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Aim. To compare two therapies based on carvedilol or metoprolol in hypertensive patients with overweight and obesity.Material and methods. 320 patients with arterial hypertension (1-2 degree) were involved in the study. 160 patients received carvedilol and 160 patients – metoprolol. Both randomized groups were comparable on the main clinical characteristics.Results. By the end of the study both systolic and diastolic blood pressure (SBP, DBP) reduced in both groups рConclusion. The results of open, randomized CAMELLIA trial confirmed antihypertensive effect and good tolerability of carvedilol in common clinical practice as well as demonstrated some its advantages in patients with metabolic syndrome. Carvedilol has positive metabolic effects on lipid, glucose and uric acid levels. Carvedilol therapy is more preferable in patients with arterial hypertension and metabolic risk factors.

Aim. To evaluate antihypertensive and metabolic effects of the therapy based on carvedilol (C) in comparison with metoprolol (M) in hypertensive patients with overweight or obesity.Material and methods. 320 patients were involved in multicenter, randomized open parallel study. One part of the patients received C 12,5 mg BID (Vedicardol, “Sintez”), another part – M 25 mg/day BID. Doubling dose of β-blockers (BB) and switching patients to combined therapy with AML 5-10 mg OD (Amlorus, “Sintez”) and hydrochlorothiazide (HCT) 12,5-25 mg OD was performed if necessary. The study duration was 24 weeks.Results. Significant reduction of systolic and diastolic blood pressure was revealed in both groups, there was no difference between groups (р=0,88 and p=0,61 respectively). Switching patients to combined therapy with AML and HCT was made more often in M group than in C group (p>0,05). Prescription of BB resulted in significant reduction of the heart rate, there was no difference between groups (p=0,61). 96,2% patients of group C and 95,5% of group M reached target levels of BP. Significant reduction of glucose (p0.05), half of them were not related to BB taking.Conclusion: Controlled antihypertensive therapy, based on С and M, allows reaching target levels of BP in majority of patients with overweight or obesity. Switching to combined therapy was made more seldom in group of С than in M group. Both drugs demonstrated metabolic neutrality, however significant lowering of glucose and uric acid levels and tendency to lowering of TC an LDLC levels was observed only in group С.

Aim. To prove the advantage of the long-term controlled antihypertensive therapy compared with the real usual standard therapy in patients with mild to moderate arterial hypertension.Material and methods. It was multicenter, randomized, prospective parallel-group study in patients with mild to moderate hypertension. One part of patients (treatment group) received the strongly regulated stepped antihypertensive therapy based on ACE-inhibitor spirapril, the second one (control group) continued their usual standard therapy prescribed by doctors of polyclinics or other patient care institutions. The study lasted one year.Results. 1742 patients were enrolled in the study, 854 patients were included in the treatment group and 888 – in the control group. 220 patients dropped out of the study by different reasons, and 1552 patients finished the study. There were 651 (37,6%) men and 1081 (62,4%) women. It was substantial decrease in blood pressure in both group, but distinctions between systolic and diastolic blood pressure in the treatment and control group during the study were significant.The target levels of blood pressure (systolic < 140 mm Hg and diastolic < 90 mm Hg) were registered substantially more frequent in the patients of treatment group than in control group (69,4% и 39,3% after three months and 83,6% и 66,9% after 12 months of the treatment correspondingly).Conclusion. Controlled stepped antihypertensive therapy resulted into more significant decrease in systolic and diastolic blood pressure and more frequent achievement of target levels of blood pressure in comparison with control group. It supposes better prognosis of patients.

Aim. To invent 10-year survival model of the men >60 y.o. with ischemic heart disease (IHD), including prognostic significance of the traditional risk factors, electric remodeling parameters of myocardium and other factors comorbid with the fatal events and survival depending on the age.Material and methods. Study cohort consisted of 167 men with IHD at the age >60 y.o. (mean age 76,3±0,5). All persons in the cohort underwent complex clinical and functional assessment of cardiovascular system, the parameters of electrical activity of myocardium studied — value of the ventricles activation velocity, repolarization heterogeneity, and stages of electrical remodeling severity. All participants were followed-up during 10 years with the analysis of the disease course and fatal events monitoring. Survival analysis was done on the base of tables of lifetimes completion with the part of died, survived, of cumulative part of survived (survival function), density of the death probability, function of momentary risk.Results. In the cohort of men >60 y.o. with IHD cardiovascular death, mortality coefficients from all cases and from cardiovascular diseases, cumulative part of the survived, density of the probability of heath and the function of momentary risk in different age groups (I group 60-74 years and II group >75 years) сdid not differ significantly. Physical activity and high density cholesterol level >0,6 mmol/L are associated with the increase of survival rate in the 1st age group, as in the 2nd. Presence of arterial hypertension in IHD cohort of men was a predictor of fatal outcomes and increased mortality — odds ratio (OR) 2,469 (p60 y.o. with IHD made it possible to create a model of survival, which makes it to predict fatal events, to establish significant for prognosis factors and focus on the specific factors of fatal outcomes for various age groups inside this age cohort.

Aim. To compare the parameters of lipid profile and calcium and phosphate metabolism in patients with coronary heart disease (CHD) or CHD combined with aortic stenosis (AS). Material and methods. The study included 147 CHD patients, aged over 60, with stable angina pectoris, (functional Class (FC) I–IV) and degenerative calcific AS. The comparison group included 41 CHD patients without calcification or stenosis of aortal valve. In all participants, the parameters of lipid profile and calcium and phosphate metabolism were assessed. Results. Dyslipidemia was more prevalent in CHD patients without AS (85,4% vs. 68%). AS was linked to lower levels of total cholesterol and triglycerides. However, the combination of AS and mitral calcification was characterised by higher levels of low-density and non-high-density lipoprotein cholesterol (LDL–CH and non-HDL–CH). More severe AS was associated with decreased levels of non-HDL–CH and elevated levels of parathyroid hormone, ionized calcium, and alkaline phosphatase. There was a direct correlation between the levels of parathyroid hormone and the presence of calcific AS (r=0,532; p=0,013). Conclusion. The results obtained confirm the disturbance of lipid and calcium metabolism among patients with calcific AS, which suggests that this cardiac valve pathology could be regarded as a manifestation of ectopic calcinosis.

Clinical effectiveness and safety of Propanorm® was studied in patients with arterial hypertension (AH), coronary heart disease (CHD), chronic heart failure (CHF) with intact systolic left ventricular (LV) function, and atrial fibrillation (AF). Effectiveness and safety of Propanorm® was compared to those in Cordarone®. Out of 137 randomised patients, 110 were included in the study (59 in the Propanorm® group, 51 – in the Cordarone® group) and followed up for 12 months. Primary end-points included all-cause mortality, cardiovascular mortality, fatal and non-fatal myocardial infarction and stroke. Secondary end-points included recurrent AF episodes, their duration, AF or decompensation-related hospitalisation rates, systolic and diastolic LF function dynamics during the treatment, and safety profile of Propanorm® and Cordarone® in CHF with intact systolic LF function. The treatment of the main pathology was associated with achieving target blood pressure (BP) levels in 67,3% of the patients, reduction in functional classes (FC) of angina (70%) and CHF (94,5%), and decrease in cardiac decompensation-related hospitalisation rates by 72,9%. After 6 and 12 months of the therapy, Propanorm® effectiveness was as high as 67,4% and 52,9%, respectively, being similar to that for Cordarone® (62,7% and 52,9%, respectively). In 33,9% of the patients, Propanorm® therapy was associated with a reduction in clinical AF symptoms, their duration, ventricular rate during AF paroxysm, and increased number of asymptomatic AF episodes by 30,9%. In cardiac patients, Propanorm® was safer than Cordarone®, with respective incidence of adverse effects of 0% vs. 31,6%. The study PROSTOR is being continued, and the present paper describes the results of 12-month therapy.

Aim. То investigate the associations between cardiovascular remodeling, endothelial hemostasis and carotid (CA) and coronary artery (CorA) atherosclerosis in patients with high blood pressure.Material andmethods. This controlled cohort study included 320 40—59-year-old patients with Stage I-II arterial hypertension (AH) and 75 healthy controls. The examination included Doppler echocardiography, carotid and middle cerebral artery dopplerography (evaluation of left ventricular hypertrophy (LVH), TV remodeling type, common carotid artery (CCA) intima-media thickness (IMT)), brachial artery (BA) reactive hyperemia test, coronary angiography, and C protein level measurement.Results. CA and CorA atherosclerosis was observed in more than 50 % of AH patients, significantly more often than in controls. CA atherosclerosis was associated with IMT (r=0,61), LVH (0,34) and blood flow velocity in the middle cerebral artery (r “it.32): CorA atherosclerosis —with IMT (r=55), LVH(r=0,45), LV posteriorwall thickness (r=0,43), concentric TV geometry (r=0,28), C protein (r=-0,29) and impaired relaxation in BA reactive hyperemia test (rM!,31).Conclusion. LVH and increased IMT are common surrogate markers of systemic atherosclerotic process. CorA atherosclerosis was associated with concentric :LV geometry and endothelial dysfunction, CA atherosclerosis — with reduced cerebral blood flow.

Aim. To assess cardiovascular risk in elderly patients with coronary heart disease (CHD), in regard to myocardial structure and function, myocardial electrical activity, myocardial repolarisation heterogeneity, metabolic, immune and traditional risk factors (RFs).Material and methods. In total, 526 people aged 18-92 years were examined, including 167 elderly men with CHD (mean age 75,4 years) as the main group (MG), and 113 healthy men aged 18-65 years as the control group (CG). The MG participants were followed up for 10 years; CHD clinical course and fatal outcomes were monitored. The examination included the assessment of lipid profile (LP), apolipoprotein metabolism, coagulation and acute phase reaction parameters, humoral and cell immunity factors, myocardial electrical activity, ventricular activation velocity, myocardial electrical remodelling, repolarization parameters and their dispersion, as well as myocardial structure and function according to two-dimension echocardiography data.Results. In univariate analysis, significant predictors of cardiovascular death among the MG patients during 10-year follow-up period were: arterial hypertension (AH), low physical activity, high-density lipoprotein (HDL), apoAI, and apoB cholesterol (CH); increased left ventricular (LV) end-systolic and end-diastolic volume; increased LV myocardial mass; eccentric myocardial remodelling; reduced ejection fraction; terminal stage of electrical myocardial remodelling; increased QLend dispersion; increased blood phagocyte activity. In the MG individuals, the 10-year risk of cardiovascular death was significantly predicted by AH, chronic heart failure functional class, HDL-CH, QLend dispersion and terminal stage of myocardial electrical remodelling.Conclusion. In elderly CHD male patients, high-risk factors included AH, heart failure, HDL-CH, QLend dispersion and terminal stage of myocardial electrical remodelling. These factors should be considered in risk stratification while predicting 10-year cardiovascular risk.

This population and clinical study, including so called «golden standard» - coronaroangiography, analyzed the prevalence and ethiopathogenic role of various risk factors for coronary heart disease (CHD) in women under 55. Total number of participants was 121. The main group consisted of 69 women with CHD, another 52 women formed the control group. The prevalence of arterial hypertension, dyslipidemia, thyroid pathology, anemia, gynecologic diseases and other factors was high in both groups. For the factors assessed, their prevalence and role in CHD ethiopathogenesis was analyzed among individuals with undamaged coronary arteries, coronary atherosclerosis, and unspecific changes like distal damage, spiral vessels, and muscle cross-bridges.

Aim. To estimate the contribution of traditional risk factors to the prediction of fatal outcomes in elderly and senile male patients with coronary heart disease (CHD). Subjects and methods. A 10-year prospective cohort study (from early 1997) included 167 male CHD patients aged 60 years or older (mean age 76,3±0,5 years); a comparison group comprised 38 males (mean age 76,9±1,06) with chronic obstructive pulmonary disease (COPD) without clinical and other signs of CHD. A control group consisted of 32 males over 60 years old without signs of cardiovascular and pulmonary diseases, who had been admitted to the therapeutic unit of the same clinic during the same period. The examined patients were followed up for 10 years, by analyzing the disease course and monitoring fatal events. Results. The probability of predicting 10-year cardiovascular mortality significantly increased the presence of arterial hypertension and low physical activity (OR, 1,67; CI, 1,11–2,51; p=0,01 and OR, 1,454; CI, 1,091–1,393; p=0,01). Elevations of systolic blood pressure up to 150 mm Hg or higher increased the risk of death from all causes in the examined males with CHD by 1.37-fold (p

Сочетание артериальной гипертонии (АГ) и ишемической болезни сердца (ИБС) является наиболее частой ассоциацией сердечно-сосудистых заболеваний.При сочетании АГ и ИБС основные причины преждевременной смертности населения не просто суммируются, а многократно усиливаются, что позволяет обозначить это сочетание как “смертельный дуэт”.В этой связи становится очевидным, что использование эффективной медикаментозной терапии, которая может предупредить развитие осложнений, в этом “дуэте” является чрезвычайно актуальным. Проведенные многоцентровые рандомизированные исследования доказали, что таким классом препаратов, существенно снижающих смертность при сочетании АГ и ИБС, являются b-адреноблокаторы (БАБ).