Aim. To evaluate  LQ in AH patients,  to analyze the relation of LQ and  treatment status,  and to study associated with LQ factors, by the data of esse-Rf study. Material and methods. The materials for analysis were representative selections of inhabitants (n=21894) of 13 regions of Rf, included to esse-Rf study in 2012-2013  y. Response was  80%.  We used  standard epidemiological  methods   and criteria. The participants  were selected to 4 groups:  1) non-AH, 2) AH not taking AHD and having normal BP, 3) AH taking drugs  with non-controlled  hypertension (non-effective treatment), 4) AH not taking AHD. LQ was assessed with international eUROQOL-5D and visual analogue scale eQ-VAs. Integral LQ assessment was done with LW shaw et al. methodics. Into analysis the following were included: sex, age, education  and wealth levels, systolic and diastolic pressure, AH treatment status, comorbidities, region of participation.

Results. In general,  women  with AH have  worse  LQ than  men  (p<0,0005).  In analysis of eQ-5D components we found, that prevalence  of prominent disorders was not higher than 3% for every single, but moderate disorders  reached 5-41% in those  with AH for different  parameters. eQ-VAs  were  significantly lower among those  having AH comparing  to non-AH — 66,4%  vs. 70,1%,  p<0,0005.  Highest values (p<0,0005) were found in those with AH not taking AHD, but AHD values in the group of those effectively managed and non-effectively managed were comparable. Total index of life quality by eQ-5D among men is higher than women (p<0,005), but it decreases with age.  Among both genders — in AH and  “AH not taking drugs” groups  — LQ by eQ-5D was comparable and  significantly higher than in groups “treated effectively” and “treated non-effectively”.

Conclusion. Prevalence of AH in Rf remains high. LQ in AH persons is lower than in non-AH (mostly for those  taking AHD). This witnesses  on the necessity  for more attention  to  AH in real  clinical practice,   including  dispensary   observation  and involvement to educational  programs. The populational data obtained  in the study, of LQ in AH persons can be applied for QALY calculation in modelling of economical efficacy of various diagnostic  and management procedures in relation to Russian patients with AH. 

Aim. To evaluate the main possible reasons for arterial hypertension in patients with thrombotic occlusion of the large arteries of extremities in atherosclerotic disease.

Material and methods. The course of arterial hypertension was analyzed in 129 cases of atherosclerotic aortic disease, complicated with acute thrombotic occlusion of the arteries of lower (112) and upper (17) extremities due to thrombosis (108) and embolism (21) of magistral vessels comparing to the data of 46 patients with chronic ischemia of lower extremities.

Results. Arterial hypertension (AH) in anamnesis was marked in all patients of study groups and comparison group. systolic AH was diagnosed in 17,8% (23), and in comparsion group — 19,5% (9). Thrombectomy was followed by the decrease of mean BP in most of patients, with good effect of operation and return of adequate circulation in the extremity — in 82,2%, by mean 17,1% systolic and 21,4% — diastolic BP. In 31 patient the dynamics of systolic and diastolic BP after operation was not single-directed and did not raise for more than 5% over baseline, and in 7% cases there was increase of BP, by mean 19,4% systolic and 22,6% diastolic. GFR levels were lower than normal in more than 70% patients of AEI and more than 65% in comparison group.

Conclusion. Thrombectomy and reconstruction interventions on occluded arteries, with successful restore of main circulation in the extremity, are followed by significant decrease of systemic systolic and diastolic arterial pressure in most patients.

Aim. To evaluate efficacy of endovascular treatment in patients with diabetes, operated with biodegradable vascular endoprostheses and everolimus eluting stents.

Material and methods. Primarily, 143 patients were selected into the study. Then 125 patients included and randomized to 2 groups. Patients of I group (n=57) underwent implantation biodegradable vascular endoprostheses, and the II group (n=68) — coronary stents eluting everolimus. For the control of biodegradable endoprostheses implantation optical coherent tomography was used, that was performed at the end of intervention and in long-term follow-up by 12 months. Results. Totally, 63 biodegradable vascular endoprostheses implanted to the patients of I group, and 102 everolimus coated stents to II group patients. Mean diameter of implanted endoprostheses in group I was — 2,88±0,06 mm, and in group II — 2,68±0,12 mm (р>0,05). Technical success of intervention was 100% in both groups. Total number of serious cardiovascular complications during in-patient phase was 3,5% and 2,94% in groups, respectively (p>0,05). Long-term results were followed-up in 41 patient from group I and in 52 from group II. In 12 months survival rate was 100%. Prevalence of non-fatal MI among I and II group patients was 4,9% and 3,8%, resp. (p>0,05). The reason was progression of atherosclerotic process in other arteries. Restenosis prevalence that required new intervention on target lesion was 2,4% and 1,9%, resp. (p>0,05). Late thrombosis in long-term follow-up was not marked in both groups. Late loss of intrinsic lumen of the vessel, by the data of optical coherent tomography was 0,14±0,19 mm and 0,12±0,23 mm, respectively, for groups I and II (р>0,05).

Conclusion. Biodegradable vascular endoprostheses in CHD patients with diabetes and mostly involvement of middle and distal segments of coronary arteries, showed equal efficacy and safety, with everolimus coated stents, in 12 months after intervention.

Aim. To assess somatic comorbidity in male and female cohort with stable angina (sA). Material and methods. Into multicenter,  simlutaneous  cohort-clinical study, 300 men included (mean  age  54±0,4 y.o.) and 230 women (mean  age  55,7±0,5  y.o.) with sA  of  I-III  functional  class.  four  institutions  participated   from  Ingushetia Republic.  Clinical and  instrumental  assessment included  anthropometry, office blood pressure, heart rate, eCG in 12 leads recording.  In fasting venous blood we measured total cholesterol (mM/L) and glucose (mM/L).

Results. In cohort of patients with sA the most prevalent are cholelythiasis, gastric and duodenal ulcer disease, chronic diseases of pancreas, separately  or together; chronic bulbitis is found in each third person,  and urinary lythiasis in 15% of cases. Gastric ulcer and duodenal  ulcer diseases, chronic bronchitis and urinary lythiasis are  two times more prevalent  in men compare  to women, but cholelythiasis and chronic diseases of pancreas show the same  prevalence  among men and women.

Among women with sA thyroid diseases are 3 times more prevalent than in men.

Conclusion. so, in sA patients  comorbidity is quite common.  Management and prevention in sA patients cohort should be multifactorial taken a broad spectrum  of social and demographic parameters, main risk factors and comorbidities.  The key role in coordination  and realization of all these  activities should be granted  to an internist of broad spectrum  or general care physician.

It is known that ventricular dysrhythmias in patients  with ischemic heart  diasease can be of various origin. Hence selection of antiarrhythmic tactics in such patients should be individual and pathogenetically proved.

Aim. To check  antiarrhythmic  abilities of metabolic  therapy  for ischemic  heart disease  combined   with variety  of  ventricular  arrhythmias  of  III-IV  grades   (by Myerburg RJ).

Material and methods. for 42 patients with ventricular arrhythmias of high grade and stable ischemic heart disease with saved ejection fraction of the left ventricle, before and after treatment were done the following: Holter monitoring, treadmill test, and  as  indicated  — coronary  arteriography,  radionuclide  methods  of perfusion assessment and metabolism  of myocardium, non-invasive topical diagnostics. To individually selected antianginal and antihypertension  therapy  for all patients  was added  ethylmethylhydroxypyridine succinate  (es) in daily dosage 300 mg, for 2 months.

Results. During the study, according  to relationship of ventricular arrhythmia with transient ischemia, patients were selected to 2 groups. In the 1 group, with ischemic arrhythmias,  in 2 months  after  start  of es, there  was significant antiarrhythmic effect: number of single ventricular premature beats decreased by 55%, couplets — by 90%,  and  episodes of non-sustained ventricular tachicardia  — by 100%.  At control positrone-emisson tomography  in the areas  of myocardial ischemia  there was significant increase of 11C-buthirate  sodium excretion,  which witness on the increase of efficacy of energetic metabolism in zones of hypoxia. In the II group, with non-ischemic  ventricular arrhythmias — antiarrhythmic effect was not achieved. Conclusion. es should be regarded as pathogenetic chain in complex antiarrhythmic treatment of ventricular arrhythmias in patients with stable ischemic heart disease.

The article focuses on the "pros" and "contras" of thiazide containing combinations usage for treatment of arterial hypertension in real clinical practice. Based on evidence, clear indications are formulated for effective and safe application of the ramipril and hyndrochlorothiazide combination.

Medical care improvement in Russan federation directly depends upon implementation to broad practice of professionally-public accreditation of professional   educational   programs   of  medical  profile.  Important  role  in  the evaluation of professional education and specialists preparing, including physicians, for the  labour  market  and  professional  standards, play a  personality  of expert participating in accreditation procedure. Under the realization of Russian society of Cardiology project “Professional-public accreditation of educational programs as an element  of medical education  improvement” and with involvement of the Central expert board  of Russian Unity of medical association  “National medical board” in fsBI “North-Western federal Medical Research Centre  n.a.  V. A. Almazov”  of the Ministry of Health, experts training is go for professional-public accreditation of the programs  of medical profile.

Medicine of 21st  Century has  absorbed a broadest knowledge  of biochemistry, genetics, pathology,  pharmacology, which make  to do wonders.  More and  more common is definition of medicine as personalized or patient-centred. However exact meanings of such “centredness” are still vague. This article is an attempt for modern reading of a classical text by G. A. Zakharyin, one of the most prominent figures in classical  medical  thought.  A  “commented reading”  is provided  of his  “Clinical Lectures”  with emphasis  on the meanings  of wholeness  of a patient  as  the one merged   into  social  background,  having  psychological  suffering  together   with somatic  pathology  itself. The possibility is commented on how to explicate  the author’s thoughts to modern evidence based  practice of medicine.

By the date,  acute  heart failure (AHf) is of the most significant problems  in whole world healthcare, as it is one of the main causes for hospitalization to specialized units and intensive care units. About 80% of AHf cases are due to acute decompensation (AD) of heart failure (Hf), and if formerly AHf was regarded as a condition  actual  only for  elderly  (older  than  70),  now  these   are  the  patients “younger” — economically active (50-65 y.o.), what makes AHf not just medical but social,  economical   problem,   demanding   special  attention   from  policies  and healthcare. It is  crucial  to  diagnose   on-time  for risk stratification  and  correct assessment. Also,  mechanisms  of  AHf  are  complicated  and  are  not  studied completely, that is why till now there  is no single strategy  for that sort of patients management. Understanding of pathophysiological mechanisms of Hf development has been  changed significantly recent  decades, from simple hemodynamic  model to a conception  of systemic  multifactorial process, with involved multiple mechanisms of various organs  and systems  interaction. Hemodynamic overloads, venous congestion, neuro-humoral  systems  activation, natri-uretic peptides, inflammation, endothelial dysfunction, oxidative stress and its influence on the heart and  vessels  remodeling,  as  mechanisms of cellular adaptation  are  currently the main in AHf pathogenesis reasons.

The article provides a review of data on cardiovascular patients’ treatment, with 1-3 grades  of chronic kidney disease (CKD). It is shown that for cardiovascular patients the function of kidneys must be assessed before beginning of treatment, which is important  for  on-time  diagnostics   of  CKD. Practitioners   must  remember  that patients with the 3rd grade of CKD require specific nephroprotection. On all stages of the disease optimal nephroprotectors are inhibitors of renin-angiotensine system (RAs)  (blockers  of  angiotensine receptors  (ARB) and  angiotensine  converting enzyme inhibitors (ACei)). The evidence provided for relation of ARBs nephroprotective effect with dosage, and that these  drugs must be used in highest tolerated dosages, but not in minimal effective dosage that leads to normalization of BP. It is shown that combination of ACei and ARBs with statins enhances cardiorenal protection  as  a  result  of nephroprotective effects  synergy  of statins  and  RAs inhibitors.

Article takes into consideration pathogenetic mechanisms of cardiovascular diseases development  in obesity and insulin resistance, approaches to atherothrombotic complications prevention. The issues of resistance to antiplatelet drugs  are condsidered and possible  ways for its overcome.  The data  is evidence based.

The literary analysis is presented to underline the importance and controversy of the meaning of patient-centered medicine, which attracts  more and more researchers and practitioners. The origins of this concept are reviewed, its further directions as a novel generalized  physician  approach to a human  with opportunity  to launch positive dynamics  on all levels from somatic  to social  and  cultural.  A  range  of questions is taken,  and  the  pathways  sketched towards  conceptualization   and evidence base for practical implementation of patient-centered paradigm.

The development  and progression of atherosclerosis in most cases takes decades, and at early stages does not present clinically. Multiple studies results witness that telomere   length  reflects  total  grade   of  DNA damage by  the  factors  that  are responsible for atherosclerosis and its complications. Velocity of telomeres shortening  increases even before the disease onset  that may play diagnostic  and predictive role.

Related  to sleep  breathing  disorders  are  prevalent  kind of disordered sleep  and influence  significantly and  negatively  on  development   of  a  range   of  somatic diseases, primarily — cardiovascular  and metabolic.  Results of evidence  research witness on the relation of the sleep apnea and arterial hypertension, ischemic heart disease, heart failure, arrhythmias, cerebrovascular diseases, diabetes. Inclusion of the  methods   of  diagnostics   and  treatment  of  sleep  related   disorders   to  the standards of management and rehabilitation of patients with these nosological units is theoretically based  and clinically significant.