The objective of this study is to assess the associative relationship between the main parameters of the infrastructure with arterial hypertension (AH) in a large industrial region (Kuzbass).

Materials and methods. The study involved 1598 people (from 35 to 70 years old) living in Kemerovo region. Blood pressure was measured according to the recommendations of the Russian Society of Cardiology / the Russian Medical Society on Arterial Hypertension (2010). The assessment of the territory of the residence zone was carried out according to the subjective opinion of the respondents about the parameters of the infrastructure (questionnaire Neighborhood Environmental Walkability Scale). The format of this structure was highlighted, which was considered unfavourable according to the respondent's answer to the questionnaire.

Results. In the course of this study, negative associations with a high risk of developing hypertension were identified for the following infrastructure parameters: inaccessibility of public transport (OR=1,84), remoteness of the workplace (OR=1,60), the lack of sidewalks on the streets (OR=1,66), the remoteness of the pharmacy (OR=1,64), the lack of pedestrian crossings that ensure safety when crossing streets (OR=1,48) and the absence of shadows falling on the sidewalk from the trees (OR=1,31).

Conclusion. This study demonstrated the importance of studying the parameters of infrastructure and planning urban space in order to provide a healthoriented space for the population of a particular constituent entity of the Russian Federation.

Aim. To evaluate the effect of prior administration of the soluble guanylate cyclase stimulator riociguat on the incidence and severity of reperfusion lung injury after balloon pulmonary angioplasty (BPA) in patients with inoperable form of chronic thromboembolic pulmonary hypertension (CTEPH).

Materials and methods. 70 patients with inoperable CTEPH were included in the study. Patients were divided into 2 groups: Group 1 (n=41) – patients who had received PAH-specific therapy with riociguat at the time of BPA, Group 2 (n=29) – patients who underwent BPA without prior administration of riociguat. In the postoperative period all the patients underwent noninvasive artificial ventilation in continuous positive airway pressure mode in order to prevent the development of reperfusion damage of lungs.

Results. Patients of group 1 received treatment with riocigiat for 6 months. At the time of BPA patients of both groups were matched for hemodynamic characteristics. In group 1, reperfusion edema above grade 1 occurred in 17.1% of patients, in group 2 – in 20.7% of patients, p=0.702. In group 1, manifestations of grade 3 reperfusion edema were found in 9.8% patients vs. 6.9% patients in group 2, (p=0.638). None of the patients in both groups had grade 4 or 5 reperfusion edema. Values of the index predicting the probability of reperfusion injury (PEPSI) were not significantly different in the group of patients who were pretreated with riociguat and in the group of patients who did not get PAH-specific therapy (p=0,588).

Conclusion. There was no reliable evidence that administration of riociguat in recommended doses at least 6 months before BPA results in additional reduction in the incidence and severity of reperfusion pulmonary edema in patients with inoperable CTEPH.

Background. Obesity and associated diseases are the most common comorbidities in patients with arterial hypertension (AH). The combination of AH and type 2 diabetes mellitus (DM2) significantly exacerbates the cardiovascular risk in this patients. BP control is one of the key components of the multivariate approach to reducing the risk of DM 2 complications. The use of drugs with pronounced antihypertensive properties and at the same time the ability to improve metabolic parameters should be a priority in this category of patients. Assessing the efficacy and safety of azilsartan medoxomil, the last molecule from the ARB class in patients with AH and DM 2 is an urgent task.

Purpose. Evaluation of antihypertensive efficacy and safety of azilsartan medoxomil in patients with AH and DM 2 and overweight or obesity.

Materials and methods. 235 overweight or obese patients with AH and DM2 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 29,7±14,5 mmHg, DBP - 13,36±10,9 mmHg (r≤0,001). Overall, the group achieved BP targets in 211 (89.41%) DM patients enrolled in the study. Response to therapy (reduction in SBP by at least 20 mmHg, DBP of 10 mm Hg) was obtained in 177 (75.0%) patients. Glycated hemoglobin (p<0.001) and fasting glucose (p<0.001) significantly decreased in patients with AH and DM. A decrease in total cholesterol, triglycerides, and LDL was observed, including in DM patients not taking statins (p<0.001). Overall, a decrease in waist circumference was observed across the group (p<0.005).

Conclusion. Azilsartan medoxomil in real clinical practice proved to be a highly effective antihypertensive drug in patients with AH and DM. The ability of the drug, including in combination with other drugs, to improve the metabolic profile, reduce the volume of adipose tissue makes it a priority drug of choice in patients with AH, obesity and type 2 DM.

Aim. To study the clinical and functional status and the early postoperative follow-up in elderly patients with chronic thromboembolic pulmonary hypertension (CTEPH).

Material and methods. Patients with CTEPH were divided into two groups: group 1 (35 people) – patients ≥65 years old, group 2 (98 people) – <65 years old. The baseline clinical and functional data of both groups and the in-hospital period after pulmonary endarterectomy, were analysed.

Results. Patients with CTEPH ≥65 years old compared with patients <65 years old were characterized by a higher comorbidity, a higher incidence of adverse cardiovascular events and the presence of chronic heart failure IV class (p<0.05). Echo-CG data in patients with CTEPH ≥65 years old were characterized by a large size of the left atrium, more pronounced hypertrophy of the right ventricle free wall, interventricular septum and the left ventricular posterior wall compared with younger patients (p<0.05). Also, in patients ≥65 years old, lower values of the left ventricular ejection fraction were found with preservation of global myocardial contractility (p<0.05). The early postoperative period in patients with CTEPH ≥65 years is characterized by a more severe course compared to the group of patients <65 years due to a larger proportion of patients with the development of newly diagnosed atrial fibrillation, multiple organ failure and postoperative bleeding (p<0.05). Despite this, there were no intergroup differences in the length of the hospital period and in-hospital mortality (p>0.05).

Conclusion. The early postoperative results of pulmonary endarterectomy in elderly patients with CTEPH showed no differences in the length of hospital stay and in-hospital mortality compared with younger patients, which indicates the feasibility of surgical treatment of this category of patients in the specialized cardiac surgical centers.

Leonid Semenovich Barbarash, a famous Soviet and Russian cardiac surgeon, a talented scientist, honored physician of the Russian Federation, academician of the Russian Academy of Sciences, professor, doctor of Medical Sciences, has passed away.