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Aim. A systematic review of studies on pulmonary hypertension (PH) cost estimates.Material and methods. A systematic literature search was performed for studies assessing the cost of PH published up to November 30, 2023. The search was carried out in the PubMed/MEDLINE, EMBACE databases for publications in English and in the RSCI database for articles in Russian according to inclusion and exclusion criteria.Results. The systematic review included 13 studies. The mean direct costs per patient with PH after verification of the diagnosis per month ranged from 2023 to 9915 USD, while the median from 1141,5 to 8144 USD. Indirect costs were assessed in only 3 following studies: in Spain and USA, the mean indirect costs were 214 and 1226 USD per patient per month, respectively, while in Russia the median was 65 USD. The mean direct costs per patient with PH per month before diagnosis verification ranged from 1017 to 9723 USD. Indirect costs before diagnosis verification were assessed in only 1 study (median $102 per patient per month). After PH verification, in general, there was an increase in treatment costs with a decrease in other direct costs.Conclusion. PH causes great socio-economic damage to society and healthcare system. A decrease in non-drug therapy costs after PH verification may indicate not only the clinical effectiveness of PH-specific therapy, but also its potential costeffectiveness with reduced costs.

In recent decades, there has been an increase in the prevalence and medical and social burden of osteoarthritis (OA) and nonspecific back pain in all countries of the world. The First Multidisciplinary Bilateral Russia-Uzbekistan Expert Council presented innovations in the prognosing, personalized prevention and adjuvant therapy of degenerative-dystrophic diseases of the joints and spine, the evidence base for the effectiveness and safety of the use of drugs that modify the course of OA (Disease-modifying osteoarthritis drugs, DMOADs): chondroitin sulfate, glucosamine sulfate, undenatured type II collagen for adjuvant pharmaconutraceutical support – prevention and adjuvant therapy (treatment) of OA and nonspecific lumbosacral pain. The expert counsil resolution presents an optimized algorithm for the management, prevention and adjuvant therapy of OA and non-specific back pain, maintaining the function of healthy joints after intense physical activity with the inclusion of the drug Chondroguard solution for intra-articular and intramuscular administration (INN – chondroitin sulfate) and a new pharmaconutraceutical from the DMOADs group – TRIO trademark Chondroguard® (Chondroguard®TRIO).

Aim: present clinical guidelines, aimed at general practitioners, gastroenterologists, cardiologists, endocrinologists, comprise up-to-date methods of diagnosis and treatment of non-alcoholic fatty liver disease.Key points. Nonalcoholic fatty liver disease, the most wide-spread chronic liver disease, is characterized by accumulation of fat by more than 5 % of hepatocytes and presented by two histological forms: steatosis and nonalcoholic steatohepatitis. Clinical guidelines provide current views on pathogenesis of nonalcoholic fatty liver disease as a multisystem disease, methods of invasive and noninvasive diagnosis of steatosis and liver fibrosis, principles of nondrug treatment and pharmacotherapy of nonalcoholic fatty liver disease and associated conditions. Complications of nonalcoholic fatty liver disease include aggravation of cardiometabolic risks, development of hepatocellular cancer, progression of liver fibrosis to cirrhotic stage.Conclusion. Progression of liver disease can be avoided, cardiometabolic risks can be reduced and patients' prognosis — improved by the timely recognition of diagnosis of nonalcoholic fatty liver disease and associated comorbidities and competent multidisciplinary management of these patients.

Aim. To assess the impact of frailty syndrome (FS) on the risk of myocardial infarction (MI) and atrial fibrillation (AF) in people aged ≥65 years.Material and methods. A prospective cohort study of a random sample of a free-living population aged ≥65 years (n=611). Measurement of blood pressure, analysis of therapy, chronic comorbidities, laboratory tests, comprehensive geriatric assessment were performed.Results. FS is associated with an increased risk of MI and AF at 2,5 years of follow-up (odds ratio (OR), 3,195, 95% confidence interval (CI), 1,129-9,042; OR, 1,609, 95% CI, 1,013-2,555, respectively). Additional risk factors for MI and AF were high levels of C-reactive protein, type 2 diabetes, and blood pressure.Conclusion. FS was one of the risk factors for MI and AF during 2,5-year follow-up. Common pathogenetic mechanisms for FS and cardiovascular disease, such as chronic inflammation and insulin resistance, may explain the increased risk of MI and AF in patients with FS. Hypertension retains significance in increasing the risk of MI in patients with FS, which must be taken into account when prescribing antihypertensive therapy. FS screening can be used to assess the risk of cardio­vascular events in the elderly and senile age.

The Russian Society of Cardiology (RKO)With the participation of: The National Society for the Study of Atherosclerosis (NOA), the Russian Association of Endocrinologists (RAE), the Russian Society of Cardiosomatic Rehabilitation and Secondary Prevention (RosOKR), the Russian Scientific Medical Society of Therapists (RNMOT), the Eurasian Association of Cardiologists, the Eurasian Association of Therapists (EAT), the Russian Association of Gerontologists and Geriatricians

The main symptoms of osteoarthritis (OA) are pain and dysfunction of the joints. Neuropathic pain (NP) occurs in more than half of patients with OA, it is refractory in nature and is the cause for seeking medical advice more frequently, poor quality of life and disability.Objective: to evaluate the frequency of NP and its relationship with geriatric syndromes (GS) in patients with OA aged 65 years and older. Patients and methods. The subanalysis of the study EVKALIPT included 2286 patients with OA and chronic pain syndrome. All patients underwent a comprehensive geriatric assessment (CGA) and diagnostics of NP using the DN4 questionnaire.Results and discussion. The prevalence of NP in patients with OA was 22.7%. Patients with OA and NP more often experienced pain of any localization with a large number of tender points, they had a higher frequency and intensity of pain syndrome, they more often took analgesics and noted limitations in daily life. When conducting a correlation analysis, correlations of medium strength were found between the sum of scores according to DN4 questionnaire and the pain intensity assessment on a numerical rating scale at the time of examination (r=0.26; p

Cognitive dysfunction is one of the most common disorders in the elderly and senile age. There are currently 57 million people with dementia worldwide.Objective: to assess cognitive functions, to understand the prevalence of cognitive impairment (CI) and to analyze their associations with socioeconomic, demographic and anthropometric factors and geriatric syndromes in people aged ≥65 years.Patients and methods. Subjects living in 11 regions of the Russian Federation took part in the EVKALIPT epidemiological study. The inclusion criterion was age ≥65 years. Participants were divided into three age groups (65–74 years, 75–84 years, and ≥85 years) according to the protocol. All patients underwent a comprehensive geriatric assessment, comprising a specially designed questionnaire and physical examination. Cognitive functions were assessed using the mini-Cog test. The study included 3545 patients (of which 30% were males) aged 65 to 107 years.Results and discussion. According to the data obtained in our study, CI was detected in 60.8% of the subjects, and severe disorders – in 19.9% (0 or 1 point according to the mini-Cog). Patients with CI had a lower socioeconomic status. One-way regression analysis showed that the risk of CI increased by 10% with increasing age for every 1 year but did not depend on the sex of the subjects. Associated with increased CI risk also were: living alone (by 28%), living in a nursing home (by 90%), widowhood (by 2.2 times) or absence of a partner (by 2.2 times), underweight (by 2.9 times) and normal body weight (by 1.6 times), disability (by 54%), primary (by 4.8 times) and secondary (by 75%) education, bad economic conditions (by 95%). On the contrary, the presence of overweight and obesity reduced the risk of CI by 14 and 24% respectively, living in a family – by 24%, having a spouse – by 55%, divorce – by 29%, having a job – by 73%, higher education and a scientific degree – by 55 and 59%, medium and good economic conditions – by 38 and 52%, respectively. In patients with CI, the incidence of all geriatric syndromes was higher.Conclusion. The frequency of CI among elderly patients was higher compared with data from other studies. The EVKALIPT study was the first to obtain national data on the prevalence and characteristics of CI in persons aged ≥65 years in the general population.

Aim. An appraisal of practitioners with chronic constipation management details in older and senile adults.Key points. Chronic constipation is a common issue in geriatrics. Aside to age-related physiological bowel disfunction, a higher constipation incidence is conditioned by declined physical activity and frailty, polypharmacy and a series of secondary constipation-developing chronic states and diseases. Chronic constipation is associated with a higher risk of cardiovascular disease and complications, impaired general perception of health and pain, growing alarm and depression, and reduced quality of life. The treatment tactics in chronic constipation is cause-conditioned and should account for the patient’s history and therapy line, overall clinical condition, cognitive status and functional activity level. An essential baseline aspect of constipation management is apprising the patient and his family of the underlying factors and methods for non-drug and drug correction. An higher-fibre diet is recommended as first measure, with osmotic laxatives added and titrated to clinical response if none observed towards the non-drug and high-fibre regimens. Stimulant laxatives and prokinetics should be recommended in patients reluctant to fibre supplements and osmotic laxatives. Subsidiary correction includes biofeedback, transanal irrigation, acupuncture, foot reflexology and percutaneous tibial nerve stimulation.Conclusion. Elderly and senile chronic constipation is a prevalent multifactorial state requiring an efficient management via assessment and correction of total risk factors and consistent use of non-medication and drug therapies.

High blood pressure is a risk factor for cardiovascular morbidity and mortality, as well as cognitive decline and loss of autonomy in the elderly and old age. Randomized clinical trials (RCTs) in populations of older patients living at home with low comorbidity and preserved autonomy indicate the benefit of lowering elevated blood pressure in patients over 80 years of age. Older patients with senile asthenia, loss of autonomy and other geriatric problems were excluded from RCTs, and observational studies in these groups of patients indicate an increase in morbidity and mortality with lower blood pressure and antihypertensive therapy. Obviously, in very elderly patients, a universal strategy for the treatment of arterial hypertension cannot be applied due to the significant heterogeneity of their functional status. The geriatric approach to the management of arterial hypertension in older patients involves an assessment of the functional status, the presence of senile asthenia, and the degree of autonomy for the choice of antihypertensive therapy tactics.

Aim: To assess an association between orthostatic hypotension and arterial stiffness, measured by the cardio-ankle vascular index (CAVI), in a group of patients≥60 years of age with arterial hypertension and frailty.Materials and methods: The study included 160 patients aged 60 to 101 years with confirmed arterial hypertension without severe concomitant physical disorders. Compliance to the previously prescribed medications was assessed. A short questionnaire, "Age is not a hindrance," was used to identify patients with frailty. According to the current diagnostic algorithm for frailty, the patients were categorized into three groups: group 1, frail, group 2, pre-frail, group 3, healthy. Arterial stiffness was assessed by volumetric sphygmometry (VaSera-VS-1500, Fukuda Denshi, Japan) with the measurement of CAVI. The orthostatic test was considered positive if blood pressure falls by≥20/10 mm Hg after changing from supine to standing position.Results: The mean age of the study patients was 77.2±8.1 years (n=160), being 72.4±6.9 years in the healthy patients (n=50), 76.6±8.1 years in the pre-frail (n=50) and 81.7±6.6 years in the frail patients (n=60). Orthostatic hypotension was identified in total of 53 (33%) patients, with marginally significant difference between the pre-frail and healthy groups (44 and 20% of the patients, respectively, p=0.053). The CAVI values were higher in frail patients, compared to healthy ones (p=0.0005). Orthostatic hypotension was associated with a higher CAVI, irrespective of the patients’ age and frailty (р=0.0067). The association between orthostatic hypotension and CAVI in frail patients was found only with unifactor analysis, but became non-significant with the additional analysis.Conclusion: Orthostatic hypotension can be found in 33% of the elderly patients with arterial hypertension. Arterial stiffness increases with increasing frailty, as well as with concomitant orthostatic hypotension in the group of the patients≥60 years of age. The progression of arterial stiffness in the elderly group is heterogeneous and depends on the presence of frailty.

Osteoarthritis (OA) is the most common pathology of the musculoskeletal system and is a serious medical and social problem. OA is of particular importance in elderly and senile people due to the high frequency of comorbid pathology. Pain relief is a priority in the formation of individual therapeutic programs for patients with OA, starting from their first request for medical assistance. At the same time, due to the ambiguity of existing clinical recommendations, most experts note a number of difficulties in prescribing treatment for patients with OA.The article presents a consensus position of experts regarding a complex approach to the choice of therapy in patients with OA at the initial visit to the doctor. The article discusses: current clinical guidelines for the management of patients with OA; most common problems in the management of patients with OA in real clinical practice; goals of treatment strategies for OA taking into account the risk factors for its progression; an algorithm of pain relief during initial treatment in patients with OA; prevention of OA exacerbations with the use of basic structure-modifying drugs; recommendations for the choice of non-steroidal anti-inflammatory drugs.According to experts, a rational approach to the treatment of OA is based on the combined use of non-drug and pharmacological methods with constant monitoring of therapy regimens and side effects. These recommendations can be considered disease-modifying strategies that in many cases allow improving functional status and achieving long-term remission in patients with OA.

Cardiovascular diseases are the main death causes in the modern world. Heart failure (HF) is the terminal stage of most cardiovascular diseases. The prevalence of HF is increasing in patients of older age groups. At the same time, the number of geriatric syndromes increases with age, one of which is malnutrition. Recent studies demonstrate the mutually aggravating effect of heart failure and malnutrition, and that the correction of malnutrition can improve the heart failure course. The introduction of screening and timely correction of malnutrition will reduce the hospitalization and mortality rates in geriatric patients with HF.

New oral anticoagulants are effective for the prevention of thromboembolic complications in patients with atrial fibrillation, or after orthopedic surgery. The use of these drugs may be associated with the risk of bleeding from the gastrointestinal tract — a dangerous complication, which can potentially lead to death. The aim of this research was systematization and analysis of information on the interactions of new oral anticoagulants with other drugs and food products, and the identification of potentially dangerous combinations that increase the risk of gastrointestinal bleeding. To assess the risk of a heavy bleeding in patients with atrial fibrillation taking oral anticoagulants to prevent thromboembolic complications, HAS-BLED scale is used. In some cases activated partial thromboplastin time, ecarin clotting time, anti-FXa, etc. can be used to assess the effectiveness of the oral anticoagulants. Potential combinations that increase the risk of bleeding include the simultaneous administration of new oral anticoagulants with antiplatelet agents, anticoagulants, including vitamin K antagonists, unfractionated heparin, low molecular weight heparins, nonsteroidal anti-inflammatory drugs, antidepressants along with other drugs and foods (curcumin, grapefruit juice, peppermint, eucalyptus, etc.). The administration of proton pump inhibitors, as well as the elimination of potentially dangerous combinations of drugs and food with new oral anticoagulants, can help prevent gastrointestinal bleeding.

Abstract. The demographic aging of the population of the earth observed in recent years is associated, inter alia, with the advent of new effective and safe medicines. However, the availability of highly effective drugs on the market also has a reverse side — the appearance of adverse drug reactions (ADRs), in particular as a result of drug-drug interactions. The use of non-pharmacological methods of treatment and prevention of diseases seems particularly relevant for patients of the older age group, as it allows not only to reduce the drug burden, to reduce the risk of ADRs but also to improve the patient’s state in case of diseases that have no effective pharmacotherapy and pharmacological prophylaxis. The aim of the study was to systematize and analyze data on non-pharmacological treatment methods in order to increase the safety of pharmacotherapy and prevent polypragmasia in elderly patients by informing health care providers about non-drug methods of correcting significant geriatric problems. The approaches to the correction of some major geriatric problems (delirium, sarcopenia, pain syndrome), including cognitive training, physical activity, diet, frequent reorientation of patients, placement of patients in specially equipped rooms («delirium room») were presented. The use of non-pharmacological approaches can significantly improve the safety of drug therapy, reduce the risks of ADRs, improve the patient’s prognosis and quality of life, and also effectively prevent polypharmacy.

Abstract. Elderly patients are at higher risk of developing infectious diseases that might have more severe progression than those of younger age groups, accompanied by an increased risk of death. These medical conditions in elderly may also present difficulties for diagnosis due to a «blurred» clinical picture. By WHO recommendations the vaccination against influenza is one of the most effective ways to prevent this type of infection in elderly patients. However the use of vaccines may be associated with a risk of adverse drug reactions. In most cases, they have subclinical manifestations and/or non-severe clinical manifestations (adverse reactions), but in a relatively small percentage of cases, the use of vaccines may be associated with a risk of developing serious post-vaccination complications (anaphylaxis, Guillain-Barre syndrome etc.). This article represents data on the safety of influenza vaccines in patients over 60 years old, with due regard to immunosenescence. According to the authors opinion, this will improve the safety of vaccination against influenza patients 60 years and older. At the end of the article, the authors conclude that despite the potential risks, the by the benefits of the use of influenza vaccines continue to overweight potential risks and vaccination of elderly people is effective and safe way to prevent influenza. To improve the effectiveness of vaccination of patients 60 years and older the use of high dose vaccines and adjuvants can be recommended.

The predictive value of vascular biomarkers such as pulse wave velocity (PWV), central arterial pressure (CAP), and augmentation index (AIx), obtained through pulse wave analysis (PWA) in resting conditions, has been documented in a variety of patient groups and populations. There are appropriate recommendations on their clinical use in clinical practice guidelines of various scientific societies. Operator-independent methods are currently available for estimating vascular biomarkers also in ambulatory conditions. The acceptable accuracy and reproducibility of ambulatory PWA makes it be a promising tool for evaluating vascular biomarkers in daily-life conditions. This approach may provide an opportunity to further improve the early cardiovascular screening in subjects at risk. However, there is no sufficient evidence to support the routine clinical use of PWA in ambulatory conditions at the moment. In particular, long-term outcome studies are needed to show the predictive value of ambulatory PWV, CAP and AIx values.

Aim. To study the relationship of vascular stiffness (cardio-ankle vascular index (CAVI)) with frailty and other geriatric syndromes in hypertensive elderly patients.Material and methods. The study included 160 patients aged 60 to 101 years with verified stage I-III hypertension. The previous therapy was assessed. A comprehensive geriatric assessment was performed with functional and neuropsychological tests to identify geriatric syndromes. Vascular stiffness was assessed by VaSera-VS-1500 vascular screening system (FUKUDA DENSHI, Japan) with determination of the CAVI.Results. The mean age of the patients was 77,2±8,1 years (n=160): in the group of patients without frailty — 72,4±6,9 years (n=50), with prefrailty — 76,6±8,1 years (n=50), with frailty — 81,7±6,6 (n=60). Patients with frailty had a higher CAVI than those without frailty and with prefrailty (10,3±1,6 vs 9,3±1,0 and 9,6±1,8, respectively; p=0,002).In patients with frailty, a negative correlation was found between the vascular stiffness and body mass index (BMI) (Rs=-0,392 (p=0,002)), and a positive correlation between the CAVI and orthostatic response (Rs=0,382 (p=0,003). In patients with prefrailty, negative relationships were found with the dynamometric parameters (Rs=-0,329 (p=0,019)), BMI (Rs=-0,343 (p=0,015) and physical activity (Rs=-0,285 (p=0,047)).In patients without frailty, the vascular stiffness was associated with an increased total cholesterol level (Rs=0,379 (p=0,009)), a low physical activity (Rs=-0,355 (p=0,015)), as well as negative correlations were found with the clock-drawing test and falls (Rs=-0,458 (p=0,011) and Rs=-0,306 (p=0,031), respectively).Conclusion. Vascular stiffness in elderly patients with frailty is associated with a decrease in body mass index and orthostatic hypotension. At the stage of prefrailty, the relationship between the vascular stiffness and muscle strength decrease (according to dynamometry) was revealed.Thus, the vascular stiffness is associated with frailty markers itself.

В данном документе обсуждаются особенности АТТ у лиц пожилого и старческого возраста в различных клинических ситуациях.

Over the past century, an increase in life expectancy has been observed in Russia and in the world. According to the United Nations, by 2100, the number of centenarians worldwide will reach 25 million. Despite the annual increase in the number of super-centenarians, this age group remains poorly understood.Aim. To estimate the prevalence of cardiovascular diseases (CVD) and the main risk factors among super-centenarians in Moscow.Material and methods. According to the register of long-livers in Moscow, 82 people aged 95 to 105 were included. Participants were examined at home.The history of life and the presence of chronic diseases was collected by participant words. To assess the state of cardiovascular system, an ultrasound of the heart and main arteries was performed.Results. Conventional CVD risk factors were the exception rather than the rule among study participants (smoking — 8 patients (9,8%), alcohol abuse — 4 (4,9%), obesity — 6 (7,3%)). Dyslipidemia was relatively widespread (n=37; 45,1%), however, there were no pronounced abnormalities in the lipid profile: the maximum increase in low-density lipoproteins was 5,6 mmol/L. The most common CVDs among the participants were hypertension (n=64; 78%), coronary artery disease (n=42; 51,2%), and heart failure (n=26; 31,7%); other diseases were much less common. The most common echocardiographic changes were left atrial dilatation (n=38; 74,5%), increased left ventricular mass, thickening of left ventricular posterior wall (n=24; 48%) and interventricular septum (n=51; 100%). Diastolic and systolic heart failure were not widespread among long-livers: 16 (32%) and 2 (3,9%), respectively. Despite a rather large number of atherosclerotic plaques in the common carotid and femoral arteries, the number of hemodynamically significant plaques was low (n=3; 4,6%). An intima-media thickening up to 1,0-1,1 mm was found.Conclusion. Long-livers in Moscow are characterized by a low prevalence of traditional CVD risk factors (with the exception of hypertension) and a fairly high prevalence of atherosclerotic CVDs, which are characterized by a subclinical course.

The purpose of the first multidisciplinary Consensus: to comprehensively analyze the pathophysiological, clinical, and pharmacotherapeutic aspects of the syndrome of increased epithelial permeability (SPEP) as one of the basic mechanisms of the development of human pathology.The Consensus presents the structure of the three main levels of cytoprotection: preepithelial, epithelial and subepithelial, and the structure of intercellular tight contacts in epithelial tissues and endothelium is considered in detail. The clinical sections of the Consensus are devoted to the role of SPEP in diseases of the digestive system, cardio-cardio-vascular and other visceral systems. A separate section summarizes the materials illustrating the significant role of SPEP in mental disorders and diseases of the nervous system.A separate chapter of the Consensus is devoted to cytoprotective therapy in SPEP. Cytoprotective effects of such proton pump inhibitor as rabeprazole, bismuth preparations and probiotics have been shown. Special attention is paid to the clinical and pharmacological specialties of the cytoprotector of rebamipide. Clinical the effectiveness of re-bamipide shown as in functional, so in organic lesions of the digestive system. Its anti-cancer preventive effects are of practical importance.

Aim. To study the prevalence of geriatric syndromes and assess their relationship with senile asthenia in persons aged ³65 years living in Russian regions with different demographic, climatic and socio-economic characteristics.Material and methods. We examined 664 patients aged 65-107 years (mean age, 79±9 years; men, 25%) living in Moscow (n=365) and Voronezh (n=299). All patients underwent a comprehensive geriatric examination, which consisted of two stages: a survey with original questionnaire and an objective examination.Results. The prevalence of senile asthenia was 66,4%, including 47,4% in people aged 65-74, 71,1% — 75-84 years, and 82,8% — ³85 years (p for trend

The review includes data over the past 20 years on the mechanisms of the influence of hypertension and related interdependent conditions, such as insulin resistance, chronic inflammation and oxidative stress on the vascular ageing. The review also discusses modern concepts of the interaction of biological and vascular aging, as well as possible ways of their reversal. The central indicators of biological aging in this review are telomere length and telomerase activity. The article discusses antihypertensive therapy as a possible way to slow down both vascular and biological aging, and describes the results of modern studies on the effect of various antihypertensives, including angiotensin-converting enzyme inhibitors, sartans and others, on the telomeres.

The pandemic of the novel coronavirus infection (COVID-19), caused by SARS‑CoV‑2, has become a challenge to healthcare systems in all countries of the world. Patients with comorbidity are the most vulnerable group with the high risk of adverse outcomes. The problem of managing these patients in context of a pandemic requires a comprehensive approach aimed both at the optimal management in self-isolated patients not visiting medical facilities, and management of comorbidities in patients with COVID-19. The presented consensus covers these two aspects of managing patients with cardiovascular disease, diabetes, chronic obstructive pulmonary disease, gastrointestinal disease, and also pay attention to the multiple organ complications of COVID-19.

A novel coronavirus infection SARS-CoV-2 (COVID19) is especially dangerous for elderly and senile patients. Preventive measures for elderly people should cover three areas: 1) direct prevention of the viral infection, 2) preservation of the functional status and prevention of geriatric syndromes, including the use of social support measures, 3) control of comorbidities. The clinical pattern of COVID-19 in older patients may be atypical, while the mildness of symptoms (no fever, cough, shortness of breath) may not correspond to the severity of the prognosis. Delirium may be the first manifestation of COVID-19, which requires special care in its screening. Management of elderly and senile patients with COVID19 should include measures for delirium prevention, the detection and improvement of nutrition. The risk of malnutrition with sarcopenia increases with hospitalization of a patient, especially when using artificial ventilation, is associated with an unfavorable prognosis during hospitalization, accelerates the progression of senile asthenia and reduces the quality of life. Geriatric assessment is the cornerstone of determining the management of an elderly patient.

Arterial hypertension in adults. Clinical guidelines 2020

The basis for the successful treatment of any disease is a clear understanding of its cause, the mechanisms of its development, and their relationship to symptoms. The article considers one of the links in the pathogenesis of arterial hypertension - an increase in the activity of the sympathetic nervous system, describes the main methods for detecting hypersympathicotonia, approaches to the selection of drug therapy.

The role of specific approaches to the management of patients with heart failure (HF) increases steeply with increasing age, as the patients of this age need attention to geriatric problems: reduced mobility, multiple diseases and cognitive impairment. Senile asthenia is a syndrome that reflects a decline in physiological reserve and increased vulnerability to various stressors. Senile asthenia is detected in 15–74% of patients with heart failure, the prevalence depends on the method of diagnosis and the studied population. This review discusses the effects of senile asthenia, comorbidity and geriatric syndromes on diagnosis, treatment, and outcomes in elderly patients with heart failure. The detection of senile asthenia in patients with HF is important from a clinical point of view, since this condition has an adverse effect on the course of heart failure and is associated with a higher incidence of emergency hospitalization and mortality. Bodily exercises can improve mobility, and the introduction of nursing observation can enhance treatment adherence among patients.

Regardless the global demographic tendencies of life duration increase, longevity and super longevity remain quite understudied and non-fully understood population. Broader studies needed to understand, what it means to live by 100-year old. Lots of studies are about the longevity predictors and ways of ageing, that could be therapeutical targets not simply for life duration, but life quality as well, and medical-social geriatrics. The program “A Centenarian”, being conducted by leading scientific groups inRussia, is approaching a country unique medical, scientific and social data.

Decrease of blood pressure (BP) and its maintenance on target level is the main factor for cardiovascular mortality and morbidity reduction in hypertensive patients. For effective BP decrease most patients need combination therapy. The article is focused on benefits and adverse events of some combinations. In details an issue considered, on the combination of beta-blocker and renin-angiotensine-aldosteron system blocker, which, by the data from Russian observational programs, is the leader among two-component combinations. R

Cardiovascular diseases impact at most the morbidity, mortality and life quality of the elderly. However this population is underrepresented in clinical trials, hence management of this sort of patients is a gap in evidence. Acute coronary syndrome (ACS) requires active treatment from the very first minutes from myocardial ischemia onset. The riskbenefit ratio of invasive approach in a very old is still foggy, as there is no consideration of the risks related to frailty and other individual specifics of a patient, as the comorbidities.In the article, randomized trials data is presented, as of registries, that included aimfully ACS patients 75 years and older. The specifics of intervention is pointed in, its efficacy, and complications of reperfusion therapy in ACS with ST elevation (STEMI) in the senile.In details, an issue considered on the tactics of ACS treatment in nonST-elevation ACS (NSTEMI), as the rationale for earlier invasive tactics — coronary arteriography and, if indicated, percutaneous coronary intervention during 72 hours, or the conservative therapy at first, and coronary arteriography and revascularization only if ischemia recur; safety of the primary invasive approach; interventional approach by default or individualized approach and influence of such choice on 5-year cardiovascular mortality and myocardial infarction. Special attention is paid on a necessity of geriatric support of patients, presence and significance of the frailty and its influence on ACS treatment outcomes, life quality of the old after ACS, and organization of ACS registry of ≥80 y. o. persons from various regions of Russia.

Elderly population is heterogenic, and persons with the same chronological age differ greatly by their physical and cognitive functioning. Regardless the convincing witness on the adverse influence of raised blood pressure (BP) in a middle age persons, its influence on the prognosis of a very old is still debatable, as the question, whether to treat arterial hypertension (AH) in elderly, and if so, how intensively. The article focuses on the results of observational and randomized clinical studies that make it to decide that not the chronological, but biological age is an important criteria for decision on AH management in elderly. The article presents in details mechanisms interacting in BP regulation, and influence of BP on the risk of morbidity and mortality in elderly. Also, the current guidelines are cited, on antihypertension treatment, as the issues dicussed on AH treatment in elderly, that require further investigation.

Aim. To investigate on the relation of microbiota content and cardiovascular risk factors among persons with no clinical signs of cardiovascular diseases.Material and methods. In the study, 92 Moscow and Moscow Region inhabitants included, men and women at age 25-76 y.o., with no clinical signs of chronic non-infectious diseases, not taking any medications, but with probable existence of cardiovascular risk factors. All participants underwent prescreening investigation that included physical examination, clinical and biochemical blood collection, electrocardiography, thread-mill test, risk factors assessment, and sequencing of the variable loci V3-V4 of the gene 16S of rRNA of gut microbiota.Results. During the study, it was revealed that in the studied cohort there were more opportunistic bacteria in the donors having risk factors: Serratia — in obese and glucose metabolism disorder, Prevotella — in obese, disordered glucose metabolism and raised systolic pressure, Blautia — glucose metabolism disorder and raised systolic pressure. Amylolytic bacteria Oscillosipa were less common in obese.Conclusion. The dysbalance of gut microbiota with riased level of opportunistic bacteria that potentially initiate systemic non-specific inflammation, is associated with the existence of cardiovascular risk factors.

Aim. To assess cognitive status of the older age patients with arterial hypertension, in outpatient setting.Material and methods. Totally, 356 patients included, age 74,9±6,1 y., 80,4% females. For cognition assessment before and after the treatment, neuropsychological test was done, with MMSE — short scale of psychic status assessment, drawing test; literal and categoric associations test.Results. In the group

The increase of life duration leads to a sharp growth of the older and senile persons number. Differences in chronological and biological ages, of the velocity of ageing in different persons, make it to study biological and genetic factors of longevity. In the series of reviews we summarize the results of studies in these areas. However, except the fundamental scientific interest, general ageing of population and longevity are related to medical and social issues on the geriatric care organization. Regardless the high interest, longevity is still underinvestigated. The review focuses on the wide spectrum of longevity issues — from genetics to medical and social problems.

A position agreement of the experts of Russian association of gerontologists and geriatricians, Gerontological society of Russian Academy of Sciences, Russian medical society for arterial hypertensionTask Force Members: Tkacheva O. N. (Chairperson), Runikhina N. K., Kotovskaya Yu. V., Sharashkina N. V., Ostapenko V. S.Expert Committee: Anisimov V. N., Arkhipov M. V., Baranova E. I., Boytsov S. A., Bolotnova T. V., Villevalde S. V., Galyavich A. S., Grinshtein Yu. I., Drapkina O. M., Duplyakov D. V., Zhernakova Yu. V., Zakharova N. O., Ilnitsky A. N., Karaeva E. V., Karpov Yu. A., Kisliak O. A., Kobalava Zh. D., Koziolova N. A., Konradi A. O., Martynov A. I., Medvedeva I. V., Moiseev V. S., Nedogoda S. V., Oganov R. G., Orlova Ya. A., Ostroumova O. D., Oschepkova E. V., Podzolkov V. I., Proschaev K. I., Skibitsky V. V., Fomin I. V., Frolova E. V., Khavinson V. Kh., Chazova I. E., Chesnikova A. I., Chukaeva I. I., Shabalin V. N.

The heart is related with vascular system anatomically and functionally. Structural and functional changes in the arterial bed increase afterload on the left ventricle (LV), and can change its function, leading to the restructuring of the LV adaptation. Systolic blood pressure (SBP) in the aorta, directly reflecting the load on the LV, differs significantly from the SBP in the brachial artery due to delaying the occurrence of a reflected wave in the aorta. Left ventricular-arterial interaction is a concept that helps to understand the various options for the «optimal» functioning of the cardiovascular system, the effects of changes in the arterial bed to heart function. Methods of analysis of left ventricular-arterial interaction, clinical consequences of the breach and the effects of antihypertensive therapy are presented in the review; the results of the authors own studies are also presented.

Recently, there was plenty studies published on the arterial stiffness assessment, and importance of this was proved as an independent prediction parameter, together with standard cardiovascular risk factors. In current document, we collect and structure the available clinical and scientific data from abroad and Russian studies. The aim of current publication is the need to bring a reader the importance of demanded in clinical practice ways of arterial wall stiffness assessment, information about conditions when it is important to the assessment, and available restrictions, as the issues remaining unresolved.

In spite of the fact that clinical measurement of blood pressure which meets methodical requirements is still a basis for diagnostics of arterial hypertension and assessment of treatment efficiency, it is widely recognized that proper diagnostics and management of patients with arterial hypertension are impossible based only on the measurements of blood pressure which are carried out by doctor. The out-patient methods of blood pressure monitoring - daily monitoring (ABPM) and measurement of blood pressure at home (home blood pressure monitoring (HBPM)) - enable to overcome restrictions of clinical measurement of blood pressure. The combined use of clinical and out-patient measurement of blood pressure significantly expands understanding of Blood Pressure phenotype at the stage of diagnostics and assessment of treatment efficiency, especially at discordance of their results. Only by means of these methods it is possible to detect white-coat hypertension and masked hypertension. The existing out-patient methods of blood pressure monitoring, its description, comparison, advantages and disadvantages, its places in modern recommendations and clinical practice guidelines as requirements to technique are provided in this article.

Aim. To study the characteristics of renin profile and parameters of central pulse wave and arterial stiffness in patients with previously untreated arterial hypertension (HT). Material and methods. Patients (n=83; 39 males (47%); age 57.3±7.6 years) with untreated uncomplicated 1-2 degree HT without associated clinical conditions and diabetes, with glomerular filtration rate>60 ml/min/1.73m2 were enrolled into the study. Plasma renin activity (PRA), plasma renin level and angiotensin II level were evaluated. The analysis of the central pulse wave, and pulse wave velocity (PWV) measurements were performed.Results. The incidence of volume-dependent HT (PRA Conclusion. The presence of volume-dependent HT is associated with older age, higher level of systolic BP and increase in arterial stiffness independent of age and BP.

Chronic kidney disease (CKD) is associated with increased cardiovascular risk. CKD is characterized by accelerated aging of vessels in which the age-related arterial stiffness increase is exacerbated by a number of uremia-related processes. Increased arterial stiffness is associated with structural and functional disorders, as well as with the increase in cardiovascular mortality in patients with CKD. Increased arterial stiffness is diagnosed at an early stage of CKD. Modern understanding of the mechanisms of increased risk of cardiovascular complications in CKD, the factors contributing to the loss of elasticity of the arteries, arterial stiffness increase consequences are analyzed. Data illustrating the twoway interaction between CKD and arterial stiffness and mechanisms of accelerated progression of arterial stiffness in CKD are presented.

The ageing is the main risk factor for arterial hypertension (AH) and cardiovascular diseases. Natural ageing with normal BP is followed by changes in large arteries (rigidity), myocardium (hypertrophy) and diastolic relaxation and filling of cardiac muscle (diastolic dysfunstion). In AH these changes develop earlier and progress faster. These can be found at any age in AH. The telomere length (TL) — a special terminal structures on somatic cells chromosomes — is dependent on the age and is being shortened with age. This review concerns modern views on the role of telomeres as biological markers of ageing to understand the pathophysiology of essential arterial hypertension as a syndrome of accelerated cardiovascular system ageing.

Reduction in cardiovascular morbidity and mortality is not always or only owed to antihypertensive effect of treatments. Decrease in systolic blood pressure helped by antihypertensive drugs may be different in the central and peripheral vascular segments, which is largely explained by different pathophysiology of central and peripheral arterial blood pressure. This review is devoted to current views on pathophysiology, diagnostic techniques, medication effects on central blood pressure, clinical and prognostic value of measuring central blood pressure and prospects for its evaluation.

Aim. To assess the risk of fatal cardiovascular (CVD) events in medical doctors of various specialities, using modern risk scales, and to identify the target groups for primary prevention with a fixed-dose combination of enalapril / hydrochlorothiazide (HCT) and simvastatin. Material and methods. The programme included 12 non-teaching Russian hospitals and was divided into epidemiological, educational, therapeutic, and control phases. In 699 doctors, aged >40 years and representing 43 specialities (22,8% men; mean age 50,5±11,7 years), the risk of fatal CVD events and coronary events was assessed with SCORE and Framingham scales, respectively. All doctors were informed about their individual risk and target levels of risk factors (RFs), and also taught to self-control their blood pressure, physical activity, and body mass. In total, 287 doctors participated in the therapeutic phase (6 months): 52 were included in the antihypertensive therapy (AHT) group (enalapril/HCT); 38 – in the simvastatin group; and 197 – in the combined therapy group (AHT and simvastatin). Six months after the end of the therapeutic phase, the prevalence of continuing pharmaceutical and non-pharmaceutical primary prevention was analysed. Results. The prevalence of the main RFs was high: dyslipidemia was observed in 69,2% of the participants, AH – in 55,6%, abdominal obesity – in 34,5%, and smoking – in 14%. As many as 54,5% of the doctors had at least 3 RFs, while 25,8% had high SCORE-assessed risk, and 47,1% had indications for pharmaceutical primary prevention. The most adverse RF profile was registered in surgeons. Pharmaceutical primary prevention with a fixed-dose combination of enalapril/HCT and/or simvastatin significantly reduced both SCORE and Framingham risk levels. Six months after the therapeutic phase, 30,2% of the doctors stopped the treatment, and 37,2% continued pharmaceutical primary prevention. Conclusion. The results of the programme point to the high prevalence of modifiable RFs in middle-aged medical doctors. The data obtained could be a basis for the programs of primary CVD prevention.

Aim. To investigate the variants of left ventricular (LV) remodelling in men aged 18-25 years, with and without arterial hypertension (AH). Material and methods. In total, the study included 211 men aged 18-25 years (mean age 21,1±0,14 years), with random blood pressure (BP) elevation at previous clinical examinations. All participants underwent repeat BP measurements, 24-hour BP monitoring (BPM), echocardiography with calculation of LV myocardial mass index (LVMMI) and relative wall thickness (RWT), and evaluation of LV diastolic function (DF). Results. According to the results of clinical BP measurements and 24-hour BPM, normal BP levels were observed in 36 participants (17 %), stable AH — in 124 (58,7 %), and unstable AH — in 51 (24,3 %). In patients with stable AH, LVMMI was significantly higher than in individuals with normal BP. Among participants with stable AH, 43 (34,7 %) had normal LV geometry, 75 (60,5 %) had concentric LV remodelling, and 6 (4,8 %) — concentric LV hypertrophy. Among participants with unstable AH, 14 (27,5 %) had concentric LV remodelling. Comparing to normotensive individuals, patients with stable and unstable AH had lower transmitral flow ratio E/A, and significantly higher peak A velocity. Conclusion. In young 18-25-year-old men with stable AH, the typical LV remodelling variant was concentric remodelling, with a tendency towards LV diastolic dysfunction development.

This literature review is focused on the modern diagnostic methods in pre-clinical renal pathology. The wide prevalence of renal dysfunction in cardiovascular disease (CVD), its role in the stratification of cardiovascular and renal complication risk, and the potential for medical prevention of these complications justify the search for the methods diagnosing pre-clinical renal pathology. Increased serum creatinine, reduced creatinine clearance or estimated glomerular filtration rate (GFR), and microalbuminuria are independent predictors of cardiovascular morbidity and mortality. In all patients with arterial hypertension, estimated GFR and urinary albumin excretion should be assessed. Nephroprotective strategies, delaying progression of proteinuria and GFR reduction, should be identified.

Aim. To investigate a new technique of transcutaneous electroneurostimulation of reflexogenic zones by shortimpulse current (DiaDENS-Cardio) as a potential method to improve blood pressure (BP) control in patients with arterial hypertension (AH) uncontrolled by three-component therapy.Material and methods. A placebo-controlled study of DiaDENS-Cardio device included 60 AH patients, receiving regular three-component antihypertensive therapy but failing to achieve the target BP level