Early diagnosis and effective pharmacotherapy of arterial hypertension are urgent problems, a significant contribution to the solution of which can be made by metabolomics. The etiology of hypertension remains unknown for the majority of patients with high blood pressure; the diagnosis for 90% is defined as essential (primary) hypertension. This population is characterized by disturbance of the metabolic pathways of lipids, glucose, biogenic amines and amino acids, which may manifest with hyperlipidemia, hyperglycemia, and insulin resistance with the possible subsequent development of type II diabetes mellitus. The study of the metabolomic signature can provide a clue to the identification of biomarkers of hypertension and contribute to the effective development of preclinical diagnosis and identification of risk groups, as well as a more complete understanding of the etiological and pathogenetic mechanisms of increased blood pressure. Published studies indicate the existence of metabolome characteristic of hypertensive patients, distinguishing them from normotensive subjects. The most typical are changes involving amino acids, polyunsaturated fatty acids, carnitines, phosphatidylcholines, and acylglycerols.
The variability of the response to antihypertensive therapy does not allow achieving effective control of blood pressure in a significant proportion of patients. The peculiarities of changes in the metabolome under the use of various pharmacological groups can be used to identify metabolite markers of the response to the main classes of antihypertensive drugs, as well as markers of the development of side effects of drug therapy. Thus, individualization of the pharmacotherapeutic approach based on pharmacometabolomics can significantly increase the efficacy and safety of antihypertensive therapy.
This review aims to study the main groups of metabolites identified in published trials as predictors of the development of hypertension, as well as metabolite markers of response to antihypertensive therapy.

The new coronavirus infection COVID-19 from the moment of the first message to the present has spread rapidly in more than two hundred countries around the world, posing a serious threat to the life and health of the population. Most patients who have recovered from COVID-19 continue to complain of shortness of breath, increased fatigue, chest pain, palpitations and other symptoms. Currently, the presence of symptoms 12 weeks after the acute phase of the new coronavirus infection COVID-19 is collectively referred to as post-covid syndrome. Studies have shown that this syndrome occurs frequently in recovered patients with COVID-19, regardless of their age and severity of the disease. This feature significantly distinguishes post-covid syndrome from other syndromes after an infection, and therefore the study of the mechanisms of its development, methods of diagnosis and treatment is an important public health problem. Particular attention is paid to patients with comorbidities, especially those with hypertension and cardiovascular diseases, since they have a more severe outcome after infection and higher case mortality rate. The current drug regimens for patients with post-covid syndrome and concomitant diseases are symptomatic. The most common manifestations of post-covid syndrome from the cardiovascular system are an increase in blood pressure and heart rate. In this regard, this review discusses the prospects for the use of a fixed combination of bisoprolol and amlodipine in the treatment of patients with post-covid syndrome, accompanied by an increase in blood pressure and heart rate.

Introduction. Currently, there is insufficient data on the effect of modern antihypertensive therapy (AHT) on venous circulation, especially during physiological stress.
Aim of the study – the investigation was to study the hemodynamic effects of a combination of a calcium channel blocker (CCB) and an angiotensin-converting enzyme (ACE) inhibitor during exercise in men with arterial hypertension (AH) and chronic venous diseases (CVD).
Material and methods. In 46 men 30–50 years old with AH on the background of AHT, a comparative assessment of the dynamics of SBP, DBP, peripheral venous pressure (PVP), ultrasound parameters of venous blood flow of the left leg in response to physical activity (Ruffier’s test) was performed. The parameters were assessed in 23 patients with hypertension without CVD and 23 patients with hypertension and CVD. We studied the reaction before and after 14 days of combined AHT with the use of CCB (Amlodipine) and an ACE inhibitor (Lisinopril).
Results. Before treatment, the response to exercise in patients of both groups was the same and was manifested by a twofold increase in the area of the lumen of the veins and a drop in blood flow velocity. Patients with CVD before treatment with exercise were characterized by an altered systemic hemodynamic response, more frequent cases of venous dilatation and decreased blood flow velocity. After AHT with exercise, both groups showed normalization and identity of SBP. DBP, PVP, a decrease in the severity of venous dilatation and a decrease in blood flow velocity. Patients with CVD after AHT in response to exercise are characterized by more pronounced venous dilatation and higher blood flow velocity.
Conclusion. After 14  days of  antihypertensive therapy in  patients with hypertension without chronic venous disease and in patients with hypertension and chronic venous disease during exercise normalization of systolic blood pressure, diastolic blood pressure, PVP, a decrease in venous dilatation and a decrease in blood flow velocity are noted. Patients with CVD after AHT under load are characterized by varicose veins and accelerated venous blood flow.

Atherothrombosis is a leading cause of myocardial infarction and ischemic atherothrombotic stroke. It represents a stage of atherosclerosis which is a pathologic process throughout the circulatory system. However, atherosclerosis has specific development characteristics in  different vascular beds. Multiple factors contribute to atherosclerosis formation and progression such as genetic factors, vessel hemodynamics, and vessel anatomy. A better understanding of differences in vessels would improve prevention and treatment of atherosclerosis and its complication. In this article we review features of atherosclerosis in carotid and coronary vessels. We discuss specific conditions of local hemodynamics in the areas of bifurcation which promote atherosclerotic plaque progression, and review characteristics of unstable plaques in carotid and coronary vessels. We analyze immunologic and inflammatory processes, extracellular matrix degradation and remodeling, cellular apoptosis and autophagy occurring during atherosclerotic plaque destabilization as well as the possibility of diffuse plaque instability in systemic atherosclerosis. We review association and interaction of  atherosclerotic processes in  coronary and carotid arteries, and its significance for a patient. Improvement in understanding of atherosclerosis pathogenesis can lead to advances in atherosclerosis prevention. Timely and effective interventions would promote prevention of myocardial infarction and ischemic stroke which is highly important taking into account high mortality and morbidity rates.

Introduction. The clinical course and outcome in patients with comorbid pathology has a number of features that require further investigation. The investigation of biomarkers is important in this area as any change in their levels reflects the severity of pathogenetic changes and has prognostic value. Cardiovascular disease (CVD) and chronic obstructive pulmonary disease (COPD) are one of the most frequently reported comorbid pathologies. This is due to a large number of common interrelated links of pathogenesis and risk factors.
The aim of the study. To study and analyze, in a comparative aspect, the level of Klotho protein in patients with MI and patients with MI and COPD, in relation to the number of stenosis of coronary arteries (CA) according to coronary angiography.
Materials and methods. 110 patients were examined, divided into two groups: the main group - patients with MI on the background of COPD (n = 60) and the comparison group – patients with MI (n = 50). Somatically healthy individuals (n = 30) were examined as a control group. Determination of Klotho protein level in plasma samples was carried out by enzyme-linked immunosorbent assay
Results. It was found that in patients with MI and COPD, the level of Klotho protein was statistically significantly lower than in the control group and in patients with MI. The relationship between the Klotho protein level and lipid profile parameters was revealed in both patients with MI and patients with MI and COPD, with a greater strength of relationships in patients with comorbid pathology. It was also found that in the group of patients with comorbid pathology in individuals with lesions of one, two, three or more CA, the Klotho level was statistically significantly lower than in patients with MI with the corresponding number of affected CA.
Conclusions. The results obtained prove the promise and the need for further study of the pathogenetic role of the Klotho protein level in patients with comorbid pathology. 

Myocardial infarction (MI) is the leading cause of death and disability in the population. Effective restoration of coronary blood flow in the infarction-dependent artery during percutaneous coronary intervention contributes to the regression of structural and functional remodeling of the left ventricle. Meanwhile, in 18% of cases, patients with myocardial infarction require implantation of a pacemaker because of the cardiac conduction disorders, among which atrioventricular blockade is the leading one. The need for pacemaker implantation is determined by the clinical features and the type of bradycardia complicating myocardial infarction. The scope of preventive measures at the stage of outpatient specialized cardiac care for patients with myocardial infarction and pacemaker includes medical, physical, and psychological rehabilitation. In addition, the presence of an implantable pacemaker necessitates specialized dynamic monitoring by an arrhythmologist, including programming the pacemaker. Performing a magnetic test allows to assess the efficiency of the pacemaker, the level of its charge and promptly determine the need to its replacement. Determination of the pacing threshold ensures efficient operation of the implantable device. After discharge from the hospital, a schedule for checking the pacemaker is determined, namely, 3 months after the date of implantation of the pacemaker, then 1-2 times a year. In the event of complaints of dizziness, fainting or damage of the pacemaker implantation site, the pacemaker check is carried out unscheduled. Patients with a history of myocardial infarction and an implantable pacemaker should be informed about the limitations that may be associated with the presence of a pacemaker. It is recommended to exclude contact with possible sources of electrical interference as much as possible, to avoid medical physiotherapy using galvanic currents. When using industrial or household equipment, safety precautions must be followed.

The article presents updated information on the frequency of use of non-recommended low dosing of direct oral anticoagulants (dabigatran, rivaroxaban, apixaban and edoxaban). It gives substantiation of the urgency of the issue of providing the maximum efficiency of the use of anticoagulants in clinical practice, taking into account the high prevalence of atrial fibrillation and the pharmacological characteristics of the most commonly used drugs. The effects of such an unreasonable reduction in anticoagulant doses in elderly and senile patients are discussed. The results of recent observational studies that assessed the relationship between the use of direct oral anticoagulants and the risk of adverse clinical outcomes are presented. The data on the relationship between the use of unreasonably low dosing of anticoagulants in patients with atrial fibrillation, which were recently obtained during the implementation of the GARFIELD-AF registry, are discussed. The data on a rather high variability of concentrations of direct oral anticoagulants are presented. The frequency of using apixaban in an unreasonably reduced dose, as well as the effects of using non-recommended doses of apixaban hold a specific place in the article. The unreasonableness of attempts to further reduce the risk of bleeding due to unreasonable reduction of apixaban dosing is emphasized, taking into account the stable data on the high safety of recommended dosing of apixaban, as well as the possible decrease in the effect if the dose reduction is not recommended. The data on the criteria for dose reduction, which are adopted in different countries, are presented. The proposed terms to designate different doses of direct oral anticoagulants, depending on their study in the course of large, randomized trials are discussed.

Endothelial dysfunction is a  valued part in  the  pathogenesis of  many diseases and conditions including the  active phase of COVID-19 and postcovid syndrome. The review presents both the viral and autoimmune pathways for endothelial and glycocalyx lesions and the  clinical impacts of  such a  lesion in  comorbid patients. Both endothelium and glycocalyx affected by the SARS-CoV-2 virus are considered as the main goal for therapy in outpatient patients and patients with postcovid syndrome. The glycosaminoglycans belonged natural components of vascular wall seem appropriate pathogenetically in order to recovery the endothelial barrier. The review demonstrates the advantages and limitations of using sulodexide in patients with COVID-19. This article presents a clinical case of a patient with confirmed COVID-19 of moderate severity, with the presence of risk factors for thrombosis, who developed a post-covid syndrome, a heterogeneous symptom complex that developed after the acute phase of COVID-19 infection. The post-covid period was marked by symptoms of rapid fatigue, tachycardia, shortness of breath. By day 25-26, itching and red rash appeared, and there was moderate swelling of the shins and feet of both lower extremities. Taking into account the clinical picture and laboratory findings, a decision was made to cancel the previously prescribed low-molecularweight heparin and prescribe sulodexide at a dose of 500 LU 2 times a day for a course of 28 days. On the 4th-5th day after the  start of  treatment there was a  decrease in  the  area  of  skin  rash, cessation of  itching, almost complete disappearance of the cutaneous vascular pattern and reduction in the severity of edema. This clinical case demonstrates endothelial damage caused by COVID-19, which makes it advisable to use angioprotective drugs.

Currently pulmonary embolism (PE) is already on the 3rd place in terms of the frequency of occurrence among vascular diseases, and there is a global trend towards an increase in its frequency. PE is also considered as the most common cause of preventable death in the hospital. In the countries of Europe, Asia and the USA, there is a tendency to reduce the cases of fatal PE due to the  use of  more effective conservative therapy, invasive interventions and following the  Recommendations. Since 2019, the European Guidelines for the diagnosis and treatment of PE have made the use of direct oral anticoagulants preferable in comparison with oral vitamin K antagonists.
A case of massive PE in a 42-year-old patient developed in the specialized department of the hospital shortly after being transferred from the intensive care unit with verified PE of small branches (D-dimer, lung scintigraphy, Echo-cardiography) is presented. The debut of a massive PE in the form of a syncopal state with cardiogenic shock, required an urgent transfer of the patient to artificial lung ventilation, the use of vasopressors and systemic thrombolysis. During Echo-cardiography, a mobile blood clot was located in the right atrium. An emergency thrombectomy was performed from the pulmonary trunk and pulmonary arteries in conditions of artificial blood circulation, later a cava filter was installed. The features of anamnesis characteristic of PE (hormonal contraceptives), complaints (sudden shortness of breath, heaviness behind the sternum at admission) and concomitant pathology (drug-induced thyrotoxicosis) are analyzed.
The  results of  the  subsequent 8-year follow-up without relapses of  PE are considered, the  feature of  which was the  use of Rivaroxaban as an anticoagulant and angiovit (B vitamins – 6, 9 and 12) for the correction of hereditary hyperhomocysteinemia. Risk factors and modern standards of treatment of massive PE in the acute period and in the long term are discussed.

Introduction. Long-term and high-quality glycemic control prevents the development of vascular complications of diabetes type 1 and improves the disease prognosis, significantly increasing life expectancy. A decrease in the quality of life (QOL) of patients with diabetes type 1 is associated with the disease complications development and carbohydrate metabolism status. In connection with the proven advantages of using indicators of time spent in glycemic ranges (TIR, TAR, TBR), the study of their associations with QOL in patients with type 1 diabetes when switching from long-acting analog insulins to insulin degludec is of particular interest.
Aims. To assess the quality of life with diabetes type 1 when switching from long-acting analogs to insulin degludec in real world clinical practice.
Materials and methods. The study was designed as a prospective, single-center, uncontrolled study. The recruitment of patients with diabetes type 1 who did not achieve the target values of control of carbohydrate metabolism control, who were on therapy with long-acting and ultrashort-acting analog insulin therapy, was carried out in accordance with the matching criteria. The calculation of TIR and TBR was carried out employing the data from professional continuous monitoring of glucose levels and selfmonitoring of blood glucose levels. The SF-36 Health Status Survey was used to assess QoL.
Results. The study included 26 patients who met the inclusion criteria and did not have the exclusion criteria. The relationships between TIR, TBR and QoL parameters during insulin degludec therapy were revealed - with vitality, bodily pain, mental health, which demonstrates an increase in QoL mainly due to the mental component of health.
Conclusions. Switching patients with type 1 diabetes from long-acting analog insulins to ultra-long-acting analog insulin on an outpatient basis provides an improvement in glycemic control due to HbA1c and TIR, TBR, and also increases QOL satisfaction, mainly due to the mental component of health.

There is a clear link between diabetes and cardiovascular disease. It is known that cardiovascular diseases in patients with diabetes mellitus occur 2–5 times more often than in people without diabetes. It is cardiovascular outcomes that are the main cause of death in patients with diabetes mellitus in both men and women. Diabetes mellitus has a high risk of coronary heart disease, myocardial infarction, arterial hypertension and acute cerebrovascular accident, and patients with diabetes mellitus may experience painless acute myocardial infarction associated with the presence of autonomic cardiac neuropathy. Various rhythm disturbances are much more common in diabetes mellitus, including paroxysmal forms of atrial fibrillation, which increase the risk of death by 1.8–2 times. The leading factor in the development of vascular complications of diabetes mellitus is hyperglycemia. In addition, early glycemic disorders - impaired glucose tolerance or impaired fasting glycemia - make a significant contribution to the increased risk of macrovascular complications. Improving glycemic control leads to a significant reduction in the risk of late macro- and microvascular complications of diabetes mellitus. Glycated hemoglobin is the gold standard for monitoring glycemic control, but it does not provide complete information on daily and intraday changes in glucose levels. Regular self-monitoring of glucose levels is important in the prevention of cardiovascular diseases in patients with diabetes mellitus. In addition, during the COVID-19 pandemic, all consensus documents and recommendations for the management of patients with diabetes indicate the need for regular monitoring of glucose levels. An important aspect of the technical impact on patients’ adherence to selfcontrol and diabetes therapy is the presence of a convenient communicative connection between the patient and the doctor, in particular, the possibility of contact remotely via a computer and a mobile phone. In conclusion, the possibilities of the new model of the line of blood glucose meters are considered.

The article reviews the efficacy of meldonium in patients with various diseases, which are based on secondary mitochondrial dysfunction. Mitochondria are complex cellular organelles that control many metabolic processes, including fatty acid oxidation, the Krebs cycle, oxidative phosphorylation in the electron transport chain, and many other processes. Many conditions can lead to secondary mitochondrial dysfunction and affect other diseases. Damage to mitochondria can promote the activation of free radical processes and the  initiation of  the  mechanisms of  programmed cell death, mitochondrial dysfunction decrease in the immune response, increase in the activity of the body’s inflammatory response in various infections. Mitochondria appear to be important in COVID-19 pathogenesis because of its role in innate antiviral immunity, as well as inflammation. The article presents data on the effectiveness of using meldonium as a drug that helps to arrest pathological processes in mitochondria. The main mechanism of action of meldonium is based on a decrease in L-carnitine levels and increase of peroxisomes activity in the cytosol Meldonium was designed as a inhibitor of carnitine biosynthesis aimed to prevent accumulation of cytotoxic intermediate products of fatty acid beta- oxidation in ischemic tissues and to block this highly oxygen- consuming process. It is based on the correction of the energy metabolism of the cell. There was a positive trend in the use of meldonium in patients with diseases of the cardiovascular system (chronic ischemic diseases, chronic heart failure, arterial hypertension, etc.), neurological disorders (stroke, cerebrovascular insufficiency, etc.), respiratory diseases. The data on the beneficial effect of meldonium on the immune response in patients with coronavirus, bronchial asthma, chronic obstructive pulmonary disease, during vaccination with anti-influenza serum are presented. A decrease in asthenia was noted against the background of the use of meldonium in patients who had undergone coronavirus infection.

Introduction. Increased arterial stiffness is one of the key links in the formation of cardiovascular pathology in older age groups. At the same time, the effect of vascular stiffness on myocardial function in cardiac patients with frailty remains insufficiently studied.
Aim of study. Тo analyze the data of arterial stiffness and diastolic function of left ventricle (LV) in patients older than 65 years with arterial hypertension and frailty.
Materials and methods. The study included 90 outpatient and inpatient patients older than 65 years with the presence of arterial hypertension. All patients were divided into two groups: with the presence and absence of frailty. To identify frailty, we used the questionnaire “Age is not a hindrance”, a short battery of physical activity tests. Methods of volumetric sphygmometry, echocardiography, including tissue Doppler were used. The obtained data were analyzed using a package of statistical programs.
Results. The results of a comparative simultaneous non-randomized descriptive study of two groups of patients are presented. The study found that the systolic function, diastolic dysfunction of the left ventricle by the type of slowing down of LV relaxation in both groups did not significantly differ in their indicators. In the group of patients with frailty, LV diastolic dysfunction was significantly more often detected by the type of pseudonormalization – with an increase in filling pressure. When analyzing data of arterial stiffness, differences were obtained in both groups in the left cardio-ankle vascular index (LCAVI), systolic blood pressure (LB SAD), pulse pressure (LB PD) in the left shoulder area, and the delta of average blood pressure in the left ankle area (LA% IDA), which were significantly higher in patients with frailty.
Conclusion. In the group of patients with hypertension older than 65 years with frailty, a violation of the LV diastolic function by the  type of  pseudonormalization with an increase in  filling pressure prevails. An increase in  filling pressure in  the  group of patients older than 65 years with hypertension and the presence of frailty is associated with an increase in the complex of indicators characterizing arterial stiffness – the cardio-ankle vascular index, systolic blood pressure, pulse pressure in the left shoulder area, the delta of average blood pressure in the left ankle area.

This literature review focuses on the association of prediabetes with cardiovascular disease (CVD). Recently, much attention has been paid to the study of prediabetes due to its extremely high prevalence and strong association with a high risk of developing serious complications that worsen the quality of kife of patients. Prediabetes is not only a metabolic condition with a high risk of developing type 2 diabetes mellitus (T2DM), but also CVD and death from all causes. This association is true for both patients who do not yet have CVD and those with a history of CVD. Also during the COVID-19 pandemic, attention is drawn to the fact that people with prediabetes have a higher risk of a severe course of infection, complications and a worse prognosis of the disease. This is associated with hyperglycemia, the  presence of  chronic systemic inflammation of  a  low degree of  activity, impaired immune response mechanisms and a procoagulant state in patients with prediabetes, although these disorders are less developed than in patients with T2DM. Therefore, early screening of early disorders of normal metabolism. Since active early intervention at the stage of prediabetes helps to prevent the development of type 2 diabetes and CVD.

Introduction. Chronic heart failure (CHF) is recognized as one of the most severe cardiovascular diseases with a high mortality rate. Early identification of patients at risk of poor outcomes is critical to optimize treatment.
Aim: to conduct comparative analysis of laboratory markers, including the erythrocyte heterogeneity index (RDW) in CHF patients of different functional classes (f.cl.) according to ICD-10 codes.
Materials and methods. A  retrospective cross-sectional study with an analysis of  the  electronic laboratory register (JanuaryDecember 2016). 8056 patients who underwent a clinical blood test and added CRP parameters were included. The determination of the patient’s belonging to CHF wascarried out according to the ICD-10 code indicated in the direction for analysis. Identification of CHF patients by f.cl. (NYHA) was carried out according to the ICD-10 codes: code I25.2 (Postponed myocardial infarction) – 1 f. cl.; code I11.0 (Hypertensive disease with predominant heart damage with heart failure) – 2–3 f.cl .; code I50.0 (Congestive heart failure) – 4 f.cl.
Results. The proportion of patients with diseases of the circulatory system (code I) was 33.4% (n = 2686), of which 403 CHF patients were selected for the study. Distribution by f.cl. according to the code MKB-10: 1 ph.cl. – 0.83% (n = 67); 2–3 f.c. – 3.84% (n = 309); 4 ph.cl. – 0.33% (n = 27). Significant intergroup differences were obtained between ph.cl. (according to Kruskal–Wallis) for  indicators: hemoglobin (H = 9.741111, p = 0.0077), erythrocytes (H = 7.176770, p = 0.0276), RDW indicator (H = 34.78287, p = 0.0000). There were no statistically significant differences in leukocytes, platelets, ESR, CRP.
Conclusions. The presence of anemia in groups of patients with CHF of different f.cl., which often accompanies the disease, has not been confirmed. But statistically significant differences were revealed depending on the severity of f.cl. CHF according to the level of hemoglobin, the number of erythrocytes, and highly significant - according to the RDW indicator. The latter allows us to discuss the role of the RDW index as a possible new laboratory biomarker of CHF severity available for routine clinical practice.

Introduction. Chronic obstructive pulmonary disease and cardiovascular diseases (arterial hypertension, ischemic heart disease, chronic heart failure) are among the comorbid conditions that mutually aggravate each other. The addition of tuberculosis in this category of patients requires additional efforts from the doctor to improve treatment outcomes.
Purpose. Тo assess the prevalence of chronic obstructive pulmonary disease, arterial hypertension, coronary heart disease and chronic heart failure in patients with newly diagnosed tuberculosis hospitalized in an anti-tuberculosis hospital.
Materials and methods. We examined 462 patients with newly diagnosed tuberculosis, hospitalized in a tuberculosis dispensary, aged 17 to 88 years, the median (Me (P25; 75) age was 43.68 (32.00; 54.00) years, including 266 men (57.6%) and 196 women (42.4%) All patients underwent clinical, laboratory, instrumental examination to establish or confirm the diagnosis.
Results. The incidence of chronic obstructive pulmonary disease among patients with newly diagnosed tuberculosis was 31.4%, with arterial hypertension – 12.1%, coronary heart disease – 6.1%, chronic heart failure – 6.1%. The incidence of cardiovascular pathology in the group of tuberculosis + chronic obstructive pulmonary disease was 40%, in the group of tuberculosis without chronic obstructive pulmonary disease 6%.
Conclusions. The prevalence of comorbid cardiovascular pathology in patients with tuberculosis + chronic obstructive pulmonary disease is significantly higher than among patients with only tuberculosis, which requires the involvement of doctors of various specialties to manage this category of patients to prevent adverse treatment outcomes, disability and mortality.

The evolution of polypharmacy, which for many years consisted of quantifying concurrently prescribed drugs, has led to an qualitative description: “appropriate polypharmacy”, which may be beneficial for some patients, and “problematic polypharmacy”, which is harmful. The concept of “appropriate polypharmacy” is to prescribe multiple drugs based on the best evidence, taking into account the patient’s clinical condition and potential drug-drug interactions. With age, the prevalence of geriatric syndromes, comorbidity/multimorbidity, and limitation of life expectancy increase, which reduces the positive benefit/risk ratio for most drugs. The problem with polypharmacy is associated with an increased risk of adverse reactions, drug-drug interactions, and decreased patient compliance. To improve polypharmacy, various methodologies are used to optimize drug use for maximum benefit and least harm. Such interventions include professional patient counseling, the use of additional tools (including Bierce’s criteria, STOPP/START, MAI index, etc.), electronic decision-making systems, educational programs. The effectiveness of interventions to reduce polypharmacy has been evaluated in several Cochrane meta-analyzes (2012, 2014, 2018) and showed a decrease in drug misuse and the risk of ADR, but there was no effect on mortality, and few studies found a decrease in the number of hospitalizations. The deprescribing methodology is especially relevant in the context of problematic polypharmacy and is considered an integral component of the continuum of good prescribing practice, promoted as a strategy to reduce polypharmacy and improve patient outcomes. Among other interventions, deprescribing has the most evidence for its utility in preventing drugrelated complications, improving clinical outcomes, and reducing costs. The International Group for Reducing Inappropriate Medication Use & Polypharmacy (IGRIMUP) in 2018 developed 10 recommendations to reduce polypharmacy and potentially inappropriate drugs. Thus, the concept of “appropriate polypharmacy” is a rational approach to optimizing polypharmacy; it should be promoted to replace existing thresholds.

Introduction. Mortality from cardiovascular disease ranks first in the world. New and high requirements are required for the anatomical substantiation of emerging methods and methods of treatment. In modern literature, there are many publications on the issues of heart morphology, but data on the influence of gender, age, body weight on heart parameters are insufficient, fragmentary and often contradictory.
Objective. To determine the thickness of the ventricles and interventricular septum in overweight men when performing echocardiography and to assess the presence or absence of the relationship of these parameters with age and body mass index (BMI) of the subjects. Patients and methods. The analysis of the protocols of ultrasound examination of the heart of 68 apparently healthy men of adolescence, the first and second periods of adulthood with a body mass index of 25.0–29.9 kg/m², with no pulmonary and cardiac pathology and the risk of cardiovascular diseases was carried out. Ultrasound examination was performed on an Aloka ProSound Alpha 6 ultrasound scanner. 
Results and discussion. When comparing the mean values of heart parameters in overweight men in three age groups according to the Kruskell – Wallis criterion, no statistically significant differences were found between the mean values (p > 0.05). Revealed a moderate strength relationship between the thickness of the anterior wall of the right ventricle with the age of the subject (r = 0.375; p = 0.020) and moderate strength relationship between the thickness of the posterior wall of the left ventricle and BMI (r = 0.352; p = 0.030).
Conclusions. The  results of  the  study supplement the  information available in  the  scientific literature on the  thickness of  the  ventricles of  the  heart and the  interventricular septum in  healthy men with overweight in  three age groups. The data obtained will be useful to doctors of functional diagnostics when performing echocardiography in matters of differentiation between norm and pathology.

Hypocalcemia (HCa) is one of the main water-electrolyte disturbances in clinical practice. An acute decrease in serum calcium levels can lead to seizures, ventricular arrhythmias, bronchospasm and laryngospasm. Chronic HCa can result in disorientation and confusion. To prevent these complications, the risk factors for low calcium levels must be carefully evaluated. One of these factors is drugs, in which case we are talking about drug-induced (DI) HCa. The list of drugs-inducers of DI HCa is quite extensive, but the leading role in this disorder is played by drugs for the treatment of osteoporosis, antineoplastic and antiepileptic drugs, as well as drugs for anti-tuberculosis therapy. When taking zoledronic acid, DI HCa is observed with a frequency of up to 39%. When taking imatinib, a targeted anticancer drug, a decrease in calcium levels was observed in 40% of cases. The pathophysiological mechanisms of DI HCa can be a decrease in bone resorption, a decrease in the concentration of vitamin D, inhibition of the action of parathyroid hormone and impaired calcium absorption. Risk factors in most cases of DI HCa are vitamin D deficiency and hypomagnesemia. An acute decrease in calcium levels leads to symptoms of neuromuscular excitability, abnormalities on the electrocardiogram (ECG) and electroencephalogram (EEG). The basis for the treatment of DI HCa is the drug withdrawal and the appointment of calcium. It is also necessary to prescribe vitamin D. The main methods of prevention of DI HCa are to determine the level of calcium and vitamin D before starting therapy with culprit medication, and to correct its level. It is also important to prescribe additional amounts of calcium and vitamin D during therapy with such drugs. Awareness of the attending physicians about the problem of DI HCa, a thorough assessment of its risk factors and the prophylactic administration of calcium and vitamin D preparations will help to effectively prevent those serious complications resulting from a decrease in calcium levels in clinical practice.