Arterial hypertension (AH) is one of the most common cardiovascular diseases and a frequent cause of cardiovascular complications and early disability. In Russia, AH of varying severity may affect about 30% of the population. [1] Hypertension is the causal factor for 27% of cardiovascular events in women and 37% in men. [2] AH accounts for about 14% of myocardial infarctions in men and 30% in women [3], 35% of ischemic strokes, 39% of chronic heart failures in men and 59% in women, and 56% of cases of chronic renal disease. [4–6]

The review is devoted to the problem of kidney damage as the arterial hypertension target organ. The data on prevalence of chronic renal disease at arterial hypertension, diagnostics and on approaches to therapy are provided. From positions of modern recommendations on therapy of arterial hypertension issues of target levels of arterial pressure in patients with combined kidney damage and/or diabetes mellitus, selection of antihypertensive drugs in these clinical situations, first of all, rational combinations of antihypertensive drugs are provided. Results of studies evidencing advantages of a combination of the angiontensin-converting ferment with calcium antagonist for therapy of drugs with arterial hypertension, diabetes mellitus and kidney damage are discussed. Advantages of ramipril for therapy of this category of patients are highlighted. The article provides data on the large RAMONA study that identified its high effectiveness and safety as well as positive metabolic effects of the fixed combination of ramipril with amlodipine.

The high prevalence of arterial hypertension (AH) – up to 40% of the whole population (and more than 50% among elderly patients) – makes it one of the most important problems of the modern medicine. In the report of the World Health Organization AH is called the first reason of mortality worldwide [3]. Reduction of increased arterial hypertension and achievement of its target value are of paramount importance for improvement of the forecast by cardiovascular complications in AH patients.

In Russia arterial hypertension (AH) is an important factor of development of cardiovascular diseases and mortality. On the whole, the AH incidence is within the 30-45% range of the total population, with the sharp increase with ageing (ESH/ESC 2013). In Russia, 40% of adult population have increased arterial pressure (AP) (AP >140/90 mm Hg), among them 40.5% of women and 38.0% of men [1, 2].

This study is devoted to the problem of arterial hypertension (AH), developing with age in women with idiopathic arterial hypotension (IAH).In the survey of 650 women doctors revealed the high frequency of AHI (up to 24,8% ), accompanied by every second or third case of periodic increase in blood pressure with clinical vascular symptoms. An important role in the prevention of hypertension on the background of IAG given to therapy with beta blockers, in particular, bisoprolol. Conducted in 27 women daily monitoring of blood pressure showed that, to revent the increase in BP in the background of the IAG, it is advisable to choose the starting dose of bisoprolol 2.5 mg, increasing it as needed under the control of blood pressure, heart rate and clinical symptoms. The most pronounced hemodynamic changes have occurred in patients receiving bisoprolol dose of 5 mg. however, almost a threefold increase in episodes of hypotension (hypotonic index) and is probably associated with increasing variability of systolic, AP, was regarded as unwanted excessive effect of the drug. Reducing the dosage of bisoprolol to 2.5 mg/day was accompanied by an almost threefold decrease in hypotonic
index and two-time decrease in BP variability. These changes occurred against the backdrop of milder antihypertensive effects and pulseraduction without any negative influence on positive clinical dynamics. . A reduction in the dose of bisoprolol during the titration of therapeutic effect lowered the risk of side reactions and improves the adherence of women with labile AD to treatment.

Results of meta-analysis of more than 20 clinical studies of use of various dosages and schemes of indication of trimetazidine to stable ischemic heart disease patients allowed considering the daily dosage of trimetazidine 70 mg as a standard therapeutic dosage. With the help of the mathematical odeling it was shown that administration of Deprenorm®MV 70 mg once per day reduces the frequency of blood plasma concentration to 1 tpd instead of 2 tpd (every 12 hours) as compared to the reference drug. From the pharmacological point of view one time administration of Deprenorm ®MV 70 mg containing the standard daily dosage of trimetazidine has a more pronounced clinical effect as compared to administration of trimetazidine 35 mg 2 tpd and allows achieving higher compliance in ID patients.

Modern antithrombotic drugs have quick and intense inhibiting action on thrombocyte aggregation as compared to clopidrogel. Ticagrelor, prasugrel or clopidrogel might be used for therapy of patients with acute coronary syndrome. But clopidrogel still remains a drug of choice for acute coronary syndrome patients who underwent transcutaneous coronary intervention with preceding thrombolysis or in patients simultaneously receiving anticoagulants.

The articles is devoted to role of the modern selective β-adrenergic blocker bisoprolol in therapy of angina, arterial hypertension, cardiac insufficiency, rhythm disturbance. The demonstrated effects of the drug include disease clinical manifestations reduction and decrease of cardiovascular incidence and mortality rates.

(IHD), stable angina of effort of functional class II (43 persons) – III (39 persons) (53.3±7.5 y.o., men - 71, women - 11), with concomitant arterial hypertension – in 21 patient. All patients received traditional anti-anginal disaggregation and hypolipidemic therapy. The therapy of patients of Group 1 was supplemented by meldonium (Mildronate®) at a dosage of 750 mg per day for 2 months. Patients of Group 2 continued to receive traditional therapy. After the period of wash-out (3 months) rotation of patients was done: meldonium was indicated to 750 mg/day for 2 months to a group of patients that previously didn’t receive meldonium previously.
Materials and methods. Evaluation of physical tolerance by the cycle ergometer test; activity of free radical processes in the blood by the level of lipoperoxides degradation in blood – diene conjugate (DC), malondialdehyde (MDA). Results. Meldonium inclusion in the complex therapy was accompanied by increase of physical tolerance, reduction of DC and MDA levels in the blood, reduction of the frequency of angina attack and demand in sublingual nitrates. Conclusion. Application of Mildronate® in a composition of complex therapy of patients with stable angina allows increasing effectiveness of traditional anti-angina therapy. 

Chronic cardiac insufficiency (CCI) is a wide-spread disease among the population of the Russian Federation and, as a rule, it is related to presence of the ischemic heart disease (IHD). Hypercholesterinemia is the major risk factor of IHD development but, however paradoxical it might seem, IHD patients often present a low cholesterol level, which, in its turn, is associated with the bad forecast. Reduction of the cholesterol level by statins reduces the incidence and mortality rate in IHD patients without CCI and possible improves the forecast in patients with CCI. But results of a number of studies testify that the high cholesterol level in patients with CCI is associated with better survival rates. This article provides data on the cholesterol paradox in CCI patients, its possible mechanisms and modern algorithms of the above-stated patients group management.

Results of randomized clinical studies and meta-analyses on evaluation of the role of statins high dosages before and after coronary bypassing and stending are analyzed. The maximum evidence basis is provided in studies with use of atorvastatin. Considerable risk reduction of early and late cardiovascular complications is demonstrated with use of high statin dosages in patients with various forms of the ischemic heart disease.

Lipid lowering therapy with statin use is one of the most important components in therapy of patients with lipid exchange disturbances. Great meaning is attributed not only to lipid-modifying but to the anti-inflammatory effect at their application. These effects are characteristics of “stronger” synthetic statins, in particular, of rosuvastatin, and have a dose-dependent nature.

The article provides discussion of the clinical importance of the increased heart rate in healthy persons and in cardiovascular disease affected patients. Results of large randomized studies devoted to evaluation of ivabradine effect evaluation in patients with coronary heart disease and chronic cardiac insufficiency, as well as study results. Results of analysis evidencing positive effect of heart rate reduction due to ivabradine use on the left ventricle remodeling are discussed. Data are provided that might confirm justification of the early addition of ivabradine to β-adrenergic blocking agents at the stationary stage of the patients therapy who were hospitalized due to cardiac insufficiency aggravation.

In therapy of patients with chronic cardiac insufficiency we must use obligatory drugs as angiotensin-converting enzyme inhibitors (ACE inhibitors)/sartans, β-antagonists and mineral- corticoid receptor antagonists (MCRA). As is known, ACE inhibitors and MCRA can lead to potassium retention in the human body [1, 2]. Fear of hyperkalemia development in patients might increase due to the fact that the majority of patients are older than 60 and they might have disturbances of the kidney function. Nevertheless, data provided by R. Pisoni [3], testify about not frequent development of hyperkalemia in patients with chronic renal disease and use in therapy of spironolactone. Results of the study RALES (Randomized Aldactone Evaluation Study) [4] showed that inclusion in the therapy of spironactone had advantages compared to therapy without pironolactone in patients with cardiac insufficiency and reduced GFR.

The article evaluates the risk of thromboembolic complications and appropriateness of oral anticoagulants (OAC) in patients with non-valvular atrial fibrillation (AF) upon admission to inpatient treatment at the Tyumen Cardiology Center in 2014. The majority of patients with non- valvular AF, which is 82% of the total number of patients admitted to the hospital, were referred to the high risk group for thromboembolic events (≥ 2 points according to HA2DS2VASc). Before hospitalization, 39.4% of high-risk patients were taking OAC, the majority receiving warfarin. The therapeutic INR range at admission was registered in 30.8% of patients treated with warfarin. 11.1% of high-risk patients received new OAC. Thus, the nticoagulant therapy could be appropriate in 205 patients (19.8% of the high-risk group). There was a relationship between OAC treatment and the risks according to CHADS2 and HAS-BLED, but not CHA2 DS2VASc. OAC were more frequently administered by patients with persistent AF. The article demonstrates the need for a comprehensive educational and organizational initiative aimed at ensuring antithrombotic therapy which corresponds to the current clinical guidelines for patients with non-valvular AF.

The article provides analysis of results of patient therapy under effect of levosimendan based on algorithm of evaluation of myocardium function on the basis of echocardiographic data. The results were evaluated on hemodynamic indicators – ejection fraction, pressure in the pulmonary artery, stroke output and myocardium contraction speed (dVol/dt), that were plotted in the automatic regime as a chart “Flow – Volume”. Vectors of the contraction speed characterize asynchronous behavior of the myocardium taking into account cardiomechanics in the form of cycle analysis of the cardiac mechanics. Effectiveness of levosimendan effect in cardiosurgical patients with the initially low ejection fraction of the left ventricle was proved.

The article deals with effectiveness and rules of blood sugar self-control. Various types of glucometers area analyzed, their possibilities and limitations. Advantages of the “No coding” technologies used in Bayer glucometers are described in detail and practical recommendations on their application are provided.

A review of the literature dedicated to topical issues of the factors forming the defeat of the cardiovascular system in individuals infected with the microorganism Helicobacter pylori. The evaluation of the impact of infection on the various clinical manifestations of atherosclerosis, hypertension, atrial fibrillation, myocardial infarction were made.

83 arterial hypertension patients of Stage II with the achieved eutonia who were on the dispensary observation by the general practitioner were studied. Risk factors, clinical signs of cerebral disturbances, rigidity of the vascular were evaluated in all patients. During a year of observation in-depth individual preventive consulting was provided to patients two times. It turned out that active dispensary observation of arterial hypertension patients with implementation in the area of responsibility of the general practitioner of individual consulting allowed not only achieving target values of arterial pressure, improving elastic and tonic properties of the vascular wall, reducing intensity of the endothelial dysfunction but reducing intensity of such modified risk factors as excessive consumption of salt with food, sedentary lifestyle, hyperglycemia, hypercholesterolemia, excessive body weight and obesity. The experience shows that to reinforce the educational skills in arterial hypertension patients with cerebral disturbances it’s necessary to perform in-depth preventive consulting (no less than 2-3 times per year), which finally increases compliance with performance of medical recommendations.