Aim. To assess therapeutic response to specific therapy in patients with distal CTEPH who are ineligible for surgical management as pulmonary endarterectomy (PEA) or balloon pulmonary angioplasty (BPA).

Materials and methods. The study included inoperable patients with CTEPH (n=53) who are ineligible for surgical management as pulmonary endarterectomy or balloon pulmonary angioplasty. The effectiveness of specific therapy were assessed after dividing the patients into improvement or nonimprovement groups based on the following indicators: functional class I-II (WHO), mean pulmonary artery pressure according to right heart catheterization ≤40 mm Hg, pulmonary vascular resistance ≤400 dyn×s×cm-5, cardiac index ≥2,5 L/min/m2 , decrease in N-terminal brain natriuretic peptide >30%, and increase in 6-minute test distance >30 m at 12th-month follow-up compared to baseline parameters.

Results. There were no differences in groups by gender, age, and received specific therapy. Multiple logistic regression was performed, resulting in a model for predicting clinical improvement with sensitivity (57,1%) and specificity (87,1%), p=0,002. It was revealed, that the absence of the loss of pulmonary vascularity by X-ray at the time of verification of the diagnosis in patients with CTEPH by 5,91 times increases the chance of achieving clinical improvement after 12 months of the specific therapy, while the absence of signs of heart failure by 5,79 times, and degree of pulmonary valve insufficiency 0-1 according to echocardiography by 9,2 times, respectively.

Conclusion. Early initiation of specific therapy in inoperable CTEPH patients due to distal lesions with the absence of severe vascular remodeling and heart failure symptoms leads to the better therapeutic response after 12 months of treatment.

Aim. To evaluate the effect of non-invasive ventilation (NIV) in CPAP (continuous positive airway pressure) mode on the development of reperfusion pulmonary edema after percutaneous balloon pulmonary angioplasty (BPA) in patients with chronic thromboembolic pulmonary hypertension (CTEPH).

Materials and methods. The study included 70 patients with CTEPH who underwent the first stage of BPA. Prevention of reperfusion edema was carried out using NIV in the CPAP mode starting from the early postoperative period in combination with oxygen and diuretic therapy (as nedeed). The presence and severity of pulmonary edema was assessed based on clinical signs and data from computed tomography or chest radiography.

Results. Patients after BPA were on CPAP therapy: average pressure: 10.0±0,7 hPa. During 1st day, the average time of use was: 990±417 minutes. Prolongation of CPAP therapy >1 day occurred in 26 (37%) patients. Depending on the severity of reperfusion edema to the lungs, patients were divided into 2 groups: group 1 (grade 1, n=42) and group 2 (grade 3-4, n=12). During the observation period, there were no cases of severe reperfusion edema (grade 5), and no cases required the use of invasive ventilation or extracorporeal membrane oxygenation. No complications of CPAP therapy were recorded. The number of PA segments and ΔPFG did not differ, but the PEPSI index was higher in group 2: 41,9 [16,0; 57,9] vs 80.5 [52,5; 111,25], p=0,0146. The number of days before discharge after BPA in patients of group 2 was higher: 4.0 [3,9; 5,5] vs 7,0 [4,6; 10,0] days, p=0,013. Despite the development of reperfusion edema, before discharge the SpO2 values in group 2 were comparable to the baseline: 93,0 [89,9; 94,2] vs 93,0 [89,7; 94,4]

Conclusion. Preventive use of NIV in the CPAP mode, starting from the early postoperative period, is safe and makes it possible to achieve optimal clinical results in patients even with moderate and severe lung reperfusion edema after large volumes of surgical intervention.

The aim of the research is to analyze correlations between uric acid and cardiovascular risk factors (age, body mass index, waist circumference, total cholesterol and low-density lipoprotein cholesterol levels, glucose) and glomerular filtration Rate in outpatient care hypertensive patients. The research was based on the data of 1285 ambulatory patients from the national register of hypertension. Hyperuricemia was detected in 28,4% of cases. A positive correlation was established between uric acid and waist circumference, body mass index; negative – between uric acid and kidney function deterioration (based on glomerular filtration rate). It was stated that diuretic therapy and smoking are associated with the increase in uric acid serum levels. The study of cardiovascular risk factors frequency in patients with hypertension and hyperuricemia concluded that 80% had more than 1 additional risk factor; combination of ≥3 risk factors occurred in males significantly more often than in females.

Acquired data proves that uric acid is closely related to disturbance in metabolic factors, kidney function and diuretic therapy admission, which makes it essential to control its levels in hypertensive patients, as well as to use measures approved by the modern guidelines to decrease uric acid in patients with hyperuricemia.

Background: epidemiological studies show that the most common arterial hypertension (AH) is complicated by coronary artery disease (CAD), such patients are classified as very high risk. Effective BP control in this category of patients is critical. Therefore, assessing the efficacy and safety of current antihypertensive drugs in patients with AH and CAD against obesity or overweight is an important task.

Purpose. Evaluation of antihypertensive efficacy and safety of azilsartan medoxomil in patients with overweight or obesity and stable CAD.

Materials and methods. 335 patients with stable CAD and overweight or obese enrolled in the international multicenter observational non-interventional prospective study CONSTANT with azilsartan medoxomil according to the approved label. The observation period is 6 months.

Results. The dynamics of SBP by visit 4 (6 months) was 30,1±15,3 mmHg, DBP – 12,5±10,4 mmHg (r≤0,001). Overall, 84,5% of patients enrolled in the study achieved BP targets across the group. Response to therapy (reduction in SBP by at least 20 mm Hg, DBP of 10 mm Hg) was obtained in 75,2% of patients. In patients who did not take statins, the level of cholesterol, triglycerides and LDL decreased significantly (p<0,001), the HDL did not change significantly. In patients with diabetes mellitus, a decrease in glycated hemoglobin was recorded (p<0,001). Overall, a decrease in waist circumference was observed across the group (p<0,005).

Conclusion. Azilsartan medoxomil has high antihypertensive properties, the ability to influence the metabolic profile and volume of adipose tissue, as well as tolerability comparable to placebo, which makes it the drug of choice in patients with AH with CAD and obesity or overweight in real clinical practice.

Aim. To study and compare the functional state of the vascular wall (pulse wave velocity, cardiac-ankle vascular index) in obesity arterial hypertension patients and in arterial hypertension patients with normal body weight 1 month after a new coronavirus infection in moderate to severe form.

Materials and methods. The study included 87 patients of both sexes, aged from 18 to 55 years, from which three groups were formed: the first group included people with AH and normal body weight (BMI<25 kg/m²) who had undergone COVID-19 within a month, the second group included people with AH and obesity (BMI≥30 kg/m²) who had undergone COVID-19 within a month, the control group consisted of 20 people with AH and obesity without COVID-19. The parameters of height, weight, waist circumference, and BMI were assessed in all subjects. The parameters of lipid profile, glucose level were determined. All patients underwent office measurement of systolic and diastolic BP. Arterial stiffness was determined according to CAVI (Cardio-Ankle Vascular Index), brachialankle pulse wave velocity – PWVba (VaSera 1000), aortic pulse wave velocity – PWVao (EnVisor ultrasound system).

Results. PWVao significantly differed between groups 1 and 2 (p<0,001), in the group of patients with AH and obesity PWV was 6,26 (5,17-7,26) m/sec, in the group without obesity – 4,50 (4,21-5,10) m/sec. Statistically significant differences were found in the parameters of ABIr (p=0,020), in the level of CAVI: R-CAVI (p=0,012) and R-tb (p=0,026), L-CAVI (p=0,010) and L-tb (p=0,007). Statistically significant differences in RHR were found between study groups 1 and 2 (p=0,005).

Conclusion. The contribution of obesity to vascular wall health appears to be more significant than that of COVID-19. However, worsening arterial stiffness scores lead to worse COVID-19 outcomes, which calls for a more thorough approach to diagnosing vascular wall health early in the hospital setting. Non-invasive assessment of arterial stiffness may help to determine those at risk of clinical deterioration.

Aim. To assess frequency and severity of sleep breathing disorders in patients with uncontrolled hypertension among patients referred to a sleep laboratory.

Materials and methods. 113 patients aged 18-80 years with arterial hypertension (AH) were included. All patients underwent sleep cardiorespiratory monitoring, general clinical and laboratory diagnostics. Uncontrolled hypertension was defined as systolic blood pressure (BP) >140 mm Hg, or diastolic BP >90 mm Hg. in case of permanent antihypertensive therapy (AHT) taking.

Results. Among all patients with uncontrolled hypertension (Group 1; n=42, 37,2%), 95,2% had obstructive sleep apnea syndrome (OSA). Compared with the controlled hypertension group (Group 2), AHI and ODI were higher in Group 1 (AHI 28,0 events/hour [14,8; 51,8] vs. 17,5 events/hour [8,7; 39,0], p=0,03; ODI 25,3 events/hour [14,4; 50,6] versus 17,1 events/hour [8,5; 37,0], p=0,04). In addition, these parameters turned out to be markers of uncontrolled hypertension (AHI >19,9 events/hour, AUC=0,62, p=0,03; OR 3,23, 95%; CI 1,7-6,1, p=0,00; ODI >19,5 events/hour, AUC=0,62, p=0,03; OR 3,07, 95% CI 1,7-5,7, p=0,01). The level of systolic BP >146 mm Hg. turned out to be a marker of the moderate or severe OSA (AUC=0,66, p=0,00; OR 4,45, 95% CI 1,811,2, p=0,00).

Conclusion. High incidence of moderate or severe OSA in patients with uncontrolled hypertension emphasizes the importance of sleep breathing disorders examining in these patients. Timely diagnostics and treatment of OSA probably will allow to provide better BP levels control and thus will lead to reducing of cardiovascular risk.

The aim was to study the medical history, laboratory and instrumental data, the trends of arterial hypertension (AH), risk factors for cardiovascular events, target organ damage (TOD), and the development of cardiovascular complications in patients with NSAA (Non-Specific Aortoarteritis).

Materials and Methods. The study included 33 women with confirmed NSAA who had been treated at the 5th Cardiology Department of the E.I. Chazov National Medical Research Center of Cardiology since 2005. Complete blood count, biochemical blood analysis, urine analysis, the following instrumental examinations, such as, ECG, echocardiography, ultrasound of the brachial, femoral, aortic, and renal arteries, MRA or CT angiography with contrast, blood pressure measurement in the arms and legs were performed for all patients. Telephone interviews were conducted to assess some patient's condition over time.

Results. The most common symptom (84% of patients) was AH, the average age of AH onset was 30 [19; 40] years and the AH average duration is 7,5 [2; 13] years. Nearly half of the patients (45%) had AH as the leading symptom that led them to perform the examination that helped to the diagnosis of NSAA. The average systolic and diastolic blood pressure values were 123±35 mmHg and 66±17 mmHg in the upper extremities, and 166±31 mmHg and 78±18 mmHg in the lower extremities, respectively. About half of patients (51%) had stage 3 AH, and almost all of them had type 3 according to E. Lupi-Herrera classification. The most common risk factors for cardiovascular events were dyslipidemia (82%), a family history of early cardiovascular events (51%), resting heart rate above 80 bpm (25%), and carbohydrate metabolism disorders (21%). When assessing cardiovascular risk, moderate risk of developing cardiovascular events was observed in 3 patients (10,7%), high risk in 16 patients (57,1%), and very high risk in 9 patients (32,1%). The most common TODs were nervous system damage (53%), including cerebrovascular ischemic events (14%) and left ventricular hypertrophy (42%). This group of patients was characterized by resistant hypertension, and combination with other risk factors for cardiovascular events, it leds to severe TOD and influenced survival rate. In terms of antihypertensive therapy, 61% of patients received combination therapy, with CCB, beta-blockers, and imidazoline receptor agonist being the most prescribed. Two fatal cases were identified in the long-term follow-up, and cardiovascular events, most frequently stroke, were the main complications observed. Additionally, AH progression and its uncontrolled course despite going through multiple drug therapy were characteristic.

Conclusion: AH is often difficult to diagnostic in patients with NSAA, and it significantly contributes to the structure of complications and mortality in this patient cohort, progressively worsening over time. It is important to measure blood pressure in both arms and legs to detect elevated values early. The main goals of treatment are achieving NSAA remission and blood pressure control and preventing cardiovascular events.