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The prevalence of hypertension (HTN) in the Russian Federation and the world continues to grow. This is largely due to the epidemic of obesity and related conditions — metabolic syndrome and type 2 diabetes. The most common and proven hypothesis of the relationship between hypertension and obesity is the activation of the sympathetic nervous system. However, modern research shows that the consequences of sympathetic hyperactivation are not limited only to hemodynamic effects, but extend to many organs and systems. Long-term sympathetic hyperactivation can lead to insulin resistance and type 2 diabetes. Neurotransmitters affect fat cells by increasing lipolysis and leading to increased fatty acid release, the liver by increasing gluconeogenesis, and pancreatic β-cells by decreasing insulin secretion. The sympathetic nervous system plays an important role in energy management by regulating metabolic rate. Obese individuals have significantly less pronounced postprandial thermogenesis, despite a higher insulin response, while the hemodynamic response to isometric or heterometric exercise is reduced. Chronic stress serves not only as a trigger for behavioral disorders, but also directly leads to various physiological disorders, including through sympathetic activation. However, the choice of antihypertensive agents affecting the sympathetic activity in patients with obesity and metabolic disorders is very limited. According to current guidelines, β-blockers are not the drugs of choice in patients with uncomplicated HTN, since it has a weaker evidence base compared to other classes of drugs and have metabolic and other side effects. Therefore, selective I1-imidazoline receptor agonists, and in particular, moxonidine may be the drugs of choice in this category of patients. Moxonidine in combination therapy of patients with HTN and metabolic disorders, including metabolic disorders in menopause, as well as with a physiological estrogen decrease, significantly improves the effectiveness of antihypertensive therapy and increases the achievement of target blood pressure. In addition, its metabolic effects improve prognosis of such patients.

Disclaimer. The EAC Guidelines represent the views of the EAC, and were produced after careful consideration of the scientific and medical knowledge, and the evidence available at the time of their publication. The EAC is not responsible in the event of any contradiction, discrepancy, and/or ambiguity between the EAC Guidelines and any other official recommendations or guidelines issued by the relevant public health authorities, in particular in relation to good use of healthcare or therapeutic strategies. Health professionals are encouraged to take the EAC Guidelines fully into account when exercising their clinical judgment, as well as in the determination and the implementation of preventive, diagnostic, or therapeutic medical strategies; however, the EAC Guide-lines do not override, in any way whatsoever, the individual responsibility of health professionals to make appropriate and accurate decisions in consideration of each patient’s health condition and in consultation with that patient and, where appropriate and/or necessary, the patient’s caregiver. Nor do the EAC Guidelines exempt health professionals from taking into full and careful consideration the relevant official updated recommendations or guidelines issued by the competent public health authorities, in order to manage each patient’s case in light of the scientifically accepted data pursuant to their respective ethical and professional obligations. It is also the health professional’s responsibility to verify the applicable rules and regulations relating to drugs and medical devices at the time of prescription.

The EAC Guidelines represent the views of the EAC, and were produced after careful consideration of the scientific and medical knowledge, and the evidence available at the time of their publication. The EAC is not responsible in the event of any contradiction, discrepancy, and/or ambiguity between the EAC Guidelines and any other official recommendations or guidelines issued by the relevant public health authorities, in particular in relation to good use of healthcare or therapeutic strategies. Health professionals are encouraged to take the EAC Guidelines fully into account when exercising their clinical judgment, as well as in the determination and the implementation of preventive, diagnostic, or therapeutic medical strategies; however, the EAC Guidelines do not override, in any way whatsoever, the individual responsibility of health professionals to make appropriate and accurate decisions in consideration of each patient’s health condition and in consultation with that patient and, where appropriate and/or necessary, the patient’s caregiver. Nor do the EAC Guidelines exempt health professionals from taking into full and careful consideration the relevant official updated recommendations or guidelines issued by the competent public health authorities, in order to manage each patient’s case in light of the scientifically accepted data pursuant to their respective ethical and professional obligations. It is also the health professional’s responsibility to verify the applicable rules and regulations relating to drugs and medical devices at the time of prescription.

VIII Eurasian Congress of Cardiology. Overview of symposiums. New opportunities for reducing cardiovascular risk in the Russian Federation. Systemic Hypertension

Guidelines on treatment of patients with arterial hypertension comorbid with metabolic disorders and diabetes mellitus type 2

The growing weight of noncommunicable diseases, primarily cardiovascular diseases (CVDs), is a great threat to the health of population worldwide, worsening the quality of life and reducing life expectancy. Realization of this threat led to initiation of epidemiological study by the Russian Ministry of Health to investigate the prevalence of CVDs and their risk factors, since it is CVDs that specify the high allcause mortality in Russia. In the modern history of epidemiology of non-infectious disease, the Epidemiology of Cardiovascular Diseases and their Risk Factors in Regions of Russian Federation (ESSE-RF) study occupies a special place. This is the largest epidemiological study, which is considered as a continuation of preventive activity in order to obtain unbiased information on epidemiological characteristics of population in Russian regions. To conduct the study, the Research Organizing Committee of ESSE-RF study was created and a protocol was developed. All interested scientists and experts from following three centers took part in the work: National Medical Research Center for Therapy and Preventive Medicine, Almazov National Medical Research Center, National Medical Research Center of Cardiology. The Russian regions were justified and selected for participation. In 2012-2014 ESSE-RF study, 13 following Russian regions took part: Volgograd, Vologda, Voronezh, Ivanovo, Kemerovo, Tyumen Oblasts; Krasnoyarsk and Primorsky Krai; the Republic of North Ossetia (Alania); cities of Orenburg, Samara, St. Petersburg and Tomsk. All participated regions used a single study protocol, while biochemical parameters were determined in Federal centers using the same equipment and reagent kits. The paper presents some of the most interesting results that indicate a change in Russian epidemiological situation over the past few years. After the end of cross-sectional study, a field of priority research areas was formed in each center.Conclusion. Epidemiological studies are the most important scientific tool for assessing the prevalence of diseases, their risk factors, as well as predicting adverse events. Based on the results obtained, healthcare system and medical community determine priorities and develop related strategies (population-based and high-risk strategies). For their implementation, a regulatory and legal framework is being created.

Arterial hypertension in adults. Clinical guidelines 2020

Obesity is one of the main risk factors for type 2 diabetes developing. The question of the advantages and disadvantages of using various anthropometric indices [body mass index (BMI), waist circumference (WC), waist-to-height ratio (WHR), lipid accumulation product index (LAPI), visceral obesity index (VOI)] has been under discussion lately.Aim. To perform an analysis of anthropometric obesity indicators (BMI, WC, WHR, VOI, LAPI) depending on the presence of type 2 diabetes in the adult population of the Russian Federation.Material and methods. The results of the study "Epidemiology of Cardiovascular diseases and their risk factors in the regions of the Russian Federation" (ESSE-RF) performed in 2012-2014 in 13 regions of the Russian Federation are included into the analysis. People aged 25-64 years (n=20878; 8058 men and 12820 women) were examined. The following indicators in people with/without type 2 diabetes were analyzed: age; sex; anthropometric indicators: height, weight, WC; smoking status (“never smoked”, “smoked”, “smokes now”); alcohol consumption, which was ranked for “never in the last year” and “a lot” (≥168 g of ethanol per week for men and ≥84 g of ethanol per week for women); the level of systolic (SBP) and diastolic (DBP) blood pressure; heart rate (HR); levels of glucose, total cholesterol (TC), high density lipoproteins cholesterol (HDL-C), triglycerides (TG); WHR; VOI; LAPI, BMI.Results. Levels of TC and glucose, excessive alcohol consumption, BMI were selected in a multifactor regression model in men after adjusting for age, region of residence and IVO. The same factors (SBP instead of alcohol and BMI instead of WHR were included in the model) were selected in women. VOI showed the greatest degree of association with type 2 diabetes regardless of gender after adjusting for age and region of residence (in men odds ratio 1,085; p=0.0001; in women odds ratio 1,136; p=0.0001). Thus, VOI (predictor of type 2 diabetes in population of working age) was common to both sexes.Conclusion. VOI has statistically significant associations with type 2 diabetes. VOI is the best surrogate marker for measuring the degree of abdominal obesity in the Russian population and can be used to determine the presence of type 2 diabetes in clinical practice. Screening for elevated VOI values in healthy individuals and patients with pre-diabetes can serve as a guide for targeted aggressive preventive interventions.Participants of the ESSE-RF Study: Vladivostok: Kulakova N.V., Nevzorova V.A., Shestakova N.V., Mokshina M.V., Rodionova L.V.; Vladikavkaz: Tolparov G.V.; Vologda: Shabunova A.A., Kalashnikov K.N., Kalachikova O.N., Popov A.V.; Volgograd: Nedogoda S.V., Chumachek E.V., Lediaeva A.A.; Voronezh: Chernyih T.M., Furmenko G.I., Ovsyannikova V.V., Bondarcov L.V.; Ivanovo: Belova O.A., Romanchuk S.V., Nazarova O.A., Shutemova O.A.; Kemerovo: Barbarash O.L., Artamonova G.V., Indukaeva E.V., Mulerova T.A., Maksimov S.A., Skripchemko A.E., Cherkass N.V., Tabakaev M.V., Danilchenko Ia.V.; Krasnoyarsk: Grinshtein Yu.I., Petrova M.M., Danilova L.K., Evsiukov A.A., Shabalin V.V., Ruph R.R., Kosinova A.A., Filonenko I.V., Baykova O.A.; Moscow: Gomyranova N.V., Oganov R.G., Oshepkova E.V.; Orenburg: Libis R.A., Basyrova I.R., Lopina E.A.; Samara: Dupliakov D.V., Gudkova S.A., Cherepanova N.A.; St. Petersburg: Konradi A.O., Baranova E.I.; Tomsk: Trubacheva I.A., Kaveshnikov V.S., Karpov R.S., Serebriakova V.N.; Tyumen: Efanov A. Yu., Medvedeva I.V., Storozhok M.A., Shalaev S.V.

Aim. Evaluation of the prevalence of sleep breathing disorder (snoring, apnea) and its association with the risk factors of cardiovascular diseases, in the framework of the study of epidemiology of cardiovascular diseases risk factors in various regions of Russia (ESSE-RF).Material and methods. The object of the trial ESSE-RF were representative selections from non-organized male and female inhabitants, age 25 to 64 y. o., in 13 regions of Russia. From the module of sleep assessment, for breathing disorders the following questions were taken: “Do you snore at sleep?”, “Do you have interruptions of breathing during sleep?” with the variants yes, no, not known. Also the gender, age, systolic pressure were assessed, as obesity, physical activity level, smoking, alcohol consumption, systolic and diastolic pressure, complaints on sleepiness, laboratory parameters: lipid profile, fasting glucose, creatinine, glomerular filtration rate and uric acid.Results. Into analysis, 2 selection of participants were included, responded yes or no about snoring (n=17461) and sleep breathing interruptions (n=13264). The results show that the prevalence of complaints on snoring increased with smoking, alcohol overconsumption, male gender, age, body mass index, glycemia, low physical activity; and for apnea — male gender, alcohol, age and obesity. Sleepiness increases significantly with the complaints on snoring and apnea.Conclusion. Complaints on snoring are widely prevalent in general population with predomination among males. With the age, the prevalence increases of both snoring and apnea. Common risk factors of cardiovascular diseases in the presence of complaints on snoring and apnea, are male gender, obesity, age and alcohol overconsumption.

Aim. To evaluate 10-year risk of potential development of type 2 diabetes (DM) in Russian population with the FINDRISC score, and to assess its associations with social, demographic and behavioral factors by the data from epidemiological study ESSE-RF. Material and methods. In the work, the data used, from multi-center study (Epidemiology of cardiovascular diseases in various regions of Russian Federation: ESSE-RF). Totally, 21923 persons investigated, age 25-64 y.o., of those 1045 (3,76% males, 5,39% females) had DM. To the final analysis 20878 persons included (8058 males, 12820 females) with no DM, for whom the 10-year risk was assessed with the FINDRISC (The FINnish Diabetes RIsk SCore). Level of risk and probability of DM onset were evaluated by the points summation. Also, associations were analyzed with education, marital status, place of inhabitance, income, smoking and alcohol status.Results. The threshold for high DM risk in Russian population was set at ≥12 level, with AUC 0,76, that represents good quality of model. The prevalence of the high risk by Russian criteria was 20,4%. Multifactorial analysis demonstrated that after correction for region and age, DM high risk was associated with smoking cessation (odds ratio (OR) 1,34; 95% confidence interval (CI) 1,14-1,58; р=0,0004) and alcohol consumption (OR 2,01; 95% CI 1,48-2,71; р=0,0001), and in women — with low income, low educational level and being married.Conclusion. Mean score by FINDRISC was 6,5±0,03, and absolute risk 5,3%. There were associations found of higher DM risk (≥12 points) with behavioral factors in males and social-demographic factors in women.

Elevated level of plasma cholesterol, together with arterial hypertension, is the main modifiable factor of cardiovascular diseases (CVD) development. Monitoring of lipid levels at populational level is an important instrument of the prevention medicine, applied for CVD populational risk assessment.Aim. Blood lipid levels assessment, with the data obatined during epidemiological study “ESSE-RF” (Epidemiology of cardiovascular diseases in various regions of Russian Federation) in 13 regions of Russia.Material and methods. In the study, the patients were included, of 25-64 y.o. All participants underwent specimens collection for total cholesterol (TC), triglycerides (TG), high density lipoproteides cholesterol (HDL-C) and low density lipoproteides cholesterol (LDL-C) by enzymatic methods on automatic analyzer Abbott Architect 8000. Also, in all the participants, hypolipidemic therapy was evaluated.Results. Totally, 21167 persons included into analysis, 7937 males and 13230 females. 807 (3,81%) had been taking hypolipidemic therapy and were ruled out from further analysis. Mean age 44±12 and 47±11 y.o., respectively. Mean values for men were TC 5,31±1,15 mM/L, TG 1,58±1,24 mM/L, HDL-C 1,30±0,33 mM/L and LDL-C 3,38±0,99 mM/L (7643 persons), for women — 5,48±1,18 mM/L, 1,36±0,85 mM/L, 1,47±0,35 mM/L and 3,42±1,04 mM/L, respectively (12717 persons). In the study we present percentile variations of the studied groups by the measured levels of TC, TG, HDL-C, LDL-C according to the age and sex. There were moderate correlations found of HDL-C with age and sex (r=0,34, p=0,000) and LDL-C (r=0,33, p=0,000). Correlation of TG with age and sex was low, but significant (r=0,18, p=0,000). There was no correlation of HDL-C with age and sex (r=-0,002, p=0,740). Also, a high prevalence is shown for severe lipid disorders. 23% of the participants had severely increased TC level (>6,2 mM/L), and 20,6% — of LDL-C (>4,2 mM/L). Severe increase of TG (>5,0 mM/L) was found much more rarely (1,1%).Conclusion. In the ESSE-RF study the prevalence of significant lipid disorders was shown as high, that demands respective prevention and management. This study might be a starting point for lipids populational dynamics analysis in Russia.

Life quality (LQ) is an integrated parameter of the health, applied for integral characterization of population health, and as the parameter of healthcare interventions effectiveness.Aim. To assess LQ in Russian population at the age 25-64 y. o. in general and in various socio-economical groups using EQ-5D, by the results of ESSE-RF (2012-2013) study.Material and methods. LQ was assessed on representative selections of inhabitants of 13 Russian Federation regions, aged 25-64 (males 8327, females 13497) with response 80%. LQ was assessed via international questionnaire EUROQOL — EQ-5D: 1) no decline; 2) mild decline; 3) significant decline; scoring also performed with visualanalogue scale (VAS). Integral LQ by EUROQOL performed with Shaw JW et al. method (ranging from 0,0 (death) to 1,0 (perfect health)).Result. EQ-5D index of Russian population was 0,87 with no gender difference. By the increase of the age LQ declines. Educational gradient of LQ was significant only in VAS (p

Aim. To assess rate of familiarity and specifics of treatment with statins among the citizens of economically active age with various cardiovascular risk by the data from epidemiological study ESSE-RF (Epidemiology of Cardiovascular Diseases in Different Russian Federation Regions). Material and methods. In the work the data from ESSE-RF study was used, of representative selection of non-organized male and female inhabitants aged 25-64 y.o. from 13 regions, investigated during 2012-2014. Responded ~80%. The study included questionning by standard scale that included data on the anamnesis, etc. Lipid profile, including total cholesterol (TC), cholesterol of lipoproteids low and high density were measured at SSRCPM and RSPCC.Results. Analysis of the whole selection showed that 20% of men and 32% of women knew their TC, and 13,6% and 18,2% were even familiar having increased level of TC. Part of those with high and very high risk was 31,3%, incl. men — 42,2%, women — 30,9%. Statins took ~7,0% of patients from this risk category. Effectiveness of treatment (target levels reached of low density cholesterol) in these groups of men and women was 14,4% and 4,8%, respectively.Conclusion. The data obtained in populational study points on insufficient knowledge and low rate of statin treatment of the persons with high and very high cardiovascular risk in RF, which confirms the anxiety provoking data of registries and other studies. The data dictates necessity of development and implementation of specific educational programs for citizens, of physician improvement and availability of cheap but effective lipid-lowering medications.

Aim: To evaluate structural and functional heart abnormalities in patients with arterial hypertension (AH) with and without metabolic syndrome.Materials and methods: The study included 303 patients with AH I, II and III, aged from 25 to 70 years (mean±SD 52±18 years). All patients were categorized into 3 groups according to severity of AH (AH I, II and III corresponded to groups 1, 2 and 3, respectively). Within each group, patients were subdivided into 2 subgroups: without metabolic syndrome (n=151) and with metabolic syndrome (n=152). Assessments included measurements of blood glucose and lipids, 24-hour monitoring of blood pressure, echocardiography with calculation of myocardial mass index of left ventricle and the use of conventional and tissue myocardial dopplerography.Results: Already at early stage of AH (gr. I), 60% patients with metabolic syndrome and 32% patients without metabolic abnormalities had some degree of left ventricular remodeling, including concentric type of remodeling in 12 and 20%, excentric hypertrophy in 18 and 6%, concentric left ventricular hypertrophy in 30 and 6%, respectively. In AH I, an increase of myocardial mass index of left ventricle was found in 39% of patients with metabolic syndrome and in 12% patients without it. In patients with AH I, abnormalities of left ventricular diastolic function according to the results of tissue myocardial dopplerography was seen in 82% of patients with metabolic syndrome and in 42% of patients without metabolic syndrome. Patients with AH I–III and metabolic syndrome had almost 5-fold higher probability of heart abnormalities than AH patients without metabolic disturbances (odds ratio 4.8, 95% confidence interval 1.9–6.4, p< 50 and>50 years).Conclusion: Metabolic syndrome contributes to heart abnormalities irrespective of gender, age and AH grade.

Aim. To study the prevalence of hyperuricemia in the Russian regions, depending on the climatic, geographical, socio-demographic characteristics and some cardiometabolic risk factors.Material and methods. Data from the ESSE-RF study from 10 regions of theRussian Federationare presented. All study participants were examined according to a uniform protocol. Measurements were standardized, biochemical tests were carried out in three Federal centers using the same methodology. The study was approved by independent Ethics committees, and all participants signed informed consent.Results. The prevalence of hyperuricemia was 16.8% (25.3% in men and 11.3% in women; pConclusion. Prevalence of hyperuricemia inRussiais defined; regions with the highest and lowest prevalence are identified. Associations of hyperuricemia with some social and demographic characteristics as well as cardiovascular risk factors are revealed.

Aim. To study the association of high-sensitivity C-reactive protein (hsCRP) level with socio-demographic, behavioral and traditional risk factors in different regions of the Russian Federation (RF).Material and methods. Data of the multicenter epidemiological study of cardiovascular disease in different regions of the Russian Federation (ESSE-RF) were used. Representative sample of the unorganized male and female population aged 25-64 from 6 regions of the Russian Federation was drown. 3407 men and 6354 women (n=9761) were included into the study. Standard questionnaire was applied in all subjects. Gender, age, level of education, place of residence and region of residence, traditional risk factors and diseases were analyzed. HsCRP level (level ≥3.0 mg/l was defined as elevated one) was evaluated to detect of indolent inflammation.Results. HsCRP levels in women was significantly higher compared to males (pConclusion. Elevated level of hsCRP (≥3.0 mg/l) was significantly associated with female gender, with an older, less educated, and smoking population of Russians. After the multivariate adjustment there remained significant associations (p

Aim. To study the prevalence of ischemic heart disease as one of the most common cardiovascular disorders, together with arterial hypertension (AH), diabetes mellitus (DM) and liver diseases (LD) in adult (25-64 y.o.) population of selected RF regions, the variance of those with gender and age, and association of cardiovascular risk factors (FR).Material and methods. Into analysis we included the results of representative selections studies from 13 RF regions, studied according to the program of multicenter study ESSE-RF during the years 2012­2014; totally 21923 patients studied. Investigation included standard questioning, including anamnesis. For statistics we used applied software SAS.Results. In men the prevalence of IHD is associated with the growth of comorbidity from 0 in the age group 25-34 y. to 77% in the age 55-64 y., almost duplicating every decade. For women there is analogic tendency, less prominent. In men there are significant associations only with AH, which increases the risk of IHD 2,5 times, though in women together with AH the associations are significant for LD. Comorbidities with DM do not influence the prevalence of IHD in men and women. At the same time, any association with two diseases increases the risk of IHD >304 times. The most negative is the association of all three diseases, with which IHD is 8,7 times more prevalent, than in their absence. Using multidimensional logistic regression after correction for the age and comorbidity in the patients with IHD of both genders, there are associations revealed of high density cholesterol lipoproteids (HDL) in blood and abdominal obesity. In men there are also positive associations with smoking and negative — with increased cholesterol.Conclusion. Comorbidities of IHD with AH, DM and LD in adult population are common, are associated with the general FR, are increasing with the age. Taking modern tendencies of population ageing, it is plausible to expect an increase of the prevalence of comorbidities, that requires a necessity of the healthcare services to these changes.

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.

In the frame of Multicenter observational study ECVD-RF (Epidemiology of Cardiovascular Diseases and their Risk Factors in Regions of Russian Federation) by the unique protocol the investigation of representative selections of adult population at the age of 25-64 y.o. of 11 regions RF (n=18305, including males, n=6919 and females n=11386): Volgograd, Vologda, Voronezh, Ivanovo, Kemerovo, Orenburg, Samara, Tomsk, Tyumen, Saint-Petersburg and Northern Osetia-Alania. The prevalence of the following risk factors (RF) of cardiovascular diseases is evaluated: high blood pressure — 33,8%, obesity — 29,7%, high total cholesterol — 57,6%, high glucose level or diabetes — 4,6%, smoking (tobacco consumption) — 25,7%, insufficient (low) level of physical activity — 38,8%, excessive salt consumption — 49,9% and insufficient vegetables and fruits consumption — 41,9%. Gender differences and an increase with the age of the parameters mentioned are described.The absence of a epidemiologic monitoring system at the Federal level leads to an impossibility of clear conclusions on the RF dynamics in Russian population. While comparing the ECVD-RF study with previous epidemiological studies we can just cautiously suppose the existence in 21st age of negative dynamics of one RF (obesity, dyslipidemia) and positive dynamics of the others (smoking).

Aim. To study prevalence of arterial hypertension (AH), mean values of systolic and diastolic blood pressure (SBP, DBP), awareness of patients about their disease, medication consumption (MC) and efficacy of treatment in several regions of Russia.Material and methods. Representative selections were made in 9 regions of Russia: men (n=5563), women (n=9737) of 25–64 y.o., studied in 2012–2013 with the response 80%. Systematic stratified multilevel random selection was formed with localilty criteria (Kisch method). The Questionnaire on the presence of AH included: awareness of the patient about his disease, drug intake. BP measurement was performed on the right arm by automatic tonometer Omron in sitting position after 5 minutes resting. The mean value of two measurements was used. BP defined as SBP ≥140 mmHg, DBP ≥90 mmHg, or if the patient had taken antihypertensive therapy. Efficacy of treatment — the part of patients (in %) who reached target BP. Control group — part of patients (in %) with BP

Aim. To investigate the associations between the severity of carbohydrate metabolism disturbances, arterial hypertension (AH) severity (based on AH stage and 24-hour blood pressure monitoring (BPM) parameters), and lipid profile. Material and methods. In 403 patients with AH and metabolic syndrome (MS), blood biochemical assay, glucose tolerance test, and 24-hour BMP were performed. Results. Patients with impaired glucose tolerance (IGT), compared to participants with impaired fasting glycemia (IFG) or particularly to individuals with normal carbohydrate metabolism, demonstrated more severe lipid profile disturbances, more advanced AH stage, and increased mean BP levels, BP load, and BP variability at 24-hour BPM. Conclusion. IGT, as a more severe variant of carbohydrate metabolism disturbances, could be associated with increased risk of cardiovascular disease and Type 2 diabetes mellitus.

Arterial hypertension (AH) is one of the most prevalent components of metabolic syndrome (MS). At the same time, AH is a major risk factor predicting the development and progression of cardiovascular disease. The available literature provides inconsistent evidence on the association between the number of present MS components, blood pressure (BP) levels, and disturbed circadian BP profile. This study demonstrated that a higher number of MS components is linked to a higher AH stage and higher mean levels of most circadian, daytime, and nighttime parameters of 24-hour BP monitoring. Moreover, there was a significant increase in the numbers of “non-dippers” (patients with inadequate nighttime BP reduction), which is associated with a higher risk of cardiovascular events.

Aim. To study the effectiveness of a direct renin inhibitor, aliskiren, in patients with menopausal metabolic syndrome (MMS), and to assess aliskiren effects on blood pressure (BP), carbohydrate and lipid metabolism parameters, microalbuminuria, and arterial stiffness. Material and methods. The study included 23 women with MMS, to whom aliskiren monotherapy (150-300 mg/d) was administered. At baseline and in the end of the study, anthropometry, carbohydrate and lipid metabolism parameters assessment, 24-hour BP monitoring, and arterial stiffness assessment by volume sphygmography were performed. Results. By the end of the study, most parameters of circadian BP profile significantly decreased. Target levels of systolic and diastolic BP were achieved in 80 % of the patients. There was a significant reduction in postprandial glucose levels. According to the volume sphygmography results, a decrease in arterial stiffness was accompanied by a significant reduction in pulse wave velocity and augmentation index, with normalization of the former parameter. Conclusion. Aliskiren therapy demonstrated not only high antihypertensive effectiveness in MMS patients, but also a reduction in postprandial glucose levels and arterial stiffness.

Aim. To assess the effectiveness of vildagliptin, its effects on visceral obesity (VO), carbohydrate and lipid metabolism parameters, and circadian profile (CP) of blood pressure (BP) in patients with metabolic syndrome (MS), Stage I arterial hypertension (AH), and impaired glucose tolerance (IGT). Material and methods. The study included 30 patients, aged 18-60 years (16 men and 14 women). All patients had IGT, VO, and Stage I AH. Previously prescribed antihypertensive therapy (AHT) was not modified after the start of the study. In all participants, carbohydrate and lipid metabolism parameters, BP CP, and body weight were measured at baseline and after 24 weeks of vildagliptin treatment. Results. Vildagliptin therapy was associated with a significant reduction in body weight, waist circumference, postprandial and fasting glucose levels, the levels of total cholesterol and low-density lipoprotein cholesterol, as well as with a sustained reduction in systolic and diastolic BP levels. Conclusion. Vildagliptin therapy resulted in weight reduction, improved carbohydrate and lipid profiles, and target BP achievement, without inducing hypoglycemia episodes.

Aim. To assess the long-term effectiveness and safety of moxonidine (Physiotens®), as antihypertensive treatment in patients with metabolic syndrome (MS), including women with menopausal MS. Material and methods. The study included 274 patients: 203 women (74 %) and 70 men (26 %). Postmenopausal women comprised a separate study subgroup. At baseline and after 24 weeks of moxonidine treatment, all participants underwent anthropometry and the measurement of systolic and diastolic blood pressure (SBP, DBP), lipid and carbohydrate metabolism parameters. Results. Moxonidine therapy was associated with a reduction in SBP and DBP levels. A positive dynamics in the levels of fasting glucose, total cholesterol, low and high-density lipoproteins (LDL, HDL), and triglycerides was observed. The changes in these parameters were similar among postmenopausal women and all study participants. Conclusion. In MS patients, moxonidine improved circadian BP profile, and also demonstrated beneficial effects on carbohydrate and lipid metabolism parameters in women with menopausal MS.

According to the latest recommendations by the European Society of Hypertension and the European Society of Cardiology, in patients with high cardiovascular risk (including individuals with diabetes mellitus and metabolic syndrome), the first-choice agents for arterial hypertension (AH) treatment are combined medications. Ideally, one medication should combine blockers of renin-angiotensin system and a metabolically neutral diuretic. The combined medication Noliprel A fulfils these requirements, being a fixed low-dose combination of ACE inhibitor perindopril arginine and thiazide-like diuretic indapamide. Noliprel A demonstrates not only good antihypertensive effects, but also beneficial metabolic and organo-protective activity. Therefore, it can be recommended as firstchoice medication in this clinical group.