To investigate volume, velocity, and energy hemodynamic parameters of large arteries among elderly patients with arterial hypertension (AH), 50 AH men, aged 62-88 years (mean age 76,3±0,9 years; mean AH duration 16,0±1,2 years) were examined. Duplex ultrasound of common carotid artery (CCA), brachial artery (BA), and femoral artery was performed. For each large artery, the following hemodynamic parameters were calculated: blood flow volume per 1 second (Q, cm³/s) in each phase, total (all phases) blood flow volume per 1 minute, and kinetic energy (h_V) of pulse wave (PW). In elderly AH patients, compared to healthy controls, blood flow volume per 1 minute was increased, with blood flow redistributed towards CCA and BA. The magnitude of these changes was the largest in patients with elevated maximal and minimal blood pressure (BP_max, BP_min). In AH subjects with normal BP and isolated systolic AH (ISAH), blood flow volume in large arteries was higher than in healthy individuals, but lower than in AH patients with elevated BP_max and BP_min. BP level was determined by the energy parameter of PW (h_V). Compared to healthy individuals, the highest h_V value was observed in ISAH patients. PW with high h_V resulted in earlier first tones and lower last tones under the cuff, which led to higher BP_max and normal or lower BP_min values. Increased tone of BA wall resulted in last tones being registered at higher cuff pressure levels and, therefore, increased systolic BP_max and BP_min in AH patients.

The authors studied specific clinical features of ischemic chronic heart failure (CHF) in elderly patients, in comparison with the analytical parameter of CHF diagnostic quality (CHF diagnostic index, CHFDI). The main clinical, laboratory, and instrumental parameters, associated with CHF hypo- and hyper-diagnostics in elderly patients were identified. The analysis of power and directions of the CHFDI associations allowed the authors to develop an algorithm for CHD diagnostics in elderly patients with normal body weight or obesity.

In 27 patients with idiopathic atrial fibrillation (AF), echocardiography and the measurement of serum levels of NT-pro-BNP and endotoxin were performed before and after the restoration of sinus rhythm. After sinus rhythm restoration, the volume of left atrium (from 69,2±4,3 to 55,7±2,4 ml; р<0,01) and right atrium (from 57,2±4,1 to 48,2±2,5 ml; р<0,01) decreased; the levels of systolic (from 28,6±0,9 to 25,3±0,3 mm Hg; р<0,01) and diastolic (from 11,5±0,6 to 9,2±0,5 mm Hg; р<0,01) pressure in pulmonary artery were reduced; NT-proBNP concentration decreased from 1610±645 to 864±463 pg/ml (р<0,05); and endotoxin level decreased from 0,31±0,04 to 0,25±0,03 U/ml (р<0,01). The results obtained point to the association between AF and subclinical congestive disturbances of both systemic and pulmonary circulation.

The study was aimed at assessing the effects of autonomous nervous system (ANS) imbalance on heart structure and function in healthy individuals. In total, 50 healthy people (11 men, 39 women; mean age 35,4±10,2 years), free from cardiovascular disease or extra-cardiac pathology, were examined. All participants underwent 24-hour ECG monitoring and transthoracic echocardiography. Based on the index of sympatho-vagal balance (LF/HF), all subjects were divided into two groups: Group I (LF/HF<2,5; n=24) and Group II (LF/HF>2,5; n=26). Heart rate variability (HRV) analysis demonstrated a statistically significant decrease in HF, SDNN, NRVti during the night, and RMSSD in Group II. Therefore, a reduction in total HRV was mostly due to decreased parasympathetic activity. In Group II, end-diastolic volume and myocardial systolic stress (MSs; p=0,009) were significantly elevated, while the ratio of ejection fraction (EF) to MSs was decreased. Therefore, “optimal” wall tension during the left ventricular (LV) ejection phase was disturbed. These results were confirmed by moderate correlations between LF/HF and MSs (r=0,39; p=0,005) and between LF/HF and EF/MSs (r=-0,36; p=0,01). Even in healthy people, ANS imbalance could result in increased LF load and functional LF disadaptation. Therefore, ANS imbalance could be considered as one of the cardiovascular risk predictors.

The dynamics of 24-hour blood pressure monitoring (BPM) and cognitive function parameters was assessed in 108 elderly patients with arterial hypertension (AH), who received combined antihypertensive therapy including Mexicor. All patients were randomized into three groups. Antihypertensive treatment included Mexicor in combination with either Ravel (indapamide), or Felodip (felodipine), or Lorista (losartan). Parallel groups were treated with Ravel, Felodip, or Lorista only, without Mexicor. Cognitive dysfunction and its dynamics were assessed by MMSE (Mini-Mental State Examination), clock drawing test, and Schulte test. The maximal beneficial dynamics of BPM parameters was observed for the combined therapy with Ravel and Mexicor, being slightly less pronounced for the combined therapy with Lorista and Mexicor, or Felodip and Mexicor. Target BP levels were achieved in 66,7%, 52,2%, and 47,6% of the patients, respectively. Adding a cytoprotector Mexicor to the complex antihypertensive therapy resulted in cognitive function improvement. The combination of Ravel and Lorista with Mexicor was associated with a significant improvement in cognitive function only in patients who achieved target BP levels, while the combination of Felodip and Mexicor improved MMSE scores in all patients, regardless of target BP achievement. Therefore, in elderly AH patients, the addition of a cytoprotector Mexicor to the complex antihypertensive therapy is associated with improved cognitive function.

The dynamics of 24-hour blood pressure monitoring (BPM) and cognitive function parameters was assessed in 108 elderly patients with arterial hypertension (AH), who received combined antihypertensive therapy including Mexicor. All patients were randomized into three groups. Antihypertensive treatment included Mexicor in combination with either Ravel (indapamide), or Felodip (felodipine), or Lorista (losartan). Parallel groups were treated with Ravel, Felodip, or Lorista only, without Mexicor. Cognitive dysfunction and its dynamics were assessed by MMSE (Mini-Mental State Examination), clock drawing test, and Schulte test. The maximal beneficial dynamics of BPM parameters was observed for the combined therapy with Ravel and Mexicor, being slightly less pronounced for the combined therapy with Lorista and Mexicor, or Felodip and Mexicor. Target BP levels were achieved in 66,7%, 52,2%, and 47,6% of the patients, respectively. Adding a cytoprotector Mexicor to the complex antihypertensive therapy resulted in cognitive function improvement. The combination of Ravel and Lorista with Mexicor was associated with a significant improvement in cognitive function only in patients who achieved target BP levels, while the combination of Felodip and Mexicor improved MMSE scores in all patients, regardless of target BP achievement. Therefore, in elderly AH patients, the addition of a cytoprotector Mexicor to the complex antihypertensive therapy is associated with improved cognitive function.

The object of this study is to evaluate the long-term effects of olmesartan on hypertension and the renin-angiotensinaldosterone system in hypertensive patients. This study evaluated 26 hypertensive male and female outpatients, 38-69 years of age, with a systolic blood pressure ≥160 mm Hg and/or a diastolic blood pressure ≥95 mm Hg. Oral doses of 5 to 40 mg olmesartan were administered once daily. Blood pressure and renin-angiotensin-aldosterone parameters (plasma renin activity and plasma angiotensin I, II, and aldosterone concentrations) were evaluated at 12-16 weeks, 6 months, and 1 year after the start of olmesartan administration. Systolic and diastolic blood pressures were significantly decreased following the administration of olmesartan. The observed decreases in systolic and diastolic blood pressures after 1 year of treatment were 28,8±2,1 mm Hg and 15,8±1,3 mm Hg, respectively. No change was observed in the pulse rate. The plasma renin activity increased significantly from a baseline premedication mean of 1,26±0,31 ng/ml/h to a mean of 2,58±0,74 ng/ml/h and 2,87±0,72 ng/ml/h after 6 months and 1 year of treatment, respectively. Angiotensin II levels decreased significantly from a baseline of 20,4±3,2 pg/ml to a mean of 8,6±2,1 pg/ml and 6,8±1,8 pg/ml after 6 months and 1 year of treatment, respectively. The plasma aldosterone level also decreased significantly after 6 months of treatment. In hypertensive patients, the long-term administration of olmesartan, a novel AT, receptor antagonist, decreased both blood pressure and plasma angiotensin II levels.

Most patients with hypertension require more than one agent to control blood pressure (BP). The purpose of this study was to assess the efficacy and safety of the angiotensin II receptor blocker olmesartan medoxomil in combination with hydrochlorothiazide (HCTZ). This was a randomized, double-blind, factorial design study. After a placebo run-in period, eligible patients (n=502) with a baseline mean seated diastolic blood pressure (SeDBP) of 100 to 115 mm Hg were randomized to one of 12 groups: placebo, olmesartan medoxomil monotherapy (10, 20, or 40 mg/day), HCTZ monotherapy (12,5 or 25 mg/day), or one of six groups of olmesar-tan medoxomil/HCTZ combination therapy. The primary endpoint was the change in mean trough SeDBP from baseline at week 8. Statistical analyses were conducted to determine whether at least one combination produced a larger reduction in SeDBP at week 8 than the individual corresponding component doses, but did not compare BP reductions with different combination doses. Olmesartan medoxomil plus HCTZ produced greater reductions in both SeDBP and seated systolic blood pressure (SeSBP) at week 8 than did monotherapy with either component. All olmesartan medoxomil/HCTZ combinations significantly reduced SeDBP and SeSBP compared with placebo in a dose-dependent manner. Reductions from baseline in mean trough SeSBP/SeDBP were 3,3/8,2 mm Hg, 20,1/16,4 mm Hg, and 26,8/21,9 mm Hg with placebo, olmesartan medoxomil/HCTZ 20/12,5 mg, and olmesar-tan medoxomil/HCTZ 40/25 mg, respectively. All treatments were well tolerated. Olmesartan medoxomil/HCTZ combination therapy produced BP reductions of up to 26,8/21,9 mm Hg and was well tolerated.

The aim of the study was a comparative assessment of two risk factors (gender and residence) across different variants of acute coronary syndrome (ACS). In 2007-2008, Mordovian doctors participated in the international ACS Registry. The database included 391 patients, hospitalised with ACS diagnosis: 243 from the Saransk City Clinical Hospital No. 4, and 148 from rural central regional hospitals (CRH). The prevalence of different ACS variants was similar in Saransk City men and women. Among rural ACS patients, the percentage of men was higher than the proportion of women. In Saransk City patients with Q wave myocardial infarction (MI), there were more men than women (65,4% vs. 34,6%; p=0,037), while in their peers with stable angina (SA), there were more women than men (28,9% vs. 15,6%; p=0,015). Among urban patients with non-Q wave MI and unstable angina (UA), the proportion of women tended to be higher than that of men. In rural patients with Q wave MI, there were significantly more men than women (66,0% vs. 24,0%; p<0,03). However, no difference in gender distribution was observed for patients with non-Q wave MI, UA, and SA. Multivariate analysis demonstrated that the effects of gender and residence on CHD variants were significant only for ST segment elevation ACS and Q wave MI (2-9%; p<0,01-0,001). For non-ST segment elevation ACS, non-Q wave MI, UA, and SA, the size of these non-significant effects was <1%, or even 0%.

This cross-sectional population study of the prevalence of coronary heart disease (CHD) and major coronary risk factors, in regard to work type, was performed among male refugees and migrants settled in Sumgait City (n=865; age 20-59 years). The prevalence of coronary risk factors was generally higher in non-working individuals and non-manual workers. The highest prevalence of Stage I obesity (36,4±8,4%), hypercholesterolemia (36,4±14,5%), hypertriglyceridemia (72,7±13,4%), and dyslipidemia was observed in the age group IV, among non-manual workers. The highest prevalence of low physical activity (83,0±4,%), arterial hypertension (77,8±3,7%), and hypo-α-cholesterolemia (31,3±8,2%) were also registered in the age group IV, but among non-working participants. Therefore, our results not only confirm the association between the prevalence of major coronary risk factors and work type among refugees and migrants residing in Sumgait City, but also point to the need for primary preventive interventions in this population.

Contrast-induced nephropathy (CIN) is an important problem in cardiology practice, due to the wide use of contrast-based diagnostic and therapeutic interventions in cardiac patients. Despite the high annual rates of coronary angiography and various coronary interventions, the problem of contrast-induced renal complications has not been adequately addressed and controlled. This literature review describes the link between CIN and increased risk of morbidity, mortality, and extended hospitalization. Based on the published data, the prevalence of CIN is assessed, and the major pathogenetic mechanisms of CIN are presented, with an emphasis on CIN risk factors. The methods for correction of modifiable risk factors are proposed, as an approach towards CIN prevention. In addition, modern strategies of CIN prevention and their effectiveness are analysed.

This review is focussed on the link between salt intake and the risk of cardiovascular disease. The results of international multi-centre, randomized, prospective, clinical and epidemiological studies from late 20th and early 21st century are analysed. It is demonstrated that salt intake differs across international populations, and that the amount of salt consumed is directly linked to the risk of arterial hypertension (AH) development. In addition, increased salt intake is associated with elevated AH risk and increased cardiovascular mortality rates even at relatively low levels of blood pressure.

The article is focussed on the role of a modern selective β-blocker bisoprolol in the management of coronary heart disease (CHD). The benefits of bisoprolol therapy are demonstrated for both clinical improvement and reduction in the risk of cardiovascular morbidity and mortality.