The challenging process of Russian healthcare reforms includes development of the healthcare concept (up to 2020) by the Ministry of Health and Social Development. The reforms are planned by prominent health managers and economy scientists who are well-recognised theorists but rarely, if ever, visit medical clinics and hospitals. As these experts have contradictory views on the Russian healthcare concept, we propose that the opinion of practitioners, such as the authors of this article, who have been working at hospital and treating patients on daily basis for several decades, has its own professional value and potential to improve prevention and treatment quality. Should the Russian healthcare be free of charge, according to Article 41 of the Russian Federation Constitution, or should it be based on market health insurance, according to the Head of the High School of Economics, Mr E.G. Yasin? At the moment, this is the main point of debates on the Russian healthcare concept. The authors believe that for the patients’ sake, the Russian healthcare system should combine both approaches.

In total, 22 healthy people (20 men, 2 women), aged 19–46 years (mean age 32,2±1,2 years), were examined. Mean blood pressure (BP) was 118,4±1,4/177,3±1,4 mm Hg. Repeated large artery Doppler ultrasound was performed. In healthy people, maximal and minimal blood flow velocity in common carotid artery was 1,5 and 2,8 times higher than in femoral and brachial arteries, respectively (р<0,001). Volume and energy components of blood flow are maximal in large arteries, due to greater vessel diameter and blood flow velocity. Pulse wave velocity increases with increasing distance from the heart and does not depend on blood flow parameters. The additional wave, following the pulse wave, is formed due to aorta damping qualities. Compression and nitroglycerin tests in health people demonstrate uniform results: increased intima-media thickness and increased artery diameter.

The study aimed to assess the risk of life-threatening ventricular arrhythmias (LTVA) in patients with non-ST elevation acute coronary syndrome (ACS) and ventricular extrasystolia (VE) developing in the first 24 hours of ACS. In 46 dogs, VE with early, postponed post-depolarisation, re-entry and ischemic mechanisms was modelled. In total, 168 patients with non-ST elevation ACS and Class II-V Lawn VE were examined. All patients underwent general clinical examination as well as the assessment of late ventricular potentials (LVP), QT interval dispersion (QTd), and heart rate turbulence (HRT). In the experimental study, persistent ventricular tachycardia and/or ventricular fibrillation developed in 100%, 75%, and 85,71% of the animals with early post-depolarisation, re-entry and ischemic VE mechanisms, respectively. In the clinical study, LTVA was observed in 13,76 % of ACS patients, including 69,32 % with arrhythmia development in the first 3 days. Positive predictive value for LVP, QTd>80 ms and pathologic HRT was no more than 42%. LTVA risk could be assessed by the formula: LTVAR = А ÷ В, where LTVAR is LTVA risk in units, A – linear deviation of corrected pre-ectopic interval (ms) for at least 20 ventricular extrasystoles, calculated separately for left and right VE, and B – analysed ventricular extrasystole number (per hour). LTVAR<0,5 could be a marker of high LTVA risk, with positive predictive value of 96,34%, in non-ST elevation ACS patients with VE.

The study included 149 patients, aged 41–75 years, with Functional Class II-III stable angina, who underwent coronary artery bypass graft (CABG) surgery or percutaneous coronary intervention (PCI). Before the intervention, Group I (n=79) received standard therapy and mildronate (750 mg/d for 3 days, then 750 mg/d twice per week). Group II (n=70) did not receive any metabolic medications. Lipid peroxidation (LP) and antioxidant potential parameters were measured at baseline, 6 and 24 hours after the intervention in CABG patients; 10–15 days before, 2–3 days before and 1 day after the intervention in PCI participants. Pre-intervention mildronate therapy was associated with decreased blood levels of LP products, due to the activation of antioxidant enzymes – superoxide dismutase (SOD) and glutathione peroxidase (GP).

In 263 patients with atrial fibrillation lasting for 0,5–30 hours, pre-hospital antiarrythmic therapy (cordarone 5 mg/kg, verapamil 5–10 mg) was ineffective in the first hour. Sinus rhythm was restored in 8,8% and 11,5% of the patients receiving cordarone and verapamil, respectively. The majority of atrial fibrillation paroxysms were terminated in the first 24 hours (>90%). Cordarone and verapamil were equally effective in pre-hospital treatment of atrial fibrillation. Verapamil reduced ventricular rate more effectively.

Aim: To investigate the effects of an ACE inhibitor spirapril (S) on office and ambulatory blood pressure (BP) levels, quality of life (QoL) and psychological status (PS) in patients with Stage 1–2 arterial hypertension (AH). Material and methods: This open, randomised cross-over study (4 weeks of spirapril therapy, 4 weeks of amlodipine (A) therapy) included 39 patients with Stage 1–2 AH, aged 53,7±10,0 years; mean AH duration was 11,8±9,5 years. After 7-day wash-out period, S (6 mg) or A (5 mg) were administered; if necessary, A dose was increased to 10 mg; S dose was constant. At baseline and in the end of each treatment phase, 24-hour BP monitoring (BPM), personality traits (Multiphasic Personality Inventory) and QoL (General Well-Being Questionnaire by Marburg University) assessment were performed. No only average levels of office and ambulatory BP, but also the masked hypertension effect (MHE), as an equivalent of masked AH treatment ineffectiveness (MTI), were assessed. MHE was evaluated based on the difference between daytime ambulatory and office BP levels. Results: Both medications were effective in achieving target levels of office and ambulatory AH. MHT value was +1,3±2,0/+0,3±1,3 and +3,6±2,0/+0,3±1,3 mm Hg for S and A treatment, respectively (р<0,05), with initial value of -4,1±1,8/-3,5±1,2 mm Hg. Both medications did not affect QoL and improved some PS parameters. MTI predictors included increased body mass index and electrocardiographic signs of left ventricular hypertrophy (p<0,01– 0,05). MTI risk was lower in older patients, those receiving antihypertensive therapy, consuming moderate doses of alcohol, or having high S7 score (psychasthenia) by MMPI scale (р<0,05). Conclusion: The difference between office and ambulatory BP levels could be explained by various factors. Optimal antihypertensive effect includes achieving target levels for both ambulatory and office BP. Spirapril is an effective antihypertensive medication, facilitating target BP level achievement and PS improvement in AH patients.

Even though the problem of stroke is actively discussed in journals, monographs, conference presentations, etc., it is still unresolved, pointing to the need for more effective strategies on reducing stroke mortality, morbidity and disability. Stroke is a multifactorial disease, asking for multidisciplinary approaches in complex risk factor assessment and individual prevention programme development.