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Aim. To identify whether the addition of red blood cell distribution width (RDW) could improve the Global Registry of Acute Coronary Events (GRACE) risk score 2.0 in patients with acute myocardial infarction (AMI).Material and methods. This prospective observational study included 577 AMI patients who underwent coronary angiography within 24 hours after symptom onset. Admission RDW was measured as part of the automated complete blood count. GRACE 2.0 score at admission was calculated. The clinical endpoint was 18-month all-cause mortality. Logistic regression analysis was used to identify predictive values of RDW. Area under the receiver-operator characteristic (ROC) curve (AUC), net reclassification improvement (NRI) and integrated discrimination improvement (IDI) were calculated to evaluate the increment of predictive value for the combination of RDW with GRACE 2.0 score in predicting clinical adverse outcome.Results. The median age of patients was 65 (interquartile range: 56-74) years, while 60,7% were male. During 18-month follow-up, 66 patients (11,4%) died. RDW was positively correlated with GRACE 2.0 score (r=0,16, p

Создание руководства поддержано Советом по терапевтическим наукам отделения клинической медицины Российской академии наук.

Aim. To evaluate the impact of acute kidney injury (AKI) on in-hospital (death) and long-term outcomes (rehospitalization or death within 30 days; death within 180 days) in hospitalized patients with coronavirus disease 2019 (COVID-19).Material and methods. The registry of patients with COVID-19 was analyzed to identify risk factors (RFs) for mortality. Discharged patients were included in a prospective study. Outcomes were assessed by telephone contacts.Results. The study included 1000 patients. The mortality rate was 20,8%, while AKI was registered in 29,6% of patients. According to multi­variate analysis, AKI, regardless of other risk factors, increased the risk of death (hazard ratio (HR), 1,62, 95% confidence interval (CI): 1,08-2,44, p=0,02). The prospective part included 691 patients. We revealed that 10% were rehospitalized or died within 30 days, while independent risk factors were age >65 years (HR, 2,72, 95% CI: 1,47-5,01, p=0,001) and AKI in the acute phase of COVID-19 (HR, 1,67, 95% CI: 1,00-2,80, p=0,05). In addition, 6% of patients died within 180 days, while AKI was the risk factor for death according to univariate analysis; the only independent predictor was age >65 years (HR, 5,96, 95% CI: 2,26-15,72, p

The guidelines have been developed for internists, general practitioners, emergency physicians, and paramedics. The guidelines are based on expert consensus papers, accumulated clinical and scientific experience. The methodology for organizing and conducting ultrasound-assisted examinations is described in detail. Algorithms for diagnosing the main syndromes in internal medicine practice are presented to help the practitioner. Particular attention is paid to the methodology of ultrasoundassisted examinations. These guidelines will be of interest to doctors, heads of medical facilities, as well as students of medical universities.

Expert Council: Drapkina O. M., Vavilova T. V., Karpov Yu. A., Kobalava Zh. D., Lomakin N. V., Martynov A. I., Roitman E. V., Sychev D. A.Scientific communities: the Russian Society for the Prevention of Non-Communicable Diseases (ROPNIZ), the Russian Scientific Medical Society of Therapists (RNMOT), the Russian Antithrombotic Forum (RAF), the National Association for Thrombosis and Hemostasis (NATH).

Aim. To evaluate the association of a high normal blood pressure (BP) with the risk of early hypertension-mediated organ damage (HMOD) in young adults.Material and methods. Medical screening of population aged 18-45 years (n=987) revealed that in 173 persons, office BP corresponded to a high normal level or hypertension (HTN). Echocardiography (GE Healthcare Vivid 9, using EchoPAC Software) was performed when HTN was confirmed by office BP measurement and/or according to 24-hour ambulatory BP monitoring (ABPM) (n=127). In addition, creatinine and albumin-to-creatinine ratio in spot urine were measured.Results. The median age was 23 [21; 25] years. The median systolic (SBP) and diastolic BP (DBP) was 129 [121; 137] and 75±12 mm Hg, respectively. The detection rate of LV geometry abnormalities was 3,3 times higher in the high normal BP group [95% CI, 1,06-6,28, p=0,02], and 10,7 times higher in the HTN group [95% CI, 2,32-16,49, p=0,04] compared with the optimal+normal BP group. In a multivariate analysis, the independence of associations with the LV mass index (LVMI) was confirmed only for the mean nighttime DBP, left atrial volume index, and the ratio of LV peak early diastolic velocity to the average septal and lateral peak early diastolic mitral annular velocity.Conclusion. In young people, the prevalance of HMOD is comparable in the groups with high normal BP and HTN, while significant differences were found between the group with optimal+normal BP levels and patients with HTN and high normal BP. An independent association of elevated LVMI with mean nighttime DBP was found.

Heart failure is a severe disease with an unfavorable prognosis, which requires intensification of therapy and the search for novel approaches to treatment. In this review, the physiological significance of soluble guanylate cyclase-related signaling pathway, reasons for decrease in its activity in heart failure and possible consequences are discussed. Pharmacological methods of stimulating the production of cyclic guanosine monophosphate using drugs with different mechanisms of action are considered. Data from clinical studies regarding their effectiveness and safety are presented. A promising approach is stimulation of soluble guanylate cyclase, which showed beneficial effects in preclinical studies, as well as in the recently completed phase III VICTORIA study.

Comorbidity of diabetes mellitus (DM) with arterial hypertension (AH) leads to four-time increase of cardiovascular risk (CVR). Achievement of target blood pressure (BP) is one of the main strategies of cardiovascular complications prevention in DM patients. Efficacy of azilsartan medoxomil is higher than of other drugs from the group.Aim. To study changes in peripheral and central BP daily profile andparameters of arterial stiffness in replacement of RAAS blocker as a partof two component antihypertension therapy (AHT) by 40 mg azilsartan medoxomil for patients with AH and type 2 DM, with dose titration to 80 mg if target BP not reached.Material and methods. Thirty AH+DM2 patients not having targetBP

Recently, there was plenty studies published on the arterial stiffness assessment, and importance of this was proved as an independent prediction parameter, together with standard cardiovascular risk factors. In current document, we collect and structure the available clinical and scientific data from abroad and Russian studies. The aim of current publication is the need to bring a reader the importance of demanded in clinical practice ways of arterial wall stiffness assessment, information about conditions when it is important to the assessment, and available restrictions, as the issues remaining unresolved.

The high prevalence of persistent dyslipidemia in primary and specialized care patients treated with statins justifies the need to identify its reasons and develop the recommendations on the treatment optimization. At present, Russian studies focusing on the achievement of target lipid levels remain scarce, which emphasizes the importance of the problem and its further investigation. Aim. Cross-sectional epidemiological study which assessed the prevalence of persistent dyslipidemia in statin-treated patients and analysed the predictors of the achievement of target lipid levels. Material and methods. The lipid profile parameters were analysed in 1586 statin-treated out-patients with varied levels of cardiovascular risk, taking into account the type of lipid-lowering therapy and its doses. The assessment of the cardiovascular event (CVE) risk and the definition of target levels of low-density lipoprotein cholesterol (LDL–CH), as well as normal levels of triglycerides (TG) and high-density lipoprotein cholesterol (HDL–CH), was based on the clinical recommendations by the European Society of Cardiology (ESC 2007) and by the European Society of Cardiology and the European Atherosclerosis Society (ESC/EAS 2011). Results. The analysis based on the ESC 2007 recommendations has demonstrated that the target levels of LDL–CH (

This review is focussed on the problem of venous thromboembolism in patients with heart failure (HF). The results of the major clinical trials of antithrombotic therapy in HF patients are presented. The authors discuss comparative effectiveness, safety, and tolerability of unfractionated heparins, low molecular weight heparins, and fondaparinux. The results of the two trials, MAGELLAN and ADOPT, are expected to clarify the clinical potential of such oral anticoagulants as rivaroxaban and apixaban (Factor Xa inhibitors). The problem of low rates e of preventive antithrombotic administration is emphasized.

Aim. To assess the risk of fatal cardiovascular (CVD) events in medical doctors of various specialities, using modern risk scales, and to identify the target groups for primary prevention with a fixed-dose combination of enalapril / hydrochlorothiazide (HCT) and simvastatin. Material and methods. The programme included 12 non-teaching Russian hospitals and was divided into epidemiological, educational, therapeutic, and control phases. In 699 doctors, aged >40 years and representing 43 specialities (22,8% men; mean age 50,5±11,7 years), the risk of fatal CVD events and coronary events was assessed with SCORE and Framingham scales, respectively. All doctors were informed about their individual risk and target levels of risk factors (RFs), and also taught to self-control their blood pressure, physical activity, and body mass. In total, 287 doctors participated in the therapeutic phase (6 months): 52 were included in the antihypertensive therapy (AHT) group (enalapril/HCT); 38 – in the simvastatin group; and 197 – in the combined therapy group (AHT and simvastatin). Six months after the end of the therapeutic phase, the prevalence of continuing pharmaceutical and non-pharmaceutical primary prevention was analysed. Results. The prevalence of the main RFs was high: dyslipidemia was observed in 69,2% of the participants, AH – in 55,6%, abdominal obesity – in 34,5%, and smoking – in 14%. As many as 54,5% of the doctors had at least 3 RFs, while 25,8% had high SCORE-assessed risk, and 47,1% had indications for pharmaceutical primary prevention. The most adverse RF profile was registered in surgeons. Pharmaceutical primary prevention with a fixed-dose combination of enalapril/HCT and/or simvastatin significantly reduced both SCORE and Framingham risk levels. Six months after the therapeutic phase, 30,2% of the doctors stopped the treatment, and 37,2% continued pharmaceutical primary prevention. Conclusion. The results of the programme point to the high prevalence of modifiable RFs in middle-aged medical doctors. The data obtained could be a basis for the programs of primary CVD prevention.

Currently, one of the important clinical issues is the combination of chronic heart failure (CHF) and anaemia, which aggravates CHF course and prognosis. The main pathogenetic mechanism of anaemia development in CHF is absolute or relative erythropoietin deficit, due to pro-inflammatory cytokine effects, and renal dysfunction. The recent studies have demonstrated that correcting even moderate anaemia in CHF results in increased exercise tolerance, reduced NYHA functional class, improved quality of life, cardiac morphology and function, decreased need for diuretics, and reduced hospitalization incidence. However, there are no available data on anaemia correction effects on long-term survival, as well as on haemoglobin levels needed to start the anaemia treatment, or safe target levels of haemoglobin.

The paper discusses the definition and classification of cardio-renal syndrome (CRS) — a pathological process in heart or kidneys, characterised by acute or chronic dysfunction of one organ which results in acute or chronic failure of the other organ. The pathophysiological mechanisms, diagnostics, and treatment are described for each clinical variant of CRS.

Aim. To investigate the variants of left ventricular (LV) remodelling in men aged 18-25 years, with and without arterial hypertension (AH). Material and methods. In total, the study included 211 men aged 18-25 years (mean age 21,1±0,14 years), with random blood pressure (BP) elevation at previous clinical examinations. All participants underwent repeat BP measurements, 24-hour BP monitoring (BPM), echocardiography with calculation of LV myocardial mass index (LVMMI) and relative wall thickness (RWT), and evaluation of LV diastolic function (DF). Results. According to the results of clinical BP measurements and 24-hour BPM, normal BP levels were observed in 36 participants (17 %), stable AH — in 124 (58,7 %), and unstable AH — in 51 (24,3 %). In patients with stable AH, LVMMI was significantly higher than in individuals with normal BP. Among participants with stable AH, 43 (34,7 %) had normal LV geometry, 75 (60,5 %) had concentric LV remodelling, and 6 (4,8 %) — concentric LV hypertrophy. Among participants with unstable AH, 14 (27,5 %) had concentric LV remodelling. Comparing to normotensive individuals, patients with stable and unstable AH had lower transmitral flow ratio E/A, and significantly higher peak A velocity. Conclusion. In young 18-25-year-old men with stable AH, the typical LV remodelling variant was concentric remodelling, with a tendency towards LV diastolic dysfunction development.

This literature review is focused on the modern diagnostic methods in pre-clinical renal pathology. The wide prevalence of renal dysfunction in cardiovascular disease (CVD), its role in the stratification of cardiovascular and renal complication risk, and the potential for medical prevention of these complications justify the search for the methods diagnosing pre-clinical renal pathology. Increased serum creatinine, reduced creatinine clearance or estimated glomerular filtration rate (GFR), and microalbuminuria are independent predictors of cardiovascular morbidity and mortality. In all patients with arterial hypertension, estimated GFR and urinary albumin excretion should be assessed. Nephroprotective strategies, delaying progression of proteinuria and GFR reduction, should be identified.

Aim. To investigate a new technique of transcutaneous electroneurostimulation of reflexogenic zones by shortimpulse current (DiaDENS-Cardio) as a potential method to improve blood pressure (BP) control in patients with arterial hypertension (AH) uncontrolled by three-component therapy.Material and methods. A placebo-controlled study of DiaDENS-Cardio device included 60 AH patients, receiving regular three-component antihypertensive therapy but failing to achieve the target BP level

Aim. To compare the wall rigidity of common carotid artery (CCA), assessed by ultrasound (US), in young men with arterial hypertension (AH).Material and methods. The study included young men aged 18-25 years (mean age 22 years): 25 with normal blood pressure (BP) during office visits and 24-hour BP monitoring (BPM), 11 with white coat AH (WCAH), and 23 with AH. Intima-media thickness (IMT) was examined by B-mode US, maximal systolic and minimal diastolic diameters — by M-mode US. Elasticity and dispensability coefficients, Peterson’s elasticity module, Young module, and flow deformation index were calculated.Results. In AH patients, IMT levels and CCA wall rigidity were higher than in young men with normal BP or WCAH.Conclusion. In young men aged 18-25 years, AH, confirmed by office measurement and 24-hour BPM, was asso­ciated with carotid artery remodelling and reduced elasticity.

Pathophysiologic mechanisms of central aortal pressure (CAP) are more complex than those of peripheral pressure, measured at brachial artery level. CAP indirectly reflects the state of circulatory system as a whole, since it is modulated by aorta elasticity, as well as structure and function of middle arteries and microcirculatory vessels. The difference between central and peripheral systolic blood pressure is maximal in young people and decreases in the elderly. For non-invasive CAP measurement, radial artery applanation tonometry is used, with subsequent computer transformation of peripheral pulse wave into central one, or applanation tonometry of carotid artery. The growing body of evidence supports the use of CAP measurement in assessing cardiovascular risk assessment and comparing various therapeutic regimens.

Aim. To study the effects of an angiotensin II receptor antagonist (ARA II) valsartan, a statin (fluvastatin XL), and their combination on endothelial function (EF) in patients with arterial hypertension (AH) and dyslipidemia (DLP).Material and methods. In total, 30 patients with untreated, non-complicated Stage I-II AH and DLP IIA or IIB were randomised for 8-week monotherapy with valsartan or fluvastatin XL, with the subsequent addition of the second component, fluvastatin XL or valsartan, respectively.Results. Valsartan monotherapy was associated with a reduced increase in linear blood flow velocity (LFV) during the reactive hyperemia test (RHT) - 177,7+5,8 vs. 170,0+4,9% (p0,05). Eight-week monotherapy with fluvastatin XL (80 mg/d) was linked to moderate but statistically significant reduction (-2%) in systolic blood pres­sure (SBP), with no effect on diastolic BP level. In RHT, LFV increase did not change, but EF improved, as manifested in BA EDVD increase. Prolonged combined therapy resulted in further EF improvement.Conclusion. Combined fluvastatin XL and valsartan therapy in patients with untreated Stage I-II AH and DLP IIA or IIB improved EF more effectively than valsartan or fluvastatin XL monotherapy.

Aim. To study the clinical and diagnostic role of pulse wave time (PWT) in 24-hour blood pressure monitoring (BPM) and its link to elasticity of larger arteries and aorta (carotid-femoral pulse wave velocity, PWVcf; cardioankle vascular index, CAVI) in patients aged over 75 years.Material and methods. The study included 52 patients (20 men) aged over 75 years (mean age 79,1±3,5 years) with arterial hypertension (AH). Fifteen participants had cardiovascular events (CVE) in anamnesis: myocardial infarction, MI (n=11) or stroke (n=4). Sixteen patients had Functional Class II-III angina (n=16), and 32 received antihypertensive therapy. 24-hour BMP and PWT parameters were measured. Corrected PWT100-60 was calculated for systolic BP (SBP) 100 mm Hg and heart rate (HR) 60 bpm. PWVcf and CAVI were assessed with a screening device VS 1000 VaSera, Fukuda Denshi, Japan.Results. In all participants, clinical BP level was 147,5+6,9/76,5+5,1 mm Hg; 24-hour BPM BP level - 139,6+6,7/70,7+4,6 mm Hg; PWT100-60 - 161,7+6,2 ms; PWVcf - 17,3+4,6 m/s, and CAVI - 10,6+3,1. A sig­nificant negative correlation between PWT100-60 and 24-hour BPM SBP (r=-0,36, p

Aim. To evaluate the role of calculated glomerular filtration rate (GFR), microalbuminuria (MAU) and cystatin С assessment in renal pathology diagnostics among patients with arterial hypertension (AH) and normal or mildly elevated serum creatinine level.Material and methods. In 114 non-diabetic patients with non-treated AH (age 53,0+1,0 years, creatinine 94,3+1,7 mkmol/1) and 158 patients with AH and diabetes mellitus, DM (age 56,2+0,7 years, creatinine 81,6+1,2 mkmol/1), serum creatinine, MAU by albumin/urine creatinine ratio, and calculated GFR by Cockroft-Gault and MDRD formulas (GFRl, GFR2) were assessed. In patients with AH and DM, cystatin С level was also measured.Results. Among non-diabetic AH patients with normal creatinine level, decreased GFR2

The recently emerged concept of cardio-reno-metabolic continuum supports common pathogenesis, development and progression risk factors (RF) for renal dysfunction and cardiovascular disease (CVD), as well as the importance of renal dysfunction, from subclinical disturbances to terminal renal failure, for CVD outcomes. Fhe review summarizes the data on uric acid as a marker of renal dysfunction and CVD RF. Original results, obtained by the authors, are also presented.

Aim. As a part of ARGUS-2 program, to demonstrate the reserves for arterial hypertension (AH) control improvement, by rational monotherapy or combined therapy with diuretics in patients with uncontrolled AH in anamnesis: individuals with isolated systolic AH (ISAH), diabetes mellitus (DM), chronic nephropathy (CN), and metabolic syndrome (MS). Material and methods. This open, non-comparative study, without washout period, included 1438 patients (mean age 57,3±10,7 years, blood pressure, BP 158,8±14,2/93,4±10,0 mm Hg), not achieving target BP levels (

More frequent statin prescription, to achieve lower target low-density lipoprotein levels, as well as statin dose increase, is associated with inevitable raise in adverse event rates. The article compares statin benefits and the risk of adverse liver, muscle, brain, and kidney effects.

Aim. Pulse wave velocity (PWV) is a classic index for arterial and aortal elasticity assessment. Aortal PWV is a strong independent predictor of cardiovascular mortality in patients with arterial hypertension (AH). The aim of the study was to investigate arterial elasticity in the elderly AH patients, as well as to assess the effectiveness, safety, and PWV effects of indapamide retard 1,5 mg (Arifon retard) in individuals aged over 80 years. Material and methods. The study included 89 patients aged over 65 years. Using vascular screening system VS-1000 VaSera, Fukuda Denshi, Japan, brachial-ankle PWV (PWVba), carotid-femoral PWV (PWVcf), cardioankle vascular index (CAVI), ankle-brachial index (ABI) were determined. Sixteen patients aged over 80 years, not treated with antihypertensive medications before, were administered Arifon retard (1,5 mg once per day) as 12-week monotherapy. At baseline and in the end of the follow-up period, PWV parameters were measured. Results. Maximal PWV and CAVI values were registered in patients aged over 80 years, comparing to younger participants. There were significant associations between PWVba and age (r=0,49), systolic blood pressure (BP) (r=0,54) and pulse BP (r=0,53), between PWVcf and systolic BP (r=0,62), pulse BP (r=0,66) and diastolic BP (r=- 0,48). There was no correlation between CAVI and BP. Arifon retard treatment associated with significant reduction of systolic and pulse BP, without orthostatic hypotension development, as well as with PWVba and PWVcf decrease. CAVI did not change significantly. Conclusion. In AH patients aged over 80 years, with decreased vascular elasticity, Arifon retard treatment resulted in well-tolerated reduction of systolic BP, pulse BP, and aortal PWV. CAVI was independent of BP level and did not change during the treatment.

Principal results of the Russian Research and Clinical Program ARGUS. In this patient group, arterial hypertension (AH) control is very low, as well as diuretic prescription rate. High AH-related hospitalization rate is an evidence of a need for studying AH in-patient management problem, clinical and psychological profiles of hospitalized patients. Blood pressure (BP) control improvement is possible only with complex efforts of health professionals and patients. Theory-practice gap in AH management could not be eliminated by traditional educating programs, focused on doctor and patient awareness increase only. BP control problem might be a result of doctors’ psychological barriers, in respect to BP target level achievement, ad well as of patients’ low motivation and unsatisfactory therapy compliance. There is a need for a program studying psychological problems of health professionals and patients, obstacles for adequate AH management and demonstrating perspectives of rational diuretic use in patients with uncontrolled AH. To solve these tasks, the project «Improving arterial hypertension control in patients with high cardiovascular event risk» (ARGUS-2) was developed.

Aim. To assess middle-size vessel wall status, by volume compression oscillometry method, in patients with arterial hypertension (AH) and various variants of left ventricular (LV) remodeling. Material and methods. The study included 112 patients (44 males; mean age 53.5±11.1 years) with AH and reproducible LV myocardial mass index (LVMMI) >100 g/m2 at echocardiography. Brachial artery (BA) wall status was assessed by volume compressive oscillometry method. Results. LVMMI significantly correlated with levels of systolic and pulse blood pressure (BP) (r=0.28 and r=0.29, р

Such periinterventional complications of percutaneous coronary intervention (PCI) as myocardial infarction (MI), “no-reflow/slow-flow” phenomenon, and stroke, affect long-term survival. Therefore, their risk should be effectively stratified and reduced. The existing approaches for predicting the risk of periinterventional complications are typically focussed on assessing the fatal outcome probability and do not consider modifiable risk factors, which restricts their use to evaluation of PCI benefits and risk only. Periinterventional statin therapy reduces the risk of periinterventional MI both in patients with stable angina and individuals with acute coronary syndrome. This beneficial action could be related to anti-inflammatory, antioxidant, antithrombotic, NO- and immunomodulating effects of statins. The evidence on cardioprotective effects of periinterventional beta-blocker therapy is contradictory for PCI patients. Existing data on the link between beta-blocker treatment and increased risk of “slow flow” phenomenon, coronary artery spasm, heart failure, and arterial hypotension point to the need for optimisation of the pulse-reducing component of pharmaceutical PCI support. One of the promising methods for solving this problem could be administration of ivabradine – a medication with confirmed anti-ischemic and antianginal action, but no effects on myocardial contractility or blood pressure level.