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The basis for the successful treatment of any disease is a clear understanding of its cause, the mechanisms of its development, and their relationship to symptoms. The article considers one of the links in the pathogenesis of arterial hypertension - an increase in the activity of the sympathetic nervous system, describes the main methods for detecting hypersympathicotonia, approaches to the selection of drug therapy.

The role of specific approaches to the management of patients with heart failure (HF) increases steeply with increasing age, as the patients of this age need attention to geriatric problems: reduced mobility, multiple diseases and cognitive impairment. Senile asthenia is a syndrome that reflects a decline in physiological reserve and increased vulnerability to various stressors. Senile asthenia is detected in 15–74% of patients with heart failure, the prevalence depends on the method of diagnosis and the studied population. This review discusses the effects of senile asthenia, comorbidity and geriatric syndromes on diagnosis, treatment, and outcomes in elderly patients with heart failure. The detection of senile asthenia in patients with HF is important from a clinical point of view, since this condition has an adverse effect on the course of heart failure and is associated with a higher incidence of emergency hospitalization and mortality. Bodily exercises can improve mobility, and the introduction of nursing observation can enhance treatment adherence among patients.

Chronic pain in joints and back is almost constant component of the comorbidities. The comorbidities are caused by the systemic inflammation syndrome, which activity affects the degree of pathology mediating the progression of chronic pain as well. The pathogenesis pattern of systemic inflammation differs in having the whole range of transcriptional proteins, which activity is associated with the level of synthesis of pro-inflammatory mediators. Many recent studies showed that vitamin D3 deficiency and insufficiency increases the activity of these transcriptional proteins, increasing the progression and intensity of comorbidity components, including pain syndrome. Fundamental research demonstrates anti-inflammatory and anti-erosive vitamin D3 effects in cartilage and bone tissue.

The article discusses stroke prevention in elderly patients with atrial fibrillation. The principles of choosing anticoagulant therapy in this group of patients are discussed. The importance of the safety profile of the selected anticoagulant is emphasized considering the high prevalence of comorbidities in elderly patients. The efficacy and profile of dabigatran etexilate demonstrated in randomized clinical trials and in real clinical practice is analyzed in detail. Based on the data discussed, the authors are coming to conclusion that dabigatran can be considered the preferred anticoagulant for long-term treatment in elderly patients with atrial fibrillation.

A position agreement of the experts of Russian association of gerontologists and geriatricians, Gerontological society of Russian Academy of Sciences, Russian medical society for arterial hypertensionTask Force Members: Tkacheva O. N. (Chairperson), Runikhina N. K., Kotovskaya Yu. V., Sharashkina N. V., Ostapenko V. S.Expert Committee: Anisimov V. N., Arkhipov M. V., Baranova E. I., Boytsov S. A., Bolotnova T. V., Villevalde S. V., Galyavich A. S., Grinshtein Yu. I., Drapkina O. M., Duplyakov D. V., Zhernakova Yu. V., Zakharova N. O., Ilnitsky A. N., Karaeva E. V., Karpov Yu. A., Kisliak O. A., Kobalava Zh. D., Koziolova N. A., Konradi A. O., Martynov A. I., Medvedeva I. V., Moiseev V. S., Nedogoda S. V., Oganov R. G., Orlova Ya. A., Ostroumova O. D., Oschepkova E. V., Podzolkov V. I., Proschaev K. I., Skibitsky V. V., Fomin I. V., Frolova E. V., Khavinson V. Kh., Chazova I. E., Chesnikova A. I., Chukaeva I. I., Shabalin V. N.

Detection of principal subclinical arterial wall lesions is one of the most important aspects of effective cardiovascular disease (CVD) primary prevention. Such lesions include: arterial wall thickening, increased rigidity, endothelial dysfunction development. However, the role of traditional CVD risk factors in the development of individual arterial wall lesions in CVD-free people is understudied. This is particularly so with people of older age. Aim. To study the role of traditional CVD risk factors in development of arterial wall lesions in relatively healthy individuals of different age. Material and methods. We have examined a total of 303 people aged 25-91 years, with no signs of CVD and other chronic diseases and without any regular medical treatment. Anthropometric parameters, blood pressure, fasting plasma glucose, total cholesterol, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol and triglycerides levels were detected in all the patients. Measurement of pulse wave velocity was conducted using SphygmoCor device (AtCorMedical,Australia). Carotid ultrasound to measure intima-media thickness and number of atherosclerotic plaques was conducted using linear transducer with ultra-high resolution 17-5 MHz (PHILIPS iU22, the Netherlands) in the B-mode. Endothelium-dependent vasodilation was assessed by the reactive hyperemia test. Results. Multivariate linear regression analysis has revealed fasting hyperglycemia and increased systolic blood pressure to be to a greater degree associated with arterial wall state in both age groups. According to the results of multivariate logistic regression analysis a relationship between risk factors and arterial wall parameters is stronger in the younger group as compared with the older one. Conclusion. Systolic blood pressure and fasting hyperglycemia must be the main targets of CVD primary prevention in older age group, while in younger age group other traditional risk factors must be taken into account as well.

Effect of hyperlipidemia on morbidity and mortality in elderly patients is considered. Authors also cover issues of efficacy and safety of lipid-lowering therapy in primary and secondary prevention of cardiovascular diseases in patients ≥80 years of age who are the most quickly growing group of population and have the highest cardiovascular risk. They stress the need to take into account polymorbidity and polypharmacy that increase the risk of adverse reactions due to the use of both statins and their drug-drug interactions, which requires an assessment of risk/benefit ratio. In addition, there is a need for development of reliable prognostic tools to predict relevant outcomes (e.g., stroke, decrease in functionality/independence, quality of life reduction) and rationales for lipid-lowering therapy in the elderly and also their adherence to treatment.

Pharmacotherapy of arterial hypertension in the elderly is discussed. Russian and international guidelines are presented with a focus on target levels of blood pressure and drugs of choice in these patients. Issues of efficacy and safety of antihypertensive therapy in patients aged 80 years and older are considered.

Arterial wall status is determined by several characteristics, the main of them are as follows: pulse wave velocity (PWV), carotid arteries intima-media thickness (IMT), the presence of atherosclerotic plaques, endothelium-dependent vasodilation (EDVD). When these parameters change, the risk for cardiovascular disease (CVD) grows. The nature of relationship between these indices in people without CVD clinical signs is understudied, especially in those of older age.Aim. To estimate correlations between different parameters of arterial wall in patients of different age without CVD.Material and methods. A total of 303 people aged 25-91 years without any manifestations of CVD or other chronic diseases and without regular medical treatment were examined. PWV estimation, carotid ultrasound with IMT measurement and atherosclerotic plaques amount calculation and EDVD estimation using reactive hyperemia test were performed. Results. Patients without CVD clinical signs rather often reveal arterial wall lesions already in the younger age group (mean age 40.9±8.7): reduced EDVD – in 26% of the cases, the presence of atherosclerotic plaques – in 22%, increased PWV – in 15%, increased IMT – in 8%. The prevalence of arterial wall alterations in the older age group (mean age 61.19±8.5) increase many-fold. All arterial wall parameters correlate with age. The stronger correlation was revealed between IMT and the amount of atherosclerotic plaques: r=0.46 (р

Aim. To study relation of vessel wall stiffness parameters and subclinical atherosclerosis with mineral density of bone (MDB) in postmenopausal women.Material and methods. Into a simultaneous study were included 107 patients at the age 45-82 y.o., being monitored in outpatient circumstances and signed informed consent. We did not include patients with any clinical sign of atherosclerosis, malignancies, secondary osteoporosis causing diseases, as those who had been taking drugs influencing calcium metabolism or vessel wall stiffness parameters. The intima-media complex (IMC), presence of absence of atherosclerotic lesions (AL) were studied via duplex scanning. Pulse wave velocity (PWV), augmentation index (AI) were measured by application tonometry (SphygmoCor). MDB of the spine and of proximal femur was measured via double energetic x-ray absorptiometry. Statistics done with the software by Statistical Analysis System (USA).Results. With the increase of menopause duration, there was gradual increase of PWV, AI, IMC and decrease of MDB. Maximal values of vessel stiffness and the highest MDB were found in 10 years after menopause. Osteoporosis was diagnosed in 27 (25%) of patients, osteopenia in 38 (36%), normal MDB in 42 (39%). The risk of bone mass decrease and of osteoporosis development increased 3 times in higher values of PWV (≥10 m/s) (р9 mm (р=0,02) and in 2,45 times if AL in carotid arteries were found (p=0,03). During multifactor regression analysis, negative relation of AI, IMC thickness and MDB remained, though association with PWV and AL was not proven.Conclusion. With the increase of menopause duration there was increase of vessel rigidity parameters PWV, AL, IMC thickness and bone mass loss. Decrease of MDB in postmenopausal women is associated with high values of PWV, IA, IMC thickness and AL amount, but as independent predictors of low bone mass were only AI and IMC.

Features of pharmacotherapy in the elderly patients are discussed. Data on the pharmacokinetics and pharmacodynamics, comorbidity, polypragmasy and treatment adherence among patients of this age group are presented.

Prevalence of cardiovascular abnormalities in women of reproductive age is not high. However, it is during this period that the risk factors of cardiovascular disorders are being formed. They include obesity, arterial hypertension, dyslipidemia, insulin resistance, diabetes mellitus, etc. The review demonstrates the link between cardiovascular risk factors and obstetric and gynecological isorders, starting from menarche and ending up with menopause. Degree of vascular ageing is considered to be one of indicators of age-related changes of cardiovascular system. There is an association between markers of ageing, such as length of telomers and telomerase activity, and estrogen deficiency.

The collected data on the interaction of human-as-host and their gut microbiota reveals new opportunities for further investigation and translation to practice the novel methods of the body influence in whole and on separate systems, particularly via correction of gut microbiota condition. Previous reviews focused on recent data on the interaction of gut microbiota with the main cariovascular risk factors. Last article in this sequel focuses on the recent data on hypertension and condition of the gut microbiota, as on the influence of smoking on the gut microbiota. The article presents the results of investigations on the influence of short-chain fatty acids on arterial pressure, and on smoking impact on the gut microbiota.

Of the main significantly prevalent modifiable risk factors of cardiovascular risk are carbohydrate and lipid metabolism disorders. Recent years have shown some findings of the mechanisms. The current review highlights contemporary understanding of the link of gut microbiota with carbohydrate and lipid metabolism disorders. The data provided on the influence of probiotics on carbohydrate and lipid metabolism. The data of last decade is covered.

The importance of adipose tissue is much greater than it has been expected. Adipose tissue is a large endocrine organ, value of which is difficult to overestimate. Its work influences a lot of metabolic disorders, cardiovascular pathology. Recently, there is active research on the relation of obesity and microbiota contents. It is studied depending on the food type, physical activity, and microbiota itself might influence the absorption of nutrients, permeability of the gut wall, and appetites. The article is focused on several mechanisms of interrelation of gut microbiota and obesity, on the results of last years studies.

Aim. To study the level of total cholesterol in patients at high and very high cardiovascular risk in real clinical practice and the correspondence of their follow-up to current guidelines for the treatment of dyslipidemia issued by European Society of Cardiology and European Atherosclerosis Society (2011), as well as Russian Society of Cardiology and Russian National Society of Atherosclerosis (2012).Material and methods. Patients aged 30 years and older who visited a general practitioner or a cardiologist in an outpatient clinic in the period from October 2013 to July 2014 were included into the study. Every patient filled out a special questionnaire. The total cholesterol measurement was performed without special preparation of the patient with portable photometric blood analyzer, which allows the evaluation of total cholesterol in 3 minutes.Results. 18.273 patients (58.9% women) were included in the final analysis. Hypercholesterolemia was found in 81.3% women and 78.9% males. In all federal districts the total cholesterol level was significantly above the target and varied from 5.82 to 6.10 mmol/L. At that, statins had not been prescribed to almost half of the patients. Total cholesterol> 5 mmol/L was found in 84.7% of the patients treated with simvastatin, in 75.2% of the patients treated with atorvastatin, in 59% of the patients treated with rosuvastatin. Target level of total cholesterol (Conclusion. The situation with the diagnosis and treatment of dyslipidemias in a real clinical practice is far from perfect, despite the availability of information for doctors and patients. The causes of this problem require further investigation.

Some aspects of prevention of thromboembolic events in patients with atrial fibrillation, in particular, the use of implantable left atrial appendage occluding devices are discussed. Along with the literature review on this issue, the results of authors own experience of left atrial appendage occluding devices implantation is presented.

The problem of vascular aging is discussed. Special attention among the signs of vascular aging is paid to the activation of the renin-angiotensin-aldosterone system as a source of chronic inflammation and oxidative stress, as well as to its relation to replicative cellular senescence. Potential routes of exposure to these processes are also considered.

Prevention of thromboembolic complications in patients with atrial fibrillation during catheter pulmonary veins isolation is discussed. This subject review is presented with special consideration to new anticoagulants.

Insulin resistance plays the main role in the pathogenesis of diabetes mellitus and its complications. It is also a major factor of the pathology associated with age, which leads to accelerated aging. Data about the role of insulin resistance and its correction in vascular aging are presented.

Aim. To study social and economic gradients — educational and occupational statuses, wealth level, behavioral risk factors (FR) in Russian population by the ESSE-RF data.Material and methods. The data for the analysis consisted of representative selections of 13 regions of RF (n=22906) participants of the study, incl. men (n=8353) and women (n=13553) of 25-64 y.o., with response 80%. We calculated the odds ratios for the presence of behavioral FR: smoking, excessive alcohol consumption, insufficient physical activity (IPA), nonrational food consumption, anxiety and depressive disorders, — in persons from different social and economic groups by education level, type of inhabitation, professional status, wealth level.Results. Higher education was associated with better FR profile, except IPA (negative association) and alcohol consumption (absence of association). "White in general had less FR probability than Blue, excl. IPA and psychoemotional deviations (in men). As for the wealth association with the FR there is backward gradient, i.e. lesser the income, higher the risk of FR presence, excl. IPA and excessive alcohol intake in women. For example, in very wealthy men the odds ratio for depressive states was 3,09 [95% CI 2,08-4,57] comparing to the persons with low income. The type of territory of inhabitance was associated with less behavioral FR in Russian population, as significant associations are found only for depression and excessive salt consumption in both genders and IPA in men. Conclusion. The significant social and economic gradients of behavioral FR prevalence are found, the direction of those is not necessary the same as in European countries. The analysis of association with social and economic parameters would help to develop the directed preventive interventions.

The experience of the recent decade has led to ability of complex evaluation of human health, including not only external influences, genetic determinants, but to regard human body as an "environment" for billions of microbes that continuously interact with the host. Microbiota of the gut — the most "inhabitated organ" — is it was discovered, relates to a variety of cardiovascular risk factors. In the series of articles the description of recent data to be provided of the relations of gut microbiota and cardiovascular risk factors. Current article focuses on the recent views on the relation with no modifiable cardiovascular risk factors — sex and age. Some aspects to be described of the microbiota formation since in the womb development and during ageing, the recent results of the studies are described. Also some data on the relation of the sex and gut microbiota is mentioned.

Aim. To study the relation of pulse wave velocity (PWV) as arterial stiffness index, and the level of biochemical factors elevation, that are involved in atherothrombogenesis and play role in determination of cardiovascular risk in various age patients.Material and methods. Totally 202 patients included at the age 30-75 y.o. (M/F 68/134) without clinical signs of atherosclerosis. Stiffness/ elasticity of arteries was assessed by PWV method. Stiff — biologically "old" — we regarded the arteries with PWV more than 10 m/s, elastic — biologically "young" — in PWV 45 y.o. von Willebrand factor and fibrinogen also were higher. In comparison of different age groups with elastic and stiff arteries we found higher levels of glucose and glycosylated hemoglobin with the same levels of insulin, C-peptide and HOMA-IR. Conclusion. Increased PWV non-dependent of age is associated with disruptions of carbohydrate metabolism as decreased insulin sensitivity. Accelerated biological ageing (increased PWV in younger age group) is associated not only with significant alterations in glucose utilization processes, but also with initial signs of chronic inflammation of arterial wall and tendency to clot formation.

Aim. To study the age-related changes in structure of myocardium of the left ventricle and their relation with telomere length. With the age even in absence of cardiovascular diseases (CVD) and risk factors (CRF) there is a changing of the left ventricle (LV) myocardium structure. Probable mechanism of the age-related changes is cell ageing. One of the markers of cell ageing is telomere length (TL) that is also a marker of biological age. Material and methods. After screening we included 303 persons at the age 23-91 y.o. without clinical signs of CVD. All participants underwent transthoracal echocardiography by the standard method. Telomere length was measured in leucocytes on the genomic desoxyribonucleic acid (DNA) by real-time polymerase chain reaction method (PCR). We measured the relative length of telomeres. For the assessment of parameters relations we used correlational logistic regression analysis and build-up of multidimensional regression models. Results. Older age group (women >55 years and men >45 years) of those without significant signs of CVD and CRF comparing to the group of younger persons we found thicker LV myocardium and its concentric remodeling. TL was significantly linked with the age (β=-0,012, p=0,0001). Also we found the relation of TL with LV structure parameters: interventricular septum thickness (IVST) (β=-0,028, p=0,01), relative wall thickness (RVT) (β=-0,012, p=0,02) using the age and CRF. However shorter telomeres (

The review of a new data is provided related to novel aspects of moxonidine use in the patients with arterial hypertension. The main attention is paid to the problem of vascular ageing, telomere biology, insulin resistance and calcium-phosphorum homeostasis. The possible ways to influence this processes are discussed.

The article provides a review of contemporary literature, which generalizes experimental and clinical data on the role of gut microbiota in atherosclerosis development. Gut microflora can be named a marker of the macroorganism condition, reacting on age-related, physiological, dietic, climatogeoraphic factors with its changes of qualitative and quantitative compounds. It was shown that L-carnitine and choline being received with food, are utilized by microflora to synthetize trimethylamine, which then rapidly oxydized by flavinmonooxygenase of liver to trimethylamin-N-oxide, that causes atherosclerosis development and increases risk of cardiovscular diseases.

Aim. To study the interrelation of different MS components and parameters of cell and vessel aging.Material and methods. Totally 136 patients studied with the age 25-75 y. without any signs of CVD or other chronic diseases, not receiving any continuous drug therapy. In all patients the antropometric parameters, BP levels, fasting plasma glucose, HDL cholesterol and triglycerides levels were measured. The PWV measurement was performed by the device SphygmoCor (AtCorMedical, Australia). Telomere length (TL) was measured by PCR.Results. Multidimensional regression analysis revealed that among all MS risk factors studied only the age (р=0,0003), waist circumference (р=0,0434), systolic BP (р=0,0001), НОМА-IR (р=0,0033), fasting glycemia (р=0,0001) and TL (р=0,0001) are the independent determinants of PWV, and this relation is reversed for TL, but direct — with the other parameters. Independent reversed relation is with TL only for age (р=0,0033) and НОМА-IR (р=0,0027).Concluson. Arterial hypertension can be named as the main hemodynamic component and impaired carbohydrate metabolism, insulin resistance and obesity as the main non-hemodynamic components of vessel wall rigidity increase and as the main target for therapeutical intervention.

Aim. To study interrelationship between cardiovascular risk factors and cellular and vascular aging processes. Material and methods. Totally 136 patients were included having no signs of cardiovascular diseases, diabetes 2nd type and receiving no drug therapy, but with one or several risk factors for cardiovascular diseases (smoking, arterial hypertension, obesity, dyslipidemia, fasting hyperglycemia). The telomere length and telomerase activity was measured by polymerase chain reaction. The thickness of intima-media complex (TIMC) and presence of atherosclerotic plaques (ASP) were measured by duplex scanning of right and left carotid arteries. Pulse wave velocity (PWV) was measured by applanation tonometry. Biochemical tests done by standard.Results. PWV significantly correlated with age, body mass index, glycosilated hemoglobin level, fasting glycemia and telomere length. Presence of ASP and increased TIMC significantly correlated with age, body mass index, arterial hypertension, dyslipidemia. Conclusion. Increase of arterial wall stiffness and subclinical atherosclerotic disease have different causes. The level of PWV more linked with carbohydrate metabolism disorder, and TIMC and ASP are linked with lipid disorders.

Aim. To assess the effects of moxonidine in terms of target blood pressure (BP) achievement; to identify potential additional benefits of moxonidine and its effects on bone metabolism and bone mineral density (BMD) in postmenopausal women with arterial hypertension (AH).Material and methods. The study included 48 postmenopausal women with Stage 1-2 AH, aged 57-71 years.Results. All participants were divided into two groups by the type of antihypertensive therapy: those receiving moxonidine and those receiving angiotensin-converting enzyme inhibitors / angiotensin receptor antagonists (ACEI/ARA). All women also received calcium and vitamin D. All participants had AH and osteopenia (both in the lumbar spine and proximal femur, according to the X-ray absorptiometry results). In the moxonidine group, BP levels remained within the target range 48 weeks later. There was a significant reduction in the levels of a bone resorption marker (p=0,041), while the dynamics of an osteopoetic marker was statistically non-significant (p=0,31). A tendency towards increasing BMD in lumbar spine and proximal femur was also observed (p=0,059 and p=0,068, respectively). In the ACEI/ARA group, BP levels also remained within the target range 48 weeks later. However, no significant changes in the levels of bone metabolism markers were registered. There was a tendency towards decreasing BMD in lumbar spine and proximal femur (p=0,052 and p=0,054, respectively).Conclusion. Moxonidine therapy was associated with a significant reduction in bone resorption activity, as demonstrated by the decrease in the concentration of a bone resorption marker, as well as with a tendency towards increasing BMD.

The share of elderly people in the general population has been steadily increasing. Age is one of the main risk factors (RFs) of cardiovascular disease. However, the current focus of preventive medicine is on modifiable RFs, such as arterial hypertension, hypercholesterolemia, and smoking, while age is regarded as a nonmodifiable, non-correctable RF. This emphasises the importance of the identification of cardiac ageing mechanisms and potential modifying interventions. All the existing methods which target cardiac ageing processes have not been used in the clinical settings and require further research. The key intervention methods are described in the paper.

Ageing is an inevitable process which affects quality of life and reduces life expectancy. Age-related cardiac changes reduce compensatory reserves of the heart and accelerate the disease development. Such changes in cardiac structure and function, observed in the absence of cardiovascular disease (CVD), are considered age-related. However, taking into account the high prevalence of CVD in the elderly, it is problematic to define the genuine cardiac ageing. This review discusses a range of subclinical cardiac conditions which are common in older people.

The authors discuss the mechanisms of insulin resistance (IR) development; the IR role in the development and progression of the major age-related vascular changes; IR and the transformation of vascular ageing into disease; and IR impact on life expectancy.

Heart ageing is a complex process including multiple cellular and molecular-level changes and resulting in different ageing phenotypes within the same biological species. According to the existing ageing theories, the multiple interacting mechanisms of ageing include somatic mutations, telomere shortening, oxidative stress, and mitochondrial defects. The review presents the most accepted ageing theories and discusses morphological characteristics of heart ageing on subcellular, cellular, and organ levels.

The authors discuss major structural and functional vascular changes accompanying ageing, the mechanisms of their development, and potential methods of their correction.

Recently obtained data have identified potential mechanisms linking D-endocrine system and blood pressure regulation. Vitamin D deficiency is associated with calcium metabolism disregulation, increased tonus of renin-angiotensin-aldosterone system, endothelial dysfunction, and metabolic syndrome development. The evidence presented suggests a possibility for developing a new, vitamin D-derived class of antihypertensive medications. This review discusses the mechanisms of arterial hypertension development which are related to vitamin D metabolism in humans.

The review is focussed on the evidence base for anti-platelet therapy (APT) algorithms in women. Gender-specific features of haemostasis and thrombosis pathogenesis are emphasized. The “female” risk factors for thrombotic events include oral contraceptive use, pregnancy and post-labour period, menopause, and hormone replacement therapy. The APT role in primary and secondary cardiovascular prevention among women is analyzed. The gender-specific indications for acetylsalicylic acid therapy include pre-eclampsia, antiphospholipid syndrome, and migraine.

Aim. To study losartan effectiveness and safety in postmenopausal women with essential arterial hypertension (EAH), and with or without hormone replacement therapy (HRT). Material and methods. In total, 58 postmenopausal women with EAH were followed up for 6 months after being administered antihypertensive therapy (AHT) with losartan, due to inadequate blood pressure (BP) control. Group I (n=30) did not receive HRT, while Group II (n=28) was administered HRT. Losartan effects on BP dynamics, endothelium-dependent vasodilatation (EDVD), intima-media thickness (IMT) of carotid arteries (CA), lipid and carbohydrate metabolism were assessed, as well as losartan tolerability. Results. Losartan therapy resulted in target BP level achievement in both groups. At the study end, EDVD increase was statistically significant in Group I (р

Arterial hypertension (AH) in pregnancy is associated with systemic endothelial damage, vasoconstriction, and blood rheology disturbances, that results in microcirculation disorders, tissue and organ ischemia. Antihypertensive therapy effects on endothelium and blood cells in hypertensive pregnant women should be taken into account. Recent experimental and clinical studies show that nifedipine has good antihypertensive effect in pregnancy, is safe, and beneficial for endothelium, platelets and red blood cells. Nifedipine non-hemodynamic effects support its use as a first-line medication in pregnancy-associated hypertensive states.

Calcium antagonist nifedipine, an antihypertensive and anti-anginal medication with vasodilating action, is widely used in cardiology practice. According to the recommendations on cardiovascular disease management in pregnancy, by the European Society of Cardiology (2003) and Society of Cardiology of the Russian Federation (2003), nifedipine could be used for hypertension treatment in pregnancy. Positive experience of nifedipine use as an antihypertensive and tocolytic agent has been obtained. The medication has been proved as safe in III pregnancy trimester; its teratogenic and embryotoxic effects in the first pregnancy half have not been confirmed in clinical practice. Oral nifedipine effectively reduces increased blood pressure (BP) in hypertensive crises. Regular nifedipine therapy in pregnancy-associated hypertension facilitates effective BP control and prevents hypertensive crises.

The study is devoted to long-term prognosis in women with gestational arterial hypertension (GAH) in anamnesis. A retrospective epidemiological study of GAH clinical importance in women with essential AH was performed. In AH group, more than 50 % women had GAH syndrome in anamnesis. As a rule (45 %), this syndrome included chronic AH (AH before pregnancy or diagnosed before 20 weeks of gestation). Low birthweight in children predicted AH risk in their mothers. Inpatients with AH and GAH syndrome, the clinical course was more severe (higher risk of target organ damage, early cerebrovascular complications, coronary heart disease) than in AH patients without GAH syndrome. In AH/GAH women, genetic factors were less important than in AH women without GAH. More than a half of GAH patients (62,3 % ) received anihypertensive therapy. The latter did not affect significantly obstetric complication risk, labor outcome, and long-term prognosis in women. Only 34 % of GAH patients received an advice to continue the cardiologic follow-up after birthgiving. GAH syndrome should be considered as an independent cardiovascular risk factor. Women with GAH should be in focus of cardiologists' special attention, even if blood pressure level normalized post-partum. Such patients require regular medical examination and active cardiovascular prevention.

Fpidemiology studies have confirmed a hypothesis on pre-natal risk determination for metabolic syndrome (MS), arterial hypertension (AH), and coronary heart disease (CHD). Gestational diabetes (GD) and obesity are typical metabolic disturbances in pregnancy. Insulin resistance (IR) development at early gestation stages results in fat tissue proliferation and increased feto-placental nutritious value by late pregnancy stages, when fetus weight increases by 70%. Increased IR in mother provides reproductive benefit in case of under-nutrition and over-working, at the same time being able to result in GD, when combined with calorie-rich diet and sedentary lifestyle. Increased IR and pre-conception obesity increase macrosomia and fetus overweight risk. Overweight children of GD mothers have increased risk of juvenile obesity and type 2 diabetes mellitus (DM-2). Decreased fetal height and body size in pregnancy and early post-natal period could also result in DM and MS later in life. In spite of low cardiovascular morbidity in young women, gestational hyperglycemia combined with pre-pregnancy obesity, as well as gestational hypertensive syndrome, significantly increase cardiovascular risk. Women with pregnancy-diagnosed metabolic disturbances and AH, as well as their children, need to be actively followed-up and treated, if necessary.

Aim. To analyse cardiovascular risk levels in patients with arterial hypertension (AH); to assess atorvastatin effectiveness in AH patients without cardiovascular events (CVE).Material and methods. In total, 612 CVE-free patients with AH were examined. The participants with SCORE risk level of 5-9% received atorvastatin (10 mg/d) and standard antihypertensive therapy. The authors examined the effects of atorvastatin on blood pressure levels, lipid profile, endothelium-dependent vasodilatation (EDVD) in the brachial artery reactive hyperemia test, intima-media thickness (IMT) of common carotid arteries, C-reactive protein (CRP) concentration, and heart rate variability (HRV).Results. At the end of the study, the atorvastatin group demonstrated a significant decrease in mean levels of total cholesterol (CH), low-density lipoprotein CH and CRP was observed, as well as an increase in EDVD. In addition, in the atorvastatin group, the reduction of sympathetic component of low-frequency and especially very low-frequency HRV was more manifested than in the standard therapy group. In CVE-free patients with AH, atorvastatin therapy (10 mg/d) effectively normalised lipid profile, neuro-humoral and sympatho-adrenal activity parameters, and also demonstrated anti-inflammatory effect.Conclusion. The majority of AH patients have high and very high risk levels and, therefore, require a complex approach towards cardiovascular risk factor modification.