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The article is devoted to various aspects of white coat effect (WCE) in patients with hypertension (HTN). WCE is due to the patient’s anxious response to office blood pressure (BP) measurement and is characterized by a BP increase. In patients with HTN, WCE is detected with a high frequency. Pronounced WCE in hypertensive patients is associated with worsening the HTN course and the prognosis of all-cause and cardiovascular mortality. In addition, BP increase in these patients during a doctor’s visit may lead to additional prescription of antihypertensive drugs, increasing costs and side effects. To identify WCE, a large number of methods are used, which can be divided into following groups: I – data from clinical and daytime ambulatory blood pressure measurement, II – clinical and home BP assessment, III – only ambulatory BP measurement, IV – clinical and laboratory BP data, and V – only clinical BP measurement. There are following WCE in patients with HTN: female sex, age, never smoking, as well as anxiety, introversion, etc. WCE is due to the patient’s anxiety state during office BP measurement and a conditioned reflex BP increase associated both with the physician presence and medical background. Severe WCE in some groups of patients with HTN may be associated with a worse prognosis compared with other hypertensive patients as follows: in individuals with a significant difference between clinical and ambulatory blood pressure levels or between the first and third BP office data, with a combination of resistant HTN and WCE, with WCE increasing from visit to visit, etc.

Some national guidelines since 2017 considered the most common method for diagnosing and controlling hypertension (HTN) (office blood pressure (OBP) measurement) as screening only. Automated OBP (AOBP) measurement claims to be a unique method by obtaining a standardized result, even in primary health care. AOBP improves the reliability of data by reducing the influence of various errors on result. However, although the level of AOBP is on average lower than similar OBP in clinical and research practice and is comparable to the mean 24-hour BP monitoring, at present, all international guidelines emphasize the mandatory use of ambulatory BP measurements for diagnostic purposes. Whether the results of AOBP and the reference level ≥130/80 mm Hg are equivalent with the same OBP level, the use of which is associated with an increase in the prevalence of hypertension and insufficient control of antihypertensive therapy, is a question for research. Compared with conventional OBP, the use of AOBP in conjunction with outpatient measurement leads to a reduction in the proportion and timing of initiation of treatment in patients with masked HTN, whose cardiovascular risk is similar to that of patients with stable HTN. However, the widespread implementation of AOBP is hindered by the high cost and lack of accumulated data. The review analyzes in detail the limitations and advantages of various types of BP measurement, as well as the potential of using AOBP in modern clinical and research practice.

The new international guidelines on hypertension management have been issued in the past few years. The AHA (2017) and ESH (2018) Guidelines are similar in many key aspects. However, they differ substantially in the area of blood pressure (BP) measurement methodology. In this article, we aim to explain the ESC Guidelines position, specifically the conservative BP thresholds and a wider use of ambulatory BP measurement methods. In our opinion, the main reason behind this position is the introduction and a relatively widespread use of automatic office BP measurement (AOBP). On one hand, this method has questioned the results of the SPRINT trial – the key evidence source for the AHA Guidelines. On the other hand, AOBP has challenged the concept of “traditional office BP measurement”. Therefore, it is important to be aware of the current multiplicity of BP measurement methods and respective threshold values recommended for each method. It is essential to perform the office BP measurement correctly and thoroughly. Throughout all stages of the hypertensive patient management (diagnosis, antihypertensive treatment choice, and long-term observation), the use of out-of-clinic BP measurement is strongly advisable.

Aim. To study the efficacy and safety of the triple fixed-dose combination (FDC) of amlodipine/indapamide/perindopril on blood pressure (BP) profile in patients with grade I-II hypertension (HTN) in actual clinical practice.Material and methods. Data from 54 patients with paired 24-hour ambulatory BP monitoring (ABPM) data were included in the TRICOLOR subanalysis (ClinicalTrials. gov study ID — NCT03722524). The mean 24-hour, daytime, and nighttime BP were calculated at baseline and after 12-week follow-up. We determined the proportion of patients with nocturnal HTN (≥120/70 mm Hg) and nocturnal hypotension (20%), as well as those without nocturnal BP decrease (>0%, non-dipper (ND)). The smoothness index (SI) was analyzed as the ratio of the mean hourly SBP fall to its mean standard deviation in paired ABPM. To assess the BP phenotypes, two methods were used with reference values of

Aim. To study a combined use of home (HBPM) and office (OBP) blood pressure measurements in assessment of prevalence and predictors of hypertensive phenotypes in population of 55 years and older.Material and methods. From prospective cohort of Moscow population, a sample was randomly formed (n=1871, 64% response), representative of parameters of general health, educational level, time of residence in Moscow, and with an equal number of men and women. Data of HBPM (4 days: 2 morning/2 evening) and OBP (2 measurements) were studied in complex after comparing the reproducibility of the valid results in 974 subjects. The prevalence of hypertensive phenotypes was assessed in subjects without treatment. The main risk factors and previous anamnesis were analyzed as potential predictors of belonging to the identified phenotype.Results. Preliminary results of 1120 patients are presented: mean age was 68,9±8 years, 43% of men; 44% with antihypertensive therapy. Themean levels of HBPM and OBP were 137,0±18,5/79,5±9,3 and 141,0±23,9/ 79,9±13,1 mmHg, respectively. The reproducibility of HBPM data was not inferior to OBP (SD for SBP/DBP =18,5/9,3 vs. 23,9/13,1 mmHg, respectively). Among 556 subjects without treatment (68,8±8 years; 47% — men; 42% — OBP ≥140/90 mmHg; 39% — abdominal obesity (AO); 17% — smoking; 8% — diabetes mellitus (DM); 8% — history of myocardial infarction (MI) and 5% — history of stroke. The both methods revealed normal level of blood pressure in 42% of patients, stable arterial hypertension — in 32%, white coat hypertension (WCH) — in 10%, masked hypertension (MH) — in 16%. DM and MI history increased by more than 1,5 times the MH risk. History of stroke and AO absence were predictors of WCH.Conclusion. HBPM reclassified data of arterial hypertension prevalence in the population. Combined use of HBPM and OBP allow to establish every sixth person with ambulatory hypertension, who requires antihypertensive treatment. Low “sensitivity” of HBPM in present case “mask” stable arterial hypertension in every second patient with WCH and history of stroke.Working group: Alexandri A. L., Balanova Yu. A., Kapustina A. V., Konstantinov V. V., Kukushkin S. K., Lelchuk I. N., Muromtseva G. A., Timofeeva T. N., Khudyakov M. B.

Recently, more and more attention has been paid to the chronotherapy of arterial hypertension (HT). This method provides an opportunity to improve the treatment efficacy by non-traditional regimes of antihypertensive drug intake. The new findings concerning a high prognostic value of the night-time blood pressure (BP) and night BP fall stimulate the interest in chronotherapy of HT. This method is very easy to use, and the evidences of its high efficacy are growing. The advantages and limitations of two potential chronotherapy approaches are discussed in detail.MAPEC was the largest project which investigated the possibility of cardiovascular complications risk reduction by normalizing the circadian rhythm of BP due to the bed-time administration of antihypertensive drugs. The authors obtained impressive results – more than a double reduction of cardiovascular complications risk in the chronotherapy group. However, the study had serious limitations: ethnically homogeneous population, the lack of independent verification of endpoints and adverse events, and inconvenience of 48-hour BP monitoring.The currently available scientific information concerning advantages of HT chronotherapy needs further confirmation in the carefully designed multi-centre prospective studies. According to the authors’ opinion, illustrated by their original data, the relatively small and short studies are still important. Such trials allow using more nuanced methodological approaches, such as a double blind or cross-over design and comparison of the pharmacokinetics of antihypertensive drugs in the morning and evening administration.

Aim. To estimate an efficiency of influenza vaccination in patients with circulatory system diseases diseases (CSD) under 3-year follow-up in outpatient clinics.Methods. The efficiency of influenza vaccination was investigated in CSD patients followed up at 2Ivanovo outpatient clinics and 2Saratov ones. The investigation enrolled 817 people, including 367 patients who consented to Grippol Plus influenza vaccination and 450 who refused.Results. During 36-month follow-up after being included in the study the vaccinated group showed a significantly fewer influenza and acute respiratory viral infections than the non-vaccinated group (28 and 442; р

Aim. To compare antihypertensive effect of ramipril monotherapy at morning and evening taking.Material and methods. 22 patients (10 men, 12 women; aged 62,1±1,9 y.o.) with arterial hypertension of 1-2 stage were involved into the open randomized crossover study. Patients were randomized into 2 groups depending on ramipril taking time (morning or evening). Ambulatory blood pressure (BP) monitoring (ABPM) was performed. Patients of both groups were comparable in basic clinical characteristics and initial ABPM indices. Analysis of peak and phase characteristics of 24 hour BP profile was used as well as standard evaluation. Treatment duration was 3 weeks. Ramipril dose titration was made in 1,5 weeks. The average daily dose of ramipril was 6,1 mg in the morning taking, and 5,0 mg in the evening taking.Results. 20 patients finished study completely. 24 hour initial level of systolic (SBP) and diastolic BP (DBP) was 141,5±1,6/85,3±1,1 mm Hg. After ramipril monotherapy with evening taking BP reduced to 132,6±1,6/79,8±1,1 mm Hg (pConclusion. Evening ramipril taking is effective and safe. It can be recommended to patients with insufficient night BP dipping (non dippers).

Aim. To compare enalapril (E) and diltiazem (D) efficacy in menopausal women with arterial hypertension (AH) using three methods of blood pressure (BP) measurement.Material and methods. There was a cross-over randomised study with E and D included 22 menopausal women with AH. E was given at a daily dose of 5-20 mg and D – at a daily dose of 180-360 mg. At baseline and at the end of each treatment period ambulatory blood pressure monitoring (ABPM) was carried out. Self blood pressure measurement (SBPM) was performed during all study period. To assess a steadiness of antihypertensive effect we calculated smoothness index and trough-to-peak ratio based on ABPM data.Results. Ambulatory 24-h systolic BP and diastolic BP were decreased in the E group (-15.2/-9.6 mm Hg) and in the D group (-10.9/-6.0 mm Hg). E demonstrated a greater antihypertensive effect on SBPM results in the evening. Values of smoothness index on E treatment were slightly higher than on D treatment (0.86±0.15/0.64±0.13 vs 0.67±0.17/0.62±0.15). Trough-to-peak ratio was inconclusive in this study.Conclusions. Results of the study have shown some advantages of antihypertensive therapy with E compared with these of D in slow release formulation (both drugs at a single daily dose) in menopausal women. A sustained antihypertensive effect without negative influence on circadian BP profile allows to consider E as one of perspective agents for the AH treatment in this type of patients.

Background. The elevation of blood pressure (BP) affects the development of vascular inflammation. At the same time, it has been suggested that inflammation itself could be an independent risk factor (RF) of arterial hypertension (AH) development. Aim. To investigate whether the association between increased levels of C-reactive protein (CRP) and AH is independent from classical RFs. Material and methods. The data were obtained during a crosssectional survey of 1876 Muscovites (47,9% men) aged ≥55 years, who participated in the prospective study “Stress, Ageing, and Health in Russia”. In all participants, socio-demographic characteristics, health behaviours, parameters of anthropometry and rest electrocardiography (ECG) were assessed. The levels of BP and blood lipids were also measured. The outcome variable was an increase in CRP levels (>3 mg/l). Statistical methods included logistic regression; the risk estimates were presented as odds ratios (OR) and 95% confidence intervals (CI). Results. There was a positive link between AH and CRP levels of >3 mg/l. After adjustment for age and sex, OR of increased CRP levels in hypertensive participants vs. their AH-free peers was 1,688 (95% CI 1,323-2,154; p=0,0001). In the final model (adjustment for age, sex, educational level, smoking, alcohol consumption, abdominal obesity, high atherogenicity index, and coronary heart disease, CHD), this effect remained statistically significant (OR 1,450; 95% CI 1,127-1,864; p=0,004). Conclusion. In elderly Muscovites, a positive association between increased CRP levels and the elevation of BP was independent from RFs and CHD.

Aim. High-sensitive C-reactive protein (hsCRP) is currently regarded as an important marker of cardiovascular disease (CVD). The aim of the study was to assess the population characteristics of hsCRP in the sample of Moscow residents aged 55 years and older. Material and methods. The analysis included 1851 people (response rate 65 %), who participated in the SAHR (Stress, Aging, and Health in Russia) study. Results. The hsCRP levels were similar in men and women, with the right-skewed distribution. The hsCRP values ranged from 0,5 to 69,5 mg/dl in men (median 1,5 mg/l), and from 0,5 to 75 mg/l in women (median 1,5 mg/l). The mean hsCRP levels were slightly higher in men than in women (3,4±0,19 vs. 3,1±0,15, respectively; р=0,36). Overall, there was no marked age-related dynamics of hsCRP levels in men or women. The prevalence of high hsCRP levels (>3 mg/l) non-significantly increased from 31,2 % in the youngest age group to 36,2 % in those aged 75 years and older. Acute inflammation (hsCRP levels >10 mg/l) was registered in 85 participants (4,5 %), including 42 men and 43 women. After adjustment for age and gender, the lower education level remained a significant predictor of hsCRP elevation. Conclusion. No clear associations between hsCRP and age or gender were observed. However, participants with university and secondary education had significantly lower hsCRP concentrations, compared to their peers with education level lower than secondary.

The article describes in detail the evidence on validation and classification of existing devices for blood pressure self-control (BPSC). The strengths and limitations of BPSC are discussed, together with modern approaches to research and clinical application of BPSC as independent method or in combination with traditional BP measurement. The current clinical and epidemiologic evidence on BPSC is analysed. Technical and clinical aspects of the method in general and of tonometer use, in particular, are emphasised.

Aim. To compare informative value of various blood pressure self-control (BPSC) and 24-hour BP monitoring (BPM) characteristics in long-term antihypertensive therapy effectiveness assessment. Material and methods. A cross-over, randomized trial of enalapril (E) and diltiazem (D) included 22 menopausal women with arterial hypertension (AH). Daily doses were 5-20 mg for E, and 180-360 mg for D. 24-hour BPM was performed at baseline, at the end of each treatment phase, and between the phases; BPSC was performed during the whole study period. Dispersion sources were examined, to assess baseline data reproducibility. Informative values for individual BP parameters were investigated with Mahalonobis distance and t-test ranging. Results. «Error» prevalence for dispersion of averaged 24-hour BPM data was 19-40%, averaged BPSC data – 7-22%. T test values were 3,2-1,2 for averaged 24-hour BPM data, 1,6-0,6 – for averaged BPSC data, 1,7-0,6 – for final/peak effect indices, 3,6-3,0 and 1,3-0,4 - for smoothness index, respectively. In logistic regression analysis, the following independent informative parameters were identified: averaged mean BP for BPSC (p=0,003); time index for mean BP (p=0,0007) and diastolic BP, DBP (p=0,02) (24-hour BPM); clinical DBP (p=0,003). BPSC was more «specific» than 24-hour BPM in diagnosing masked treatment ineffectiveness in the morning hours. Conclusion. The benefits of 24-hour BPM include high formal informative value and a chance for assessing evenness of antihypertensive medication effects. BPCS facilitates more precise diagnostics of masked treatment ineffectiveness, and also provides highly reproducible results.

Controlling antihypertensive therapy effectiveness by traditional office blood pressure (BP) measurement only is linked to evident restrictions. Therefore, recently, BP self-control (BPSC) has gained more attention. Its benefits include affordability, registration of long-term spontaneous BP variations, prognostic value of results obtained. Its disadvantages include no information on manifold characteristics of circadian BP profile. In particular, assessment of antihypertensive effect evenness is a prerogative of 24-hour BP monitoring (BPM). Relevant tasks for future studies include development of optimal BPCS regimens, and comparison of 24-hour BPM and BPCS informative value in controlled clinico-pharmacological studies.