA method. The EFT was measured with echocardiography. Results. EFT in patients with MS was twofold higher than in healthy persons. EFT in patients with MS and AF didn't differ significantly from that in patients with MS without AF. Positive correlation between the levels of EFT and galectin 3 in serum was revealed. Serum galectin 3 and EFT were associated with atrial fibrillation in patients with MS (OR:1,27, 95% CI 1,02-1,58 and OR:1,73, 95% CI 1,37-2,19, correspondingly).Conclusion. Definition of EFT at echocardiography can be used in the assessment of risk AF in patients with MS.

To evaluate plasma concentration of apelin and its correlation with structural and functional heart parameters in patients with abdominal obesity. 93 patients with abdominal obesity (criteria IDF, 2005) and 21 healthy people at the ages from 25 to 57 years old were investigated. Weight, height, waist circumference, and plasma apelin concentration were measured. Dimensions and volume of the cardiac chambers, systolic and diastolic functions of the ventricles were measured with echocardiographic method. Plasma apelin concentration was higher in patients with abdominal obesity as compared to healthy people (0.70 (0.55 - 0.94) ng/ml and 0.55 (0.42 - 0.72) ng/ml, respectively; p = 0.04). There is significant negative correlation between apelin level and longitudinal size of the left ventricle (r=-0.307; p = 0.003); index of the left atrial volume (r=-0.201; p = 0.05); longitudinal size of the left atrium (r=-0.248; p = 0.02); right atrium volume (r=-0.261; p = 0.01); right atrium area (r=-0,251; p = 0,02); basal size of the right ventricle (r=-0,202; p = 0,05); longitudinal size of the right ventricle (r=-0.234; p = 0.02). Plasma apelin concentration was higher in patients with abdominal obesity as compared to healthy people. There were revealed significant negative correlation between apelin level and longitudinal size of left ventricle, index of left atrial volume, longitudinal size of left atrium, right atrium volume, right atrium area, basal size of right ventricle, and longitudinal size of right ventricle.