The key goal in the treatment for patients with AH is to reduce the risk of cardiovascular complications through reaching the target level of arterial pressure (AP) and organ protection, treatment of concomitant diseases and correction of risk factors. The new US guidelines for the management of hypertension indicate that the target blood pressure level for all patients was less than 130/80 mm Hg. This is due, among other things, to changing the blood pressure levels classification and categorizing all adults with blood pressure of 130/80 mm Hg. and higher as having hypertension. The need for not only wider combination therapy for the treatment of hypertensive patients, but also its earlier commencement has been strongly confirmed by these new guidelines for the management of AH. The wider use of combinations, especially in fixed doses, such as the calcium channel blocker amlodipine, and the angiotensin II receptor antagonist olmesartan for the treatment of hypertension, will help improve blood pressure monitoring, reduce the risk of complications and increase the AH patients’ life expectancy.

This article discusses clinicopharmacological niches of fosinopril, one of the most popular ACE inhibitors in daily outpatient practice. The authors cover aspects, where fosinopril has advantages over other ACE inhibitors and angiotensin II receptor blockers (sartans) from the point of view of therapy, cardiology and clinical pharmacology. The theses taken as a basis of the article are confirmed by the authors, who named and reviewed the leading clinical trials of fosinopril and its potentially possible combinations with diuretics and calcium channel blockers. The article also covers issues and satellite phenomena of “vascular” comorbidity in patients with arterial hypertension, chronic heart failure and chronic kidney disease; describes the mechanisms of their development and mutual aggravation; examines the points of administration and the evidence for the efficacy and safety of fosinopril in this cohort of patients. One of the main theses of this article is the importance of organ-protection (-cardio, -nefro, -angio). The main directions and postulates of its implementation are provided using the example of ACE inhibitors.

This analytic review provides the information about frequency of myocardial infarction in patients, treated with direct oral anticoagulants in randomized clinical trials and retrospective cohort studies. It is indicated that direct thrombin inhibitor dabigatran has higher incidence of myocardial infarctions than warfarin. Direct factor Xa inhibitor rivaroxaban has the most convincing arguments of coronary safety.

The article discusses new opportunities for reducing the risk of complications of cardiovascular diseases caused by atherosclerosis in a wide range of people for the purposes of primary and secondary prevention. The article provides for the data of the most important clinical studies, both randomized and observational, which can become the basis for revising the target and threshold blood levels of low-density lipoprotein (LDL) cholesterol (CS) in the near future. In addition, the rational for the wider use of combination drugs containing statins and antiplatelet agents is considered to increase adherence to therapy in conditions of induced polypharmacotherapy in a wide range of patients with cardiovascular diseases. In recent years, lipid-lowering therapy has got two main trends: 1) determining the lipid levels in the blood, and especially lowdensity lipoprotein (LDL) cholesterol, which stops progression or regression of atherosclerosis; 2) obtaining evidence on improvement of the prognosis for patients with cardiovascular diseases caused by atherosclerosis (CVDCA), with a decrease in the concentration of LDL-C in the blood to lower levels compared with those that were previously accepted. In this article, we wanted to recall the results of the most important studies that reflect these modern trends in lipidology.

Acetylsalicylic acid remains the basis of anti-platelet therapy for stable ischemic heart disease (IHD), including conditino after coronary artery bypass grafting. Double anti-platelet therapy (APT) consisting of acetylsalicylic acid and a P2Y12 receptor inhibitor (clopidogrel, prasugrel, ticagrelor) reduces the risk of recurrence of major ischemic complications in patients with acute coronary syndromes (ACS) and/or those who underwent percutaneous coronary intervention (PCI), but inevitably increases the risk of major bleeding compared with anti-platelet monotherapy. The principle of personified treatment is implemented on the basis of an assessment of the patient’s clinical status (stable ischemic heart disease or ACS), the ratio of the ischemic and bleeding risks, strategies of management. The review presents the evidence-base to support anti-platelet therapy of stable IHD and ACS in conservative treatment and myocardial revascularization, which forms the basis of the current clinical guidelines. According to the current views the optimal duration of APT after ACS and PCI can vary from 1 to 48 months and continues to be studied in randomized trials. Most recently, the principle of de-escalation of anti-platelet therapy after ACS and PCI has been developed, taking into account the actively discussed findings of clinical projects published in the second half of 2017.

The influence of gene polymorphisms ADRB1 (Ser49Gly), ADRB1 (Arg389Gly) on myocardial remodeling and 12-month prognosis of patients with ST-segment elevation myocardial infarction (STEMI) was studied. The gene polymorphisms ADRB1 (Ser49Gly) and ADRB1 (Arg389Gly) does not affect myocardial remodeling. Ser49 allele is associated with a greater incidence of acute coronary events, such as death from cardiovascular causes, repeated non-fatal myocardial infarction, unplanned coronary revascularization, hospitalization for progressive angina pectoris within a year after STEMI. The Gly49 allele and the Gly49Gly genotype are associated with a favorable prognosis within a year after STEMI. The gene polymorphism ADRB1 (Arg389Gly) does not affect the prognosis after STEMI.

Prevention of fatal complications in patients with high cardiovascular risk means achieving target blood cholesterol and its fraction in low-density lipoprotein levels, which level depends on the cardiovascular risk (CVR) degree and is determined by the guidelines of the European Cardiology Society (2016) and the Russian National Atherosclerosis Society (2017). When choosing statins for lipid-lowering therapy, one should be guided by the hepatic metabolism nature, hypolipidemic activity, and the pleiotropic profiles of the drug.

Therapeutic potential of replacement of one antiagregant by another one in patients receiving double antiaggregant therapy Double antiaggregant therapy reduces the risk of adverse cardiovascular events. There are currently several P2Y12 platelet receptor inhibitors available, which suggests that not only optimal therapy needs to be chosen, but a patient can also be switched from one drug to another. At present, there are limited research data, as well as guidelines based largely on the experts’ opinions on replacing one drug by another. The existing options for changing double antiaggregant therapy should be taken into account in order to achieve optimal treatment outcomes for each patient.

The article presents the contemporary views of the role of aldosterone in the progression of cardiovascular and renal diseases. It addresses matters related to the efficacy and safety of mineralocorticoid receptor antagonists in patients with chronic heart failure, chronic kidney disease at various stages including terminal renal failure, dialysis therapy, and kidney transplantation.

Endothelial dysfunction plays a major role in the pathogenesis of target organ damage in patients with chronic heart failure (CHF) and type 2 diabetes mellitus (DM). The aim of the study was to evaluate the effect of trimetazidine on the parameters of the elasticity of the large arteries and microcirculation (MC) in patients with CHF and type 2 diabetes. 60 diabetic patients with CHF at the age of 45–70 years were included. All patients received baseline therapy of CHF and DM. Trimetazidine at a dose of 70 mg / day was prescribed for all patients of 1 group (n = 30) in addition to traditional treatment. The elastic properties of large arteries were evaluated by analyzing the velocity of the pulse wave propagation (SRV), and the MC parameters were studied. Results. Treatment with using of trimetazidine in addition to traditional treatment for 16 weeks significantly improved endothelial function, clinical state of patientsфтв the state of the parameters of the microcirculation.

The article considers the possibility of prescribing anticoagulant therapy to elderly patients with atrial fibrillation in various clinical situations. It presents key data from randomized clinical trials for the safe and effective use of direct thrombin inhibitors in elderly patients undergoing percutaneous coronary intervention, acute cerebrovascular event/ transient ischaemic attack, and patients with concomitant chronic kidney disease and diabetes mellitus.

Type 2 diabetes mellitus is one of the main health problems not only in our country, but also in the world. Due to the steady rise in the number of persons with DM, it is extremely important to pay due attention to preventive measures aimed at reducing the prevalence of type 2 diabetes. The article describes the main principles of primary non-drug prevention of type 2 diabetes mellitus.

The article discusses the choice of anticoagulant therapy in patients with atrial fibrillation and a number of concomitant diseases – coronary heart disease, including after percutaneous coronary interventions, diabetes mellitus, chronic kidney disease, chronic obstructive pulmonary disease, and in the elderly. The data of subanalyses of a randomized clinical trial of ARISTOTLE are presented, indicating a high profile of efficacy and safety of the new oral anticoagulant apixaban in this category of patients.

Thrombosis is one of the leading causes of death and disability around the world, therefore their treatment and prevention are relevant in modern medicine. The article discusses the features and possible applications of the new oral anticoagulants in General, and particularly of apixaban as the newest representative of this group of drugs.

Smoking is a very significant risk factor for cardiovascular, respiratory and cancer diseases. To date, practitioners have a number of drugs for pharmaceutical support of smoking cessation in their arsenal. The review presents the latest data on the comparative effectiveness and safety of modern methods of treating nicotine dependence, including in high-risk patients.

Mediastinal masses include a wide range of both benign and malignant diseases. Current evidence shows that they constitute 3–7% of all oncological diseases, with primary tumours (thymoma, lymphoma, germ cell tumours) accounting for 3% of all mediastinal masses. Lymphoma and thymoma, for instance, are the most common, while germ cell tumours are of much less frequent occurrence. Neurogenic tumours, it bears noting, are also widespread making up 12–21% of all mediastinal masses, predominantly so among paediatric population. Morphologically 25–49% of all masses are malignant. The rationale of the subject matter is the fact that statistics for progress of the disease masked as other conditions have been on the rise. It is noted that about 60% of mediastinal masses manifest themselves in classical respiratory symptoms, while the rest of cases are represented by a variable clinical picture, which makes it more difficult to diagnose and decide on the therapeutic approach. The article presents a clinical case of a 32-year-old female patient diagnosed as primary mediastinal large B-cell lymphoma which made its first appearance as a clinical picture of respiratory complaints. This clinical case describes the  diagnosis algorithm using up-to-date laboratory and instrumental methods.

Severe thrombocytopenia significantly (at times and dozens of times) increases in-hospital mortality, especially for General surgical, vascular, orthopedic and traumatological patients in comparison with cardiosurgery and interventional cardiac patients. Heparin-induced thrombocytopenia is immune-mediated complication, paradoxically accompanied by frequent thrombosis. The risk of thrombosis varies from 30–50% for moderate and up to 90% in severe thrombocytopenia. Venous thrombosis predominate over the arterial, especially thrombosis of deep veins of lower extremities and pulmonary thromboembolia. Strokes, acute myocardial infarction, thrombosis of the mesenteric, vertebral arteries, central catheters are also not rare. The delay in diagnosis and in cessation of the heparins, the use of tromboconcentrate, not appointment of alternative anticoagulants – all of it worsen prognosis and increase mortality. Currently, in order to assess the possibility of Heparin-induced thrombocytopenia «Scale 4 T» is often in usage. It contains inaccuracies and provides 4 criteria and 3 degrees, that to some extent complicates its use. In early 2014, on the basis of literature analysis and own experience, we have developed a simplified «Rule» for the rapid diagnosis of this condition. Key points are highlighted in review regarding the pathophysiology, epidemiology, diagnosis, aspects of modern management, as well as the economic impact of heparin-induced thrombocytopenia and clinical examples in surgical patients confirmed by immunoassay. The next message will show a 3-year analysis of the incidence, causes, dynamics of outcomes in a multidisciplinary hospital, and the results of the implementation of the original «Rule».

84 patients aged 40 to 70 years received Holter ECG monitoring to determine the values of QT’interval measurement. All patients were divided into 4 groups: group 1 – 24 healthy patients, group 2 – (n = 24) patients with ischemic heart disease (IHD) without indication to atrial fibrillation (AF), group 3 (n = 20) patients with IHD with AF using amiodarone for prevention of AF at a dose 200 mg/day, 5 days a week, group 4 (n = 16) – patients with IHD with AF using lappaconitine hydrobromide for prevention of AF at a dose of 25 mg 3 times a day. In the groups, QTav. varied from 391.78 ± 6.60 ms (in healthy subjects) to 437.13 ± 7.16 ms (on the top of amiodarone therapy). But despite a significant increase in this parameter in patients with IHD without AF, QTav. interval remained within the normal limits on the top of lappaconitine hydrobromide and amiodarone therapy compared with the healthy subjects group. The QTc interval was recorded from 389.20 ± 9.32 ms (IHD without FP) to 421.88 ± 6.08 ms (on the top of amiodarone therapy) in the groups. This parameter was not significantly different across the groups and remained within the normal limits. The QTd interval spread was from 14.75 ± 2.00 ms (on the top of amiodarone therapy) to 32.50 ± 11.26 ms (on the top of of lappaconitine hydrobromide therapy) in the groups. Despite the fact that this parameter was significantly higher on the top of lappaconitine hydrobromide therapy, it did not go beyond the normal limits either.

This paper was aimed at studying the structural and functional changes in the myocardium and heart valves in patients of advanced and senile age with coronary pathology. 128 patients with coronary heart disease were examined; the average age was 82.4 ± 10.6 years (from 65 to 90 years old). According to the WHO classification, the patients were divided into two age groups: 1st – elderly people – from 65 to 74 years (32%), 2nd – senile people – from 75 to 90 years (68%). All subjects underwent anamnesis, physical examination, electrocardiography, echocardiography with tissue dopplerography, assessment of global longitudinal strain using a 2D-speckle-tracking technique, coronaroangiography. Patients of elderly and senile age with coronary pathology have age-associated structural and functional myocardial changes, multivessel lesions in the coronary arteries, history of previous myocardial infarction, as well as concomitant pathology (arterial hypertension). The patients older than 75 years have a progression of coronary pathology, systolic and diastolic dysfunction, aortic valve calcification, combined aortic and mitral valve defects, also the number of people with left ventricular hypertrophy is increasing. The number of people with left ventricular hypertrophy is increasing. The study showed informative value of echocardiographic evaluation of global longitudinal myocardial strain to identify the subclinical systolic dysfunction of the myocardium in patients of elderly and senile age with coronary pathology.