Aim. To study the state of the main arteries and vascular age in conjunction with the level of leptin and adiponectin in patients with arterial hypertension (AH) and obesity.

Material and methods. One hundred and twenty patients with AH stage II aged from 45 to 65 years were divided into 3 groups depending on body mass index (BMI). Group 1 was represented by patients with AH and normal BMI, the 2 group was represented by patients with AH and excessive BMI, the 3 group was represented by patients with AH in combination with obesity. A standard clinical examination was performed, the stiffness of the vascular wall was measured by measuring the pulse wave velocity (PWV) of the muscle and elastic vessels (PWVe), vascular age was calculated, and the laboratory markers of obesity were determined.

Results. High percentage of visceral obesity was observed: 20,0% among people with normal BMI, 64,4% among overweight people and 100% among people with obesity (differences between 1 and 2, 1 and 3, 2 and 3 groups are reliable). A statistically significant increase in PWVe was detected in patients with AH and obesity in comparison with patients with AH and normal body weight (9,8 [8,5; 11,3] vs 8,0 [79; 8,1] m/s). Vascular age was higher in patients with AH and overweight or obesity compared with patients with AH and normal weight (670 [60,0; 76,0], 68,0 [60,0; 72,0] vs 58,0 [57,0; 60,0] years, respectively). A statistically significant increase in the concentration of leptin (6,9 [4,5; 15,1] vs 19,0 [74; 42,7] vs 53,8 [38,4; 75,8] ng/ml) was detected, as well as a decrease in adiponectin concentration from the 1 to the 3 group (44,9 [36,6; 55,8] vs 16,5 [12,5; 24,7] vs 18,6 [15,3; 22,4] ng/ml, respectively).

Correlation analysis revealed the presence of highly reliable relationships between the parameters of rigidity of the main arteries and laboratory markers of obesity.

Conclusion. The results indicated a negative effect of hyperleptinemia and hypoadiponectinemia on the elasticity of the vascular wall of the main arteries and the vascular age in hypertensive patients with its combination with overweight or obesity.

Aim. To study the catestatin plasma level in patients with primary hypertension of different cardiovascular risk and to assess its relationship with heart rate variability (HRV) parameters.

Material and methods. One hundred eighty men aged 30-50 years were divided into groups: group 1 (n=28) — hypertensive patients with medium risk of developing cardiovascular complications (CVC), group 2 (n=76) — hypertensive patients with high risk of CVC, group 3 (n=31) — hypertensive patients with very high risk of CVC. The control group consisted of healthy men with normal blood pressure (BP) (n=45). We determined plasma catestatin (ng/ml) and conducted Holter monitoring.

Results. A pattern was found to reduce the concentration of catestatin with increasing risk of CVC in hypertensive patients, but there were no significant differences between the studied groups (p>0,05).

We determined corrections between catestatin levels and echocardiography thickness of left ventricular posterior wall (r=-0,523; p=0,045) and interventricular septum (r=-0,523, p=0,045) in diastole in group 2; thickness of left ventricular posterior wall (r=0,258; p=0,035) and interventricular septum (r=0,254; p=0,038) in systole in group 3. In patients of group 2, direct correlations of catestatin levels and sympathicotonia LF/HF were revealed during the whole observation period (r=0,301; p=0,019) and during wakefulness (r=0,308; p=0,019); inverse correlations — with parameters of parasympathetic tone: nHF during the whole observation time (r=-0,318; p=0,013) and during wakefulness (r=-0,342; p=0,007), pNN50 in the afternoon (r=-0,270; p=0,037).

Conclusion. A decrease in catestatin concentrations in hypertensive patients is associated with the progression of disease and an increase in cardiovascular risk. It is assumed that catestatin is involved in the formation of HRV in patients with primary hypertension.

Aim. There is evidence that central aortic blood pressure (BP) is more associated with left ventricular myocardial hypertrophy than brachial BP. The purpose of this work is to compare the association of brachial and central aortic BP with electrocardiographic parameters of left ventricular hypertrophy in the general population of Novosibirsk.

Material and methods. We examined 327 people: 155 men and 172 women aged 25-44 years from a representative sample from the general population of Novosibirsk. The study program included anthropometry, BP measurement, electrocardiography, biochemical blood analysis. Radial artery applanation tonometry and pulse wave analysis were performed using the SphygmoCor system. Left ventricular hypertrophy was determined by electrocardiographic parameters.

Results. In the general population of Novosibirsk, central aortic BP is more associated with left ventricular myocardial hypertrophy than brachial BP. Central pulse pressure, in contrast to brachial BP, is significantly associated with the R+S index (p=0,0085), as well as RI (p=0,0038) and RaVL (p=0,0039) wave amplitude. Central systolic aortic BP, in contrast to brachial systolic BP, is significantly associated with RI (p=0,042) and RaVL (p=0,029) wave amplitudes. Amplification parameters of central aortic BP, regardless of brachial BP, are associated with indices of left ventricular hypertrophy. Pulse pressure amplification in groups with or without left ventricular hypertrophy, standardized for age, gender, height, waist circumference, heart rate, triglyceride levels, high density lipoprotein cholesterol, low density lipoprotein cholesterol, blood glucose, and brachial pulse pressure, was 13,3 mm Hg and 12,5 mm Hg, respectively (p=0,035).

Conclusion. The results of this study substantiate the relevance of the practical use of central aortic BP parameters in addition to the office measurement of brachial BP.

The presented study in Azerbaijan is carried out for the first time within State Programs on fight against a type 2 diabetes mellitus (DM2) and other noninfectious diseases.

Aim. To define predictors of arterial hypertension (AH) in patients with DM2 in Azerbaijan population.

Material and methods. In the single-step clinical-epidemiology cohort study were included 528 patients with DM2 at the age of 30-69 (30,5% — men and 69,5% — women) who answered questions using “ARIC” questioner to define AH and its risk factors.

Results. The prevalence of AH in women (72,4%) was 2,6 times more than in men (27,6%) and the frequent occurrence of AH was at the age of 60-69 (respectively, 26,7±2,1% vs 9,6±2,9%, p<0,001). It was not determined remarkable differences between AH level and occupation status, alcohol consumption, low physical activity, feeding disorder of the patients, at the same time in patients with AH smoking frequency was about 2 times often than in others (respectively, 19,3±1,9% vs 10,6±3,0%, p<0,05). In parents of AH patients AH rates, in comparison with eutonics, were occurred like these: (respectively, in fathers 21,9±2,0% vs 12,5±3,2%, p<0,05; in mothers 42,2±2,4% vs 26,9±4,3%, p<0,01), in mothers DM2 (respectively, 33,7±2,3% vs 221 ±4,1 %, p<0,05), overweight and obesity were watched much more often (95,0±1,1% vs 88,5±3,1%, p<0,05), at the same time these patients were suffered from abdominal obesity (respectively, 96,5±0,9% vs 89,4±3,0%, p<0,01). The mean values of systolic and diastolic arterial pressure (respectively, 148,3±1,1 vs 119,8±1,3 Hg, p<0,001 and 85,9±0,5 vs 74,8±0,8 Hg, p<0,001) were often determined in patients with AH, and on the other hand in these patients were noted prevalence of anxious syndrome (respectively, 78,5±2,0% vs 72,1±4,4%, p<0,05) and depression (68,2±2,3% vs 62,5±4,7%, p>0,05). Regardless of AH level in all patients was noted stress (respectively, 99,8±0,2% vs 100,0±0,0%, p>0,05), which changed for the worse life quality of the patients with AH significantly (respectively, 1,0±2,2% vs 61,5±4,8%, p<0,05).

Conclusion. For patients with DM2 in Azerbaijan cohort female sex, increasing of the age, body mass index, abdominal obesity and anxious conditions are significant risk factors for AH. Presence of AH in both parents and DM2 in mothers increase this risk significantly, which decrease life quality of these patients.

Aim. To study the influence of arterial hypertension (AH), smoking, and their combination on the risk of all cause and cardiovascular mortality.

Material and methods. We conducted a 27-year cohort prospective study of the unorganized population of Tomsk (916 women and 630 men aged 20-59 years). At the first stage, we studied the prevalence of AH and smoking (1998-1991), at the second (2015) — the effect of these risk factors (RF) and their combination on the risk of all cause and cardiovascular mortality. AH was diagnosed at a blood pressure level of >140/90 mmHg and <140/90 mm Hg in individuals taking antihypertensive drugs. Smokers were individuals who smoked at least 1 cigarette per day and quit smoking less than one year ago.

Results. The study found a significant effect of AH and smoking on mortality: the relative risk (RR) of all-cause mortality in people with hypertension was 2,2, in smokers — 2,3, in those with a combination of RF — 5,0. The RR of cardiovascular mortality in AH individuals was 3,4, in smokers — 1,6, in smoking men and women suffering from AH — 5,2. An increase in the risk of all-cause mortality in people with AH and smoking was observed in all gender-age groups. Smoking was found to increase the risk of all-cause mortality in individuals with high levels of blood pressure by 2,1 times compared with non-smoking hypertensive patients. It reduces the chances of a 27-year survival rate to 64,4%, and more so in the youngest (20-39 years) age group (RR — 3,9). Multivariate analysis showed that AH and smoking make the most significant contribution to the formation of mortality compared to other modifiable RFs.

Conclusion. We found that AH and smoking are among the most influential RFs, and their combination increases the RR of all-cause mortality by 5,0 times (cardiovascular — 5,2 times). We also determined an additional risk of smoking in individuals suffering from AH to the all-cause mortality.

Aim. To conduct a pharmacoeconomic assessment of the use of modern technologies in the follow-up care of patients with arterial hypertension (AH) in the Tyumen region.

Material and methods. Using a random sampling technique we selected and examined 1704 patients with AH in the Tyumen region. The average age of patients was 62±75 years, 31,5% were men. Patients are divided into active monitoring and control groups. Weekly sms and e-mail messages with prevention information were sent to patients of the active monitoring group. General practitioners receive a course of training seminars on the features of follow-up observation of patients with AH. After 12 months (±3,2), the patients had repeated examination. We conducted pharmacoeconomic analysis of the intervention.

Results. The results of our study showed that the total cost of the disease with active follow-up of patients with AH decreases, which mainly occurs due to indirect expenses. Weekly sms and e-mail notification of patients in combination with educational seminars for general practitioners and cardiologists leads to a change in the structure of expenses for the treatment of patients with AH. We noticed reducing the cost of inpatient treatment, emergency calls, and a decrease in indirect expenses. On the other hand, there is a redistribution of funds spent on pharmacotherapy and cases of outpatient visits. Such redistribution, combined with a decrease in the total cost of the disease, leads to savings in the resources of the health care system and allows an additional 231 patients to be treated within 12 months.

Conclusion. The proposed model of active follow-up is economically viable, both by reducing the total cost of the disease, and by redistributing funds towards using pharmacotherapy and outpatient visits, which is the most rational in the treatment of AH.

Aim. To compare the relationships between conventional and new potentially more early investigational biomarkers (urine and ultrasound) of kidney injury and central aortic blood pressure, vascular stiffness and reactivity, endothelial dysfunction in patients with different severity of hypertension.
Material and methods. Urine levels NGAL, KIM-1, L-FABP, albuminuria and serum levels of сystatin C and creatinine were measured in 92 hypertensive patients with mild and severe hypertension, 46 male (mean age 50,7±12,2 years). Glomerular filtration rate was estimated by the level of serum creatinine and cystatin C by MDRD and CKD-EPI formulas. Instrumental examination included measuring office blood pressure, 24-hour ambulatory blood pressure monitoring (SpaceLabs 90207), applanation tonometry (SphygmoCor, Artcor Medical) with the calculation of central aortic blood pressure, pulse wave velocity and augmentation index and Doppler ultrasonography with assessment of intraparenchymal renal arterial resistance indices — resistive index and pulsatility index (Vivid 7 dimension). Endothelial function was assessed by reactive hyperemia index with EndoPAT device (Itamar Medicals).
Results. There were no differences in conventional levels of biomarkers between patients, however, cystatin C level increased and serum cystatin C estimated GFR and serum creatinine and cystatin C estimated GFR (CKD EPI formula) (sCr,Cys-estimated GFR) levels decreased with the severity of hypertension. These novel biomarkers were associated with increased central aortic blood pressure, arterial stiffness and intraparenchymal renal arterial resistance indices. Decreased sCr,Cys-estimated GFR levels were associated with lower reactive hyperemia index. There were no differences in NGAL, KIM-1 and L-FABP levels in patients with hypertension. However, NGAL levels were associated with increased augmentation index, resistive index in intralobular and pulsatility index in arcuate arteries, KIM-1 and L-FABP levels were associated with increased systolic and diastolic central aortic blood pressure, pulse wave velocity only in patients with severe and resistant hypertension.
Conclusion. Serum cystatin C, NGAL, KIM-1 and L-FABP levels seem to be biomarkers of increased systemic and intrarenal vascular stiffness in patients with different severity of hypertension.

Aim. To study the relationship of subjective and objective signs of chronic venous diseases (CVD) with the state of the autonomic nervous system (ANS) in men with arterial hypertension (AH).

Material and methods. The object of the study were 74 men with AH at the age of 30-50 years with SBP level 148 (144-155) mm Hg. and DBP 101 (92-108) mm Hg. Two groups of 20 people were selected with the extreme parameters of vegetative index (Kerdo index).

Results. The most common complaints in patients with severe parasympathicotonia were pain in the legs and fatigue when walking, cramps in the calf muscles, oedema and sural trophic disorders. An objective examination of patients with severe vagotonia revealed a more frequent occurrence of the leading symptom of CVD — oedema.

Conclusion. AH with severe parasympathicotonia in men 30-50 years old is characterized by an increase in the frequency of subjective and objective signs of CVD, which indicates the role of ANS in the development of CVD in AH.

Aim. To study long-term results and predictors of adverse outcomes of transcatheter aortic valve implantation in patients with high surgical risk with severe aortic stenosis.

Material and methods. The prospective single-center study included 140 patients with hemodynamically relevant aortic stenosis who underwent transcatheter aortic valve implantation. We assessed hemodynamic and clinical status, quality of life before and after 1 year of the intervention.

Results. In the long-term follow-up after transcatheter aortic valve implantation, an improvement in the quality of life was noted in both the physical and psychoemotional aspects of health. We did not registered cases of prosthesis dysfunction, repeated surgical interventions one-year survival was 92%. Predictors of adverse outcomes of aortic valve transcatheter implantation were the comorbidity index (odds ratio (OR) 2,8 (1,6-4,9), p<0,001) and, especially, the comorbidity index over 5 points (OR 9,3 (2,9-19,4), p<0,001). Initially low level of quality of life, both in the physical aspect (OR 0,93 (0,86-0,99), p=0,013) and in the psycho-emotional aspect of health (OR 0,94 (0,89-0,99), p=0,027).

Conclusion. Aortic valve transcatheter implantation showed high efficiency in improving the quality of life and reducing mortality in patients with severe aortic stenosis and high surgical risk. Initially low level of quality of life and comorbidity index adversely affect on long-term results.

Aim. To assess safety and efficacy of intramyocardial implantation of autologous bone marrow cells treated with erythropoietin in surgery for coronary artery disease (CAD).

Materials and methods. Eighty patients with CAD with diffuse and (or) distal lesions of the right coronary artery were randomly assigned to two groups: patients of group 1 (n=40) underwent coronary bypass surgery, implantation of autologous bone marrow cells treated with erythropoietin into the lower wall of the left ventricle, patients of group 2 (control group, n=40) underwent bypass surgery of the left coronary artery. Evaluation of the clinical status, perfusion and contractility of the myocardium was performed initially, 6 and 12 months after surgery.

Results. Six months after the operation, we found more pronounced decrease of functional class (FC) of angina and improvement in the 6-min walk distance in the main group compared with the control group.

Twelve months after surgery, the severity of angina remained at the same level in both groups. In the control group, 45,2% of patients had FC I, 52,3% of patients did not have angina. In both groups, angina return was detected in 1 patient (FC III). According to the results of two-step myocardial scintigraphy with Technetril (Tc99), 6 months after surgery, a significant improvement in myocardial perfusion was observed. In the control group, after 6 months, no significant dynamics of perfusion of the lower wall of the left ventricle was detected.

Twelve months after the surgical treatment of the right coronary artery in patients from the group 1 revealed a decrease in the stress defect and the stable perfusion defect. In patients from the control only a significant stress defect was found to decrease.

Conclusion. The study demonstrated decrease of FCs, significant improvement in perfusion, functional state of the myocardium and 6-min walk distance in patients of group 1.

Aim. To assess the possibility of azilsartan medoxomil to achieve target blood pressure (BP) (less than 130/80 mm Hg), to study angioprotective features and reduction of adipokines levels and inflammatory markers in patients with hypertension and previous therapy with other ARBs.

Material and methods. In open observational study with 24 weeks follow-up were included 60 patients with previous therapy (losartan or valsartan or telmisartan).

All patients underwent ambulatory BP monitoring, applanation tonometry (determination of the augmentation index and central BP), measurement of the pulse wave velocity, laboratory tests (lipid profile, uric acid, fasting glucose, Homeostasis Model Assessment, homocysteine, leptin, adiponectin, highly sensitive C-reactive protein, tumor necrosis factor alpha, interleukin-6).

Results. Azilsartan provided the systolic BP (29,05%, 22,5% and 8,9%) and diastolic BP reduction 18,82%, 20,46% and 8,54% (p<0,05) in patients previously treated with losartan, valsartan or telmisartan, respectively. Central systolic BP (by 25,95%, 8,78%, 11,94%), central pulse BP (by 40%, 18,38% and 19,6%), augmentation index (by 28,87%, 20,69% and 14,29%) and pulse wave velocity (by 21,57%, 24,56% and 24,92%) were decreased (p<0,05). There were positive changes in leptin, C-reactive protein, IL-6, adiponectin levels in all patients with losartan, valsartan or telmisartan initial therapy (p<0,05).

Conclusion. Azilsartan medoxomil has advantages in BP control, the arterial elasticity improving, reducing of insulin-resistance and inflammation.

Many clinical studies have shown seasonal dynamics of blood pressure (BP), which most authors attribute to seasonal variations in air temperature. However, the fact that in the conditions of modern urban society the influence on the person of air temperature on the street is minimized, as well as the fact that the seasonal dynamics of BP is observed and in a tropical climate contradict this statement. It is known, that the length of the day, the atmospheric pressure, the relative humidity, geomagnetic activity are subject to seasonal dynamics. Studies have shown that fluctuations in these meteorological factors can cause change in blood pressure.

Aim. To use meta-analysis of the results of studies, conducted in different climatic zones (from subarctic to tropical) and devoted to seasonal dynamics of BP, to determine which meteorological conditions most often corresponded to the annual maximum of BP and which to the annual minimum of BP.

Material and methods. We selected 15 publications about seasonal dynamics of BP and seasonal exacerbations of arterial hypertension in 21 regions of the Northern Hemisphere of the Earth.

Results. We confirmed that, in addition to air temperature, other factors are also subject to seasonal dynamics (atmospheric pressure, relative humidity, partial oxygen density in the air). No correlation was found between the amplitude of seasonal fluctuations in air temperature and the amplitude of seasonal fluctuations in BP. In addition, the amplitude of drcannual blood pressure fluctuations was greater in regions with a clear seasonal dynamics of the average monthly atmospheric pressure, compared with regions in which the this parameter does not have a clear seasonal dynamics. Also, in some regions, the seasonal maximum of BP coincided with high geomagnetic activity.

Conclusion. According to the results, we concluded that seasonal fluctuations of BP are not a reaction of the cardiovascular system to seasonal dynamics of air temperature only. Most likely, seasonal fluctuations of BP are caused by changes in all meteorological factors that have seasonal dynamics.

Patients with atrial fibrillation have a high risk of developing stroke and death, which requires constant anticoagulant support. In this regard, the physician faces the difficult task of selecting the appropriate oral anticoagulant for patient with individual risk factors and comorbidities. Currently, three non-vitamin K antagonist oral anticoagulants or directly acting oral anticoagulants have been registered in the Russia, which in large randomized clinical trials (RCTs) were compared with warfarin in the prevention of stroke and systemic embolism. The present article analyzes the data of RCTs, postmarketing studies of oral anticoagulants, and presents groups of patients for whom these drugs are preferred. The choice of oral anticoagulants for the prevention of stroke in the following subgroups of patients with atrial fibrillation is discussed: patients with one stroke risk factor (CHA2DS2VASc1 in men or 2 in women), patients of different age groups, patients with concomitant coronary artery disease/acute coronary syndrome, a history of stroke, patients with chronic kidney disease, patients with a high risk of gastrointestinal bleeding, and a group of patients with concomitant arterial hypertension and chronic heart failure. We compared the efficacy and safety of oral non-vitamin K antagonist oral anticoagulants or directly acting oral anticoagulants with vitamin K antagonists in patients with non-valvular atrial fibrillation.

The staffing of medical specialists plays an important role in the timely provision of specialized medical care to the population.

Aim. To analyze the sufficiency of pediatric cardiologists and their activities in the Russian Federation.

Material and methods. We used data of federal statistical observation over the period from 2013 to 2017 The study was conducted with statistical, analytical and descriptive methods of statistics.

Results. In almost all federal districts, there was an increase in the sufficiency of pediatric cardiologists with a decrease in the staffing of outpatient specialists. In the North-Western and Southern Federal District there was an increase in the number of visits per 1 specialist by +4,9% and +1,7%, respectively, and in the Central Federal district — in the proportion of visits by disease (+15,0%).

Conclusion. The analysis showed an increase in the sufficiency of medical specialists with a decrease in the number of visits.

The Editors' Network of the European Society of Cardiology (ESC) provides a dynamic forum for editorial discussions and endorses the recommendations of the International Committee of Medical Journal Editors (ICMJE) to improve the scientific quality of biomedical journals. Authorship confers credit and important academic rewards. Recently, however, the ICMJE emphasized that authorship also requires responsibility and accountability. These issues are now covered by the new (fourth) criterion for authorship. Authors should agree to be accountable and ensure that questions regarding the accuracy and integrity of the entire work will be appropriately addressed. This review discusses the implications of this paradigm shift on authorship requirements with the aim of increasing awareness on good scientific and editorial practices.