More active out-of-pocket payment for medical care by wealthy people would allow increasing healthcare funding for deprived groups of the Russian population. The country has objective prerequisites for creating elite medicine. On the other hand, there is a need to develop and approve by law the lists of medical services, provided for free as a part of regional programs of state-guaranteed healthcare, in accordance with regional medico-economic standards. Additionally, it is necessary to provide free access to these services for all citizens, especially the deprived ones.

The study was focused on assessing sympatho-adrenal system (SAS) activity in patients with arterial hypertension and included 454 hypertensive individuals at high risk. Plasma renin activity (PRA) and plasma aldosterone concentration (PAC) were measured by radio-immune method. Adrenalin and noradrenalin concentration in 24-hour urine was measured by fluorometry. SAS increase was associated with increased PRA and decreased PAC or PAC/PRA ratio. On the contrary, SAS reduction was linked to decreased PRA and elevated PAC or PAC/PRA ratio. Heart rate at rest electrocardiography correlated with 24-hour urine excretion of catecholamines.

The study was aimed at identifying the features of heart rate variability (HRV) in patients with workplace arterial hypertension (WPAH). The study included 329 men with AH, divided into two groups, according to their blood pressure monitoring results: Group I – 197 WPAH individuals, and Group II – 132 patients with essential AH (EAH). All participants underwent the five-minute HRV recording, with the analysis of temporal, spectral and histogram parameters. It was demonstrated that HRV parameters were influenced by patient age, AH stage and duration. In people aged over 40 years, WPAH was associated with increased sympathetic tone, reduced adaptation potential of cardiovascular system, and decreased humoral effects on HR, comparing to EAH. Additionally, WPAH patients with Stage I, comparing to their peers with EAH, demonstrated increased sympathetic tone, while Stage II was linked to reduced cardiovascular adaptation potential and humoral influences.

The examination of 126 patients with Stage II arterial hypertension (AH) demonstrated that in men, progressing left ventricular hypertrophy (LVH) was associated with increased free wall thickness and especially interventricular septum thickness, without LV size or volume increase but with significant reduction in right ventricular (RV) length. In females, moderate LVH was linked to increased LV free wall and interventricular septum thickness, as well as to increased LV and RV volumes. In patients with severe LVH, women had inadequate night-time blood pressure drop more often than men.

The study evaluated sympatho-adrenal system (SAS) function and lipid peroxidation (LPO) in 105 men: 95 patients with Type 2 diabetes mellitus (DM-2), including 50 individuals with arterial hypertension (AH), and 15 healthy controls. The measurements included 24-hour urine excretion of adrenaline, noradrenalin, dopamine, and DOPA, serum levels of an LPO product, malonic dialdehyde (MDA), and lipid profile (total cholesterol, low and high-density lipoprotein cholesterol, triglycerides). In DM-2 patients with AH, catecholamine and DOPA excretion, as well as serum MDA levels, were significantly higher than in controls or DM-2 patients without AH. Therefore, SAS activation, LPO, and insulin deficiency could increase metabolic disturbances in DM-2 and AH patients, which affects clinical course severity and disease prognosis.

Blood lipid (total cholesterol (CH), triglycerides, low and high-density lipoprotein CH (LDL-CH, HDL-CH), lipoprotein (a)) and non-lipid (high-sensitive C-reactive protein (hsCRP), homocysteine, interleukins (IL) beta, 6, and 8, tumor necrosis factor (TNF), metalloproteinase (MP) 3 and 9) were measured in 96 Novosibirsk men, aged 42–70 years, with angiography-confirmed coronary atherosclerosis and Functional Class II-IV stable effort angina, but without acute coronary syndrome. More than 70% of the patients demonstrated an increase in blood levels of total CH, LDL-CH, hsCRP, homocysteine, IL-6, IL-8, and especially MP-9 (elevated in 100% of the men examined).

The study aimed to identify the interrelations between pulse wave velocity (PWV) and endothelial function (EF), measured by a new non-invasive method vs. brachial artery Doppler ultrasound, as well as to investigate intima-media thickness (IMT) in carotid artery bifurcation area, in healthy people, patients with arterial hypertension (AH), and individuals with coronary heart disease (CHD). Comparing brachial-forearm PWV levels measured with the Tonocard device, and brachial artery linear blood flow velocity demonstrated statistically significant differences between velocity figures in healthy people, CHD patients, and AH participants. IMT values were significantly greater in CHD patients, but not in AH individuals, than in healthy people from the same age group. The new method for PWV and EF assessment provides an opportunity to evaluate CHD risk and risk-reducing therapy effectiveness in minimal time.

The study was focused on dibicor effects on carbohydrate metabolism (CM) and insulin resistance (IR) in patients with metabolic syndrome (MS), as well as the correlations between various CM parameters, chronic heart failure (CHF), and abdominal obesity (AO). In total, 61 patients aged 31–66 years gave their informed consent to participate in the study, including 21,7% of men and 78,3% of women. The control group (n=30) received standard therapy only, while the main group (n=30) also received dibicor. All participants underwent anthropometry, blood pressure and IR measurement, lipid and carbohydrate metabolism assessment. Twelve-month dibicor therapy was associated with improved CM and reduced IR. Functional class (FC) of CHF directly correlated with CM disturbance severity, while AO correlated with fasting and glucose tolerance test levels of plasma glucose. In MS and CHF, dibicor improved CM, reduced IR, and therefore, facilitated the CHF FC reduction.

The study assessed the dynamic of red blood cell (RBC) structure, aggregation, and deformation in patients with progressing angina receiving standard therapy or therapy including an antioxidant medication mexicor. In total, fifty 53–65-year-old patients with progressing angina and Stage III essential arterial hypertension (EAH) were examined. The comparison group included 20 patients with Stage III EAH. Angina patients were divided into subgroups, according to antioxidant-cytoprotector mexicor presence or absence in combined therapy scheme. RBC structure was assessed by phase-contrast cell microscopy; transformation index (TI), reversible transformation index (RTI), irreversible transformation index (ITI), and reversibility index (RI) were calculated. RBC aggregation was assessed by direct optic method, with mean aggregate size (MAS), aggregation index (AI), and non-aggregated RBC percentage (NAP) calculation. RBC deformation was studied by filtration method, with rigidity index (RiI) calculation. Angina patients demonstrated significant changes in RBC structure and function, comparing to the control group: reduced discocyte number, increased degenerative RBC number, AI, MAS, RiI and decreased NAP. Mexicor therapy was associated with increased discocyte and reduced degenerative RBC numbers, decreased AI and MAS, comparing to standard therapy scheme. Combined mexicor-including therapy demonstrated beneficial effects on RBC structure, aggregation and deformation in patients with progressing angina. Studying the dynamics of RBC rheology provides the evidence for choosing additional pharmaceutical therapy and assessing its effectiveness.

In total, 149 patients, aged 41–75 years, with Functional Class (FC) II-III stable angina, who underwent coronary artery bypass graft surgery (CABG) or percutaneous coronary intervention (PCI), were examined. Group I (n=79) received standard therapy, as well as post-intervention mildronate therapy (750 mg/day for three days, then 750 mg per day twice a week). Group II (79 controls) did not receive any metabolic medications. Total and local left ventricular (LV) myocardial contractility was assessed by echocardiography 10–15 days before, 2–3 days before, and 10–12 days after the revascularisation. Mildronate therapy was associated with total and local myocardial contractility improvement, observed even before the intervention and further increasing after the operation. It was also linked to the reduction in post-revascularisation, reperfusionrelated LV myocardial dysfunction.

In 62 patients with Stage I-II arterial hypertension (AH) and metabolic syndrome (MS), clinical effectiveness and insulin resistance (IR) effects of a non-selective alpha-beta-adrenoblocker carvetrend were investigated, for 16-week carvetrend monotherapy, carvetrend combination with corinfar UNO, or their combination with formin and zorstat. Carvetrend, as monotherapy or combined with corinfar UNO, effectively reduced office and 24-hour monitoring blood pressure levels, regardless of the risk factor number. Carvetrend increased peripheral tissue insulin sensitivity, without affecting carbohydrate and lipid metabolism.

The manifold studies on ACE gene impact on left ventricular hypertrophy (LVH) development in hypertrophic cardiomyopathy (HCMP) and arterial hypertension (AH) have provided too contradictory results to clarify the association between ACE gene I/D polymorphism and cardiovascular pathology in these nosologic forms. The study aimed to analyse the associations between clinical course, LVH severity, and ACE gene polymorphism among HCMP and AH patients. In total, 35 HCMP patients and 33 individuals with long AH duration and LVH were examined. ACE gene I/D polymorphism was studied by PCR method. Electrocardiography (ECG) and echocardiography (EchoCG) were also performed. In HCMP, ID type of ACE gene was associated with more severe ECG signs of LVH (voltage, ST-T changes), comparing to DD type. II Type was linked to greater myocardial mass, interventricular septum thickness, and left atrium dilatation, comparing to DD type. II allele was regarded as a risk allele. In AH and LVH, ACE gene ID type was associated with a tendency towards greater interventricular septum thickness, while II allele was very rare (5,4%) and linked to LVH absence. No relations to clinical course and ECG changes were observed.

The aim of the study was to investigate the phenotypic manifestations of chromosome nucleoli area transcription activity, at the level of erythrocyte cell membrane main proteins, as a cytogenetic marker of arterial hypertension (AH) risk. The comparison of AH patients and people at AH risk demonstrated significantly reduced activity of nucleoli area 10Ag activity, comparing to the main population. In the former, this could explain less active erythrocyte membrane protein synthesis, linked to AH development. Therefore, human nucleoli area 10Ag levels could be regarded as a cytogenetic marker of AH risk and development.

At certain phylogenesis stages, during closed circulatory system formation, the heart as a central pump was included into the peripheral peristaltic pump system of muscular type arterioles, which had been functioning for centuries. Hydrodynamic pressure, or blood pressure, could be a physical factor regulating metabolism in the body as a whole. Cell destruction in paracrine-regulated complexes is associated with superoxide anion inactivation of NO – the regulator of peristaltic pump function. The heart compensates cell perfusion by increasing hydrodynamic pressure in intravascular pool, proportionally to peripheral resistance. Cell degradation products disturb biological endoecology, which could be restored by inflammation activation (endothelium monolayer trans-cytosis and macrophage utilisation of biological “debris” with high molecular mass), as well as by increased glomerular filtration eliminating endogenous pro-inflammatory agents of low molecular mass. Passive stages of these biological reactions are activated by hydrodynamic pressure increase. Blood pressure could be considered, therefore, as a part of the complex biological reaction of inflammation. Exotrophy disturbances could also lead to intercellular «debris» accumulation, disturbed endoecology, and compensatory inflammation. Disturbed homeostasis and passive trans-cytosis in bio-layers separating local pools in vivo (liquor, placenta, renal, and pulmonary pools) are also compensated by the heart, by increased hydrodynamic pressure in intravascular pool. Homeostasis, exotrophy, and endoecology disturbances need to be compensated by activated inflammatory reaction, heart hyper-function, and increased hydrodynamic pressure. This is the main course of increasing arterial hypertension incidence in developed countries.