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Aim: To analyse recent data on the treatment of arterial hypertension (AH) with other risk factors (RF) of cerebral stroke in the Russian Federation, assessment of effects of antihypertensive treatment with a combined drug Hyzaar on the risk of cardiovascular complications (including cerebral stroke), on affection of target organs and metabolic factors of atherosclerosis., Material and Methods: A total of 500 outpatients with primary AH and risk factors including the risk of stroke received Hyzaar (losartan 50/100 mg and hydrochlorthiaside 12.5/25 mg) for one year., Results: More frequent RF in hypertensive patients are the following: high blood cholesterol (86.7%), left ventricular hypertrophy (53.2%), familial history of AH (74.2%). A combination of three and two RF occurs in 49.1 and 37% hypertensive patients, respectively. A 6-month treatment with Hyzaar lowered systolic blood pressure by 28.4 mm Hg and diastolic one by 15.4 mm Hg. The target blood pressure was achieved in 83.5%. Real clinical practice showed that administration of a target Hyzaar dose for 6 months leads to a 6.5% regress of left ventricular hypertrophy, an 11% decrease of total cholesterol, a 4% decrease of glucose and a 8.9% decrease of uric acid., Conclusion: A control of AH and correction of RF in hypertensive patients with a high RF of stroke and other cardiovascular complications is real in use of adequate antihypertensive therapy.

Aim: To verify incidence of risk factors of chronic venous insufficiency (CVI) of the lower limbs and efficacy of outpatient treatment., Materials and Methods: A total of 4388 patients were examined by questioning and examination of the lower limbs. 1209 patients with CVI stages C1, C2 and C3 were included in the study. They received recommendations to use elastic compression, topic modalities, physiotherapy. Patients of the study group were given, in addition, detralex for 8 weeks., Results: Characteristic symptoms of CVI were seen in 68% males and 84% females but only 17.5 and 20%, respectively, had complaints. The risk was highest in history of CVI in the patient's mother, sitting or standing job, hard physical labour, obesity and constipation, two or more labours in women. The effect was achieved in the detralex group., Conclusion: Many outpatients had symptoms of chronic venous insufficiency but had no complaints. Detralex therapy proved highly effective in outpatient practice.

Aim: To study effects of depression on the course and prognosis of arterial hypertension (AH) and coronary heart disease (CHD), potentialities of the combined treatment in a prospective multicenter trial., Material and Methods: A total of 376 patients with AH and/or CHD having depression (10 scores and higher by HADS scale) were assigned to two groups: 189 (50.3%) patients received somatotropic therapy+coaxil (the study group), 187 (49.7%) patients received somatotropic therapy alone (the comparison group). Coaxil was given for 6 weeks in a dose of 37.5 mg/day, to patients over 70 years--25 mg/day. The effects were assessed by changes in HADS, CGI scale, blood pressure, heart rate; by tolerance and side effects (objective effects); complaints, well- being, stress, tolerance (subjective effects)., Results: The addition of coaxil to somatotropic therapy of patients with AH and/or CHD associated with depression led to improvement of the psychological status (a 36% decrease by HADS depression scale from 13.1 +/- 2.75 to 8.43 +/- 3.64, -delta4.76, p < 0.0001; by HADS anxiety scale--by 35.6% from 12.08 +/- 3.90 to 7.78 +/- 3.63, -delta4.31, p < 0.0001; by response to psychoemotional stress--by 23% from 6.65 +/- 1.94 to 4.77 +/- 1.85, -delta1.88, p < 0.05). Control patients also showed a positive trend in the above indices (a decrease in the above indices from 13.15 +/- 2.65 to 11.79 +/- 3.31, from 11.50 +/- 3.66 to 10.12 +/- 3.95, from 6.63 +/- 1.99 to 6.03 +/- 2.07, p < 0.05, respectively) but positive changes were much weaker than in the coaxil group (p < 0.001). To the end of the treatment, patients of the study group had less number of complaints, more patients achieved the target level of arterial pressure under 140/90 mm Hz (43.9 versus 29.9% in the control group; p < 0.005)., Conclusion: Standard somatotropic treatment of AH patients with CHD and depression is not sufficiently effective. Combination of such treatment with antidepressive therapy (coaxil) significantly improves psychological status, and efficacy of therapy of basic cardiological diseases.

Aim: Integration of noliprel treatment of arterial hypertension with educational programs on correction of associated risk factors in outpatient practice for reduction of the overall cardiovascular risk., Material and Methods: An open, multicenter, non-comparative trial with participation of 140 physicians from 14 regions of Russia comprised 1195 patients aged 30-65 years with mild-to-moderate hypertension (SBP = 140-179 mmHg, and/or DBP = 90-109 mm Hg) who had never received regular antihypertensive therapy. This one-year study had an active 3-month stage and follow-up stage for 9 months., Results: Noliprel significantly decreased both systolic and diastolic blood pressure. The response to the treatment was achieved in 95.6% patients, the target blood pressure was achieved in 76.2% patients. A mean level of total cholesterol lowered from 5.5 +/- 1.0 mmol/l to 5.1 +/- 0.8 mmol/l (p < 0.001), body mass index--from 28.4 +/- 4.5 to 27.2 +/- 4.3 (p < 0.001). Hypercholesterolemia occurred before the study in 65.5% patients, at the end of the study--in 49.2%, obesity was registered in 79 and 70.2%, smoking in 21.6 and 14.6%, respectively. The mean overall risk to develop fatal cardiovascular events reduced from 2.5 +/- 3.6% at initiation of the study to 1.3 +/- 1.8% in the end of the study (p < 0.001)., Conclusion: The integration of medication with noliprel and training program successfully lowered overall risk to develop fatal outcomes of cardiovascular diseases in primary health care service.

Aim: To evaluate efficacy of combined use of moderate exercise and nicotinic acid drug enduracin in patients with coronary heart disease (CHD) with moderate dyslipidemia (DE)., Material and Methods: The effects of exercise therapy alone, enduracin alone and their combination on physical performance (PP), hemodynamics, blood lipid spectrum and clinical course of CHD were studied in 93 CHD patients with moderate DE. The results were evaluated clinically after 1-year treatment., Results: Combined used of exercise and enduracin in CHD patients showed its efficacy manifesting in improvement of PP, hemodynamics at rest and exercise test, left ventricular systolic function, clinical course, reduction of DE. Enduracin + exercise appeared more efficient than their use in monotherapy. Enduracin monotherapy had a positive action on PP, arterial pressure and anginal attacks frequency., Conclusion: Enduracin is recommended as monotherapy and in combination with moderate exercise in outpatient rehabilitation and secondary prophylaxis of CHD patients with moderate dyslipidemia and angina pectoris to relieve myocardial ischemia under exercise, to raise PP, improve lipid composition of blood and prevent maladaptive left ventricular remodeling.

Aim: To detect the correlation between complete metabolic syndrome (MS) and combinations of arterial hypertension (AP) with abdominal obesity (AO), hyperlipidemia (HLP), and both without disorders in glucose tolerance., Materials and Methods: 122 men aged 35-66 years were examined, in whom AP was diagnosed 4-6 years before. The following criteria were used for detecting MS components: AP was diagnosed at diastolic AP of at least 90 mm Hg or systolic AP of 140 mm Hg; HLP was confirmed at total cholesterol (CS) level of at least 5.2 mmol/liter and/or triglyceride (TG) level of at least 2.3 mmol/liter; AO was diagnosed at body weight index of at least 26 kg/m2 and the ratio of waist/hip circumferences more than 0.90. Poor glucose tolerance was diagnosed at glucose level in capillary blood 120 mg/dl and higher, but no more than 180 mg/dl 2 h after 75 g glucose loading, if glucose level after an overnight fasting was no higher than 120 mg/dl., Results: The majority of patients (39.3%) had combinations of AP with AO and HLP; complete MS was diagnosed in 21%. Isolated AP was found in only 8.2% of examinees. Dyslipidemia in the presence of MS and in combinations of AP with AO and HLP was characterized by increased levels of TG and total CS and decreased content of CS and high-density lipoproteins, which was associated with basal hyperinsulinemia., Conclusion: MS alone and clusters of AP, AO, and HLP characterized by insulin resistance, accelerate the development of cardiovascular diseases associated with atherosclerosis.

Novel antihyperlipidemic micronized phenofibrate lipantil 200 M was tested for safety and efficacy (one 200 mg capsule a day for 3 months) in 27 patients having cholesterol level above 6.5 mmol/l. The effect emerged upon 1 month of administration and persisted till the end of the treatment. In combined hyperlipidemia triglycerides decreased by 45-60%, total cholesterol and LDL cholesterol by 10-12%. In isolated hyperlipidemia the latter two values appeared lower by 20-23 and 22-27%, respectively. After lipantil 200 M treatment HDL cholesterol went up by 9% in low baseline level (< 1 mmol/l) by 27%. No negative clinico-biochemical shifts were seen, while fibrinogen and uric acid reduced by 16%, apoB by 23-30%. Lipantil 200 M proved active against hyperlipidemia and is recommended for clinical practice.

The prevalence of systolic and diastolic arterial hypertension (AH) was studied on a material of random representative samples of male population aged 20-54 years in the cities of Moscow, Saint Petersburg [correction of Sankt-Peterburg], Tallinn, Kiev, Novosibirsk, Alma-Ata, Tashkent and Bishkek. AH was estimated in connection with risk factors (RF) from the standpoint of uni- and multidimensional statistical analysis. It has been established that RF (age, cholesterol and triglycerides concentration, overweight and alcohol use) make more significant contribution into the prevalence of diastolic AH whereas the systolic AH prevalence is largely determined only by age and education. The data obtained are likely to form the basis for the design of a more integral system of prophylaxis of cardiovascular diseases.

Interrelations between arterial pressure (AP) and overweight and excess consumption of table salt (TS) with food were examined in female workers of a large industrial enterprise within the framework of the All-Union cooperative program of AP control. It has been demonstrated that overweight is one of the main risk factors of AP. In hypertensive persons, overweight is recordable much more frequently whatever the age group. In normotensive workers, overweight was established in 19.2% of cases, whereas in high AP, in 39.8%. Studies into percentile distribution of body weight in the examinees with normal and high AP have shown that in hypertensive subjects, this indicator is higher than in normotensive ones in all the cut-off percentile level. No appreciable differences have been discovered in excess consumption of TS with food by normotensive and hypertensive women in any age groups or in the population on the whole.

The authors provide the results of a prospective study carried out for almost 10 years among men who underwent screenings in 1975-1977 at an age of 40-59 years in Moscow and Leningrad (overall 6431 persons) with a purpose of analyzing potential causes of high risk of death from coronary heart disease in a group of subjects with hypocholesterolemia. Based on a mathematical-statistical analysis, variants of the interpretations of the indicated fact are presented.

The diet enriched with omega-3 polyunsaturated fatty acids (5 g/day for 4 weeks) was applied to the treatment of patients (n-22) with angina pectoris occurring for the first time. Meanwhile 6 patients received the control diet similar to the fish one as regards the protein, fat, carbohydrate, cholesterol and caloric ratio. The control group patients showed no alterations in blood lipids and apoproteins of in platelet function. The patients who received the fish diet manifested an appreciable decrease in the concentration of triglycerides (p less than 0.01), a slight reduction of cholesterol content. The level of high density cholesterol remained unchanged. There was a decrease in the concentration of thromboxane (p less than 0.05) and in the platelet count (p less than 0.05). In some patients, individual reactions of ADP-induced platelet aggregation were revealed: from the lowering (-60-10%) seen in the third of the examined up to the rise (+10+90%) in the other third. The decrease of apoprotein A1 established as safe for the protective cholesterol-transport properties of high-density lipoproteins was established.

The paper is concerned with the data on the brain stroke incidence and lethality among the population aged 25-64 years in 3 districts of Moscow during 1985. The rate of brain stroke was noted to be increased with age without any essential differences in the indicators in men and women. Comparison of the results of the investigation with the data of the Register, carried out in one of the districts of Moscow during 1972-1973 did not reveal any changes in both the disease incidence and lethality due to brain stroke. The rise of the calls on ambulances and emergency medical service for acute derangement of brain circulation is explained by the authors by a possible growth of the number of the disease cases among senile patients or by aging of the population of Moscow.