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Pulmonary hypertension (PH) is a group of diseases with a hemodynamic pattern of progressive increase in pulmonary vascular resistance (PVR) and pulmonary artery pressure (PAP), which leads to right ventricular dysfunction and the development of right ventricular heart failure.

Objective. To study the efficacy and safety of radiofrequency renal denervation with mono-electrode and multi-electrode devices in patients with uncontrolled arterial hypertension during follow-up period. Materials and methods. The study included 42 patients with uncontrolled arterial hypertension (mean age 51±12 years), while receiving multicomponent antihypertensive therapy, including diuretic. All patients underwent radiofrequency denervation of the renal arteries with a mono-electrode (n=27; group A) and multi-electrode devices (n=15; group B). The safety of the procedure was assessed using creatinine and glomerular filtration rate (MDRD equation), as well as according to ultrasound of the kidneys and renal arteries. The effectiveness of the procedure was study according to office blood pressure (BP) and ambulatory BP monitoring (ABPM). Results. In the general group, according to office BP after 6 months, there decreased in systolic (SBP)/diastolic BP (DBP) by 28/13 mm Hg (p=0.000001). According to ABPM, there was a decrease in the average daily SBP by 9 mm Hg (p=0.007) and DBP by 6 mm Hg (p=0.03). No significant changes in creatinine and glomerular filtration rate were detected in the general group. According to ABPM, after 6 months in group B, there was a decrease in the average daily SBP/DBP by 13 and 6 mm Hg (p=0.1). In group A, according to the ABPM, after 6 months, there was a decrease in the average daily SBP and DBP by 7 mm Hg (p=0.001) and 4 mm Hg (p=0.03). After 1 year, according to the office BP, there was a decrease in SBP/DBP by 14/11 mm Hg (p=0.002), and after 3 years at 15/17 mm Hg (p=0.3). Conclusion. The results confirm the safety and efficacy of radiofrequency renal denervation. Renal denervation in combination with drug therapy leads to decreasing of BP after 6 months and in the long-term

Thromboendarterectomy is undoubtedly the most widely used method in chronic thromboembolic hypertension treatment. Although surgical treatment is highly effective, it is often associated with high risk of complications. One of the main reasons for impossibility of surgery performance is distal pulmonary artery obstruction. In this case medical therapy or staged balloon angioplasty is considered the treatment of choice. This case report discusses if pulmonary artery angioplasty can be used in patients with proximal pulmonary artery obstruction.

Objective. To determine the possibility of radio frequency denervation of the renal arteries (RDN) in the treatment of patients with refractory essential hypertension (GRA). Materials and methods. The study included 57 patients with a diagnosis of the guide RAG. According to the results of surveys conducted by RDA was performed of 25 patients diagnosed with essential RAG. Within 12 months after the procedure was carried out monitoring of clinical blood pressure (BP), BP monitoring (ABPM), and laboratory evaluation of renal function and renal artery ultrasound. Statistical analysis was performed using Statistica 6.1 program, significant differences were recognized when p

Aim: to evaluate the effect of renal denervation (RDN) on the stiffness of the aorta and major arteries, central blood pressure and index augmentation in patients with resistant hypertension. Material and methods. We included 20 patients with systolic blood pressure 178 [170; 180] mm Hg and diastolic blood pressure 100 [94; 100] mm Hg on 5.1±0.7 antihypertensive drugs with diuretic, who underwent bilateral RDN. Blood pressure (BP) was studied before intervention, at 7 days and 6 months after RDN by tree methods: office BP, 24-hour ambulatory blood pressure (ABPM) and aortic BP with applanation tonometry a. radialis (SphygmoCor). All patients were divided into two groups by ABPM in 6 months after RDN: responders (decrease of mean ABPM≥5 mm Hg) and non-responders (decrease of mean ABPM

Aim - to analyze functional status and hemodynamic changes in patients who demonstrate vasoreactivity but doesn’t reach the criteria of "positive respond" ("grey zone") and to compare this data with "responders" and "true non-responders". Material and methods. We enrolled 159 patients with pulmonary hypertension. Right heart catheterization with acute vasodilator testing was performed in all cases. Depending on hemodynamic respond during acute vasoreactivity testing patients were divided in to three groups: "responders", "true non-responders" and patients in the "grey zone". The following parameters were analyzed in all included patients: basic clinical parameters, hemodynamic changes, right ventricle size, right atrium area, 6-minute walking test distance and time to clinical worsening. Results. In our study it was shown that patients of "grey zone" had several clinical and hemodynamic parameters that differ significantly from patients "responders" and "true non-responders". Patients in the "grey zone" also have the longest time to clinical worsening.

Over the last decade, the interest in the treatment of idiopathic pulmonary hypertension (IPAH) has greatly increased because of the development and implementation of innovative therapeutic approaches. One of the modern drug groups for the treatment of pulmonary arterial hypertension are phosphodiesterase type 5 inhibitors (PDE5), which can cause pulmonary vasodilation via a NO-dependent mechanism.The aim of the research was to study the efficacy and safety of sildenafil treatment in patients with IPAH received 16-week course and to study sildenafil impact on clinical, hemodynamic and functional status.Material and methods: 20 patients with IPAH (mean age 40.9±11.5 years) functional class (FC) II-IV (WHO), who were receiving standard therapy (anticoagulants, diuretics, glycosides, calcium antagonists), were prescribed sildenafil 20 mg three times a day for 16 weeks. Initially, and after 16 weeks of treatment we studied FC, and the results of the six-minute walk test (6MWT), transthoracic echocardiography (ECHO), right heart catheterization (RHC) and laboratory tests to determine the safety of the therapy were carried out, as well.Results: the group of patients had 6MWT distance of 344±116 m at the beginning of the study. For about 90% of the patients suffered from dizziness, 75% - from the pain in the heart, 65% of the patients had edema and 35% - hepatomegaly. The patients suffered from severe pulmonary hypertension according to the functional and hemodynamic status. The estimated pulmonary artery systolic pressure (PASP) according to ECHO results was 89.6±22 mm Hg. According to the data from RHC we noted the elevation of mean pulmonary arterial pressure (mPAP) to 56.3±19 mm Hg, of pulmonary vascular resistance (PVR) to 1218±709 dyne/sec x per x cm-5 and the decrease in cardiac output (CO) - 3.4±0.8 l/min/m2.There were slight increasing in 6MWT distance (+23 m, p>0.05) and a statistically significant improvement in clinical status in comparison with the initial data: dizziness - 71%, heart pain - 38%, edema and hepatomegaly were observed in 15% and 14% (p

Resistant hypertension is an urgent problem in modern cardiology, leading to myocardial infarction, stroke, and, as a consequence, early disability of patients. The emergence of such a method as radiofrequency denervation of the renal arteries in the complex antihypertensive therapy can expect to achieve control of blood pressure and thus reduce the risk of cardiovascular complications. This article presents the current state of the use of this method in clinical practice.

Objective: in our study, iloprost was used as a drug for acute tests in patients with pulmonary arterial hypertension (PAH). Design and Method. We included 7 pts with pulmonary arterial hypertension (PAH): 5 females and 2 males, average age 32,0±12,0 years. All patients underwent right heart catheterization including acute tests with both nitric oxide and Iloprost. In addition to hemodynamic changes the intravascular ultrasound (IVUS) parameters were analyzed. We used parameters such as: intima-media thickness, the pulsatility index (PI), the outer and inner diameter of the vessel, the area of the vascular wall. Results. Compared with the action of nitric oxide, the degree of reduction of medium pulmonary arterial pressure (mPAP) after Iloprost was 17,2±5 and 25,37±9 mm Hg respectively, and pulmonary vascular resistance (PVR) 251,4±120 and 276±129 dynes×c×cm-5 respectively (p

В последнее время появились достаточно убедительные данные, указывающее на то, что такие факторы, как пониженное высвобождение оксида азота (NO) после проведения перорального теста толерантности к глюкозе (ПТТГ), повышенный уровень лептина, гиперинсулинемия и инсулинорезистентность (ИР), являются важными предикторами развития рестеноза внутри стента у больных ишемической болезнью сердца (ИБС) с нормальными уровнями глюкозы натощак и гликированного гемоглобина. Как известно, именно эти факторы являются основополагающими в структуре формирования метаболического синдрома (МС). Настоящий обзор предполагает, что и ИР, и эндотелиальная дисфункция являются независимыми предикторами рестенозов после коронарного стентирования с использованием непокрытых металлических стентов. Оценка толерантности к глюкозе, секреции инсулина и высвобождения NO после стандартного ПТТГ является важным инструментом в попытке выявить пациентов с высоким риском раннего рестеноза среди больных с МС, подвергающихся эндоваскулярным вмешательствам. Более того, изолированное определение ИР и постнагрузочной гиперинсулинемии хотя и служит важным фактором риска ИБС, является слабым предиктором рестенозов после коронарного стентирования, но становится высоко прогностически значимым при повышенном уровне лептина и сниженном уровне высвобождения NO во время ПТТГ.

Despite the availability of modern medicines for treating the majority of cardiovascular diseases, the existence of such severe diseases as refractory arterial hypertension and pulmonary hypertension, has brought us to the development of the pathogenetic invasive method of such conditions treatment. Identification of potential responses at the stage of patients selection will help us to see in details the pathogenesis and development of this nosology, to determine the predictors of the efficacy of alternative methods of treatment sand to develop the protocol for these situations. From there, the article discusses various methods of activity evaluation of the sympathetic part of the vegetative nervous systemas the mainsector of pathogenesis of systemic hypertension development.

Every year scientific interest in studying of interventional methods of treatment of resistant hypertension steadily increases. Row of high technology device are created for performance of such procedures as well as techniques of their management are also developed. Non-pharmacological ways of treatment are described in this article, which are widely used in clinical practice: baroreflex activation therapy, radiofrequency renal denervation, and central iliac arteriovenous anastomosis.

Идиопатическая, или первичная, легочная гипертензия (ПЛГ) является редким заболеванием неизвестной этиологии. В настоящее время эндотелиальная дисфункция считается ключевым звеном в патогенезе ПЛГ. Поэтому с точки зрения современных подходов к лечению больных ПЛГ основной целью является воздействие на процессы ремоделирования сосудов. Это стало возможным при наличии у препарата не только вазодилатирующей способности, но и ряда дополнительных свойств - цитопротективных, антипролиферативных, антиагрегационных и т.д. К таким лекарственным веществам относятся простаноиды и их аналоги, антагонисты рецепторов эндотелина, оксид азота и его донаторы. В НИИ кардиологии им. А.Л.Мясникова в течение последних 5 лет простагландин Е 1 (алпростадил) широко используется для лечения больных ПЛГ. Этот препарат является синтетическим аналогом простагландинов, синтезируемых эндотелиальной стенкой. В качестве примера, иллюстрирующего возможность использования курсовой терапии простагландином Е 1 у больной ПЛГ, представляем следующий клинический случай.