Despite the existing recommendations for the diagnosis and treatment of arterial hypertension, a wide selection of antihypertensive drugs, the efficacy of treatment of arterial hypertension remains low. The main cause for unsatisfactory control of arterial hypertension is patients’ non-adherence to treatment, which adversely affects the prognosis for cardiovascular complications. The first step in increasing adherence to antihypertensive therapy is to determine its level. There are various methods characterized by their accessibility and accuracy for assessing adherence. There are several categories of factors influencing the level of adherence. Identifying the cause in a subsequent patient is a significant step in reducing adherence to antihypertensive therapy. In addition, it’s necessary to use strategies to increase adherence to antihypertensive therapy, including both “simplification” of the treatment regimen and strengthening the doctor-patient interaction.

   The aim of this consensus is to summarize and supplement knowledge about the prevalence of adherence to antihypertensive therapy in patients with arterial hypertension, methods for assessing the level of adherence, the reasons for low adherence to the treatment of arterial hypertension and approaches to improving adherence to antihypertensive medications.

   Aim: to analyze the features of antihypertensive therapy in a sample of patients with arterial hypertension observed in primary healthcare (2019-2022), to identify the features of therapy in patients with uncontrolled and controlled hypertension.

   Materials and methods. An analysis was made of antihypertensive therapy in 4543 patients, the frequency of prescription of various combinations of
antihypertensive drugs. For statistical data processing, the SPSS statistical software package was used. Drug combinations prescribed in less than 2% of cases were excluded from the graphical presentation.

   Results. The majority of patients with hypertension were prescribed combined AHT (2, 3 and 4-component therapy represented in 28.3 %, 33 %, 24.8 %, respectively). More than 90 % of patients receive drugs that block the RAAS system, more than 85 % – BB. Every third patient received a CCB, diuretic therapy most often prescribed mineralocorticoid receptor antagonists (39.8 %), loop diuretics (20 %). Thiazide-like diuretics are prescribed 1.8 times more often than thiazide ones (18.6 % and 10.1 %). In the structure of monotherapy in patients with hypertension, the leading prescriptions are BBs, ACEIs and ARBs (43.3 %; 31.4 %; 15.1 %) with a high incidence of coronary heart disease and heart failure. Combinations of BB, ACEI and ARB form the most frequently prescribed double combinations (BB+ACEI – 48.3 %; ARB and BB – 22.8 %). Almost all of the most commonly prescribed 4-antihypertensive combinations contained MRA. Among patients with controlled and uncontrolled hypertension, the frequency of prescription of different classes of antihypertensive drugs as monotherapy did not differ. Features of combination therapy in patients with uncontrolled hypertension included more frequent prescription of BB+ARB (25.6 % vs. 20.8 %), BB+ARB+TlD (15.7 % vs. 10.3 %), BB+ARB+CCB (11.1% vs. 6.3 %), ARB+CCBd+TlD (2.9 % vs. 1 %), BB+BRA+CCBd+TlD (15.3 % vs. 8.1 %), BB+ ACEI+CCBd+TlD (7.1 % vs. 2 %), BB+ACEI+CCBd+TlD+AB (5.3 % vs. 0 %), BB+ARB+CCBd+TlD+AB (5.3 % vs. 0 %). Patients with controlled hypertension were more often prescribed BB+ACEI (53.5 % vs. 41.3 %), BB+ACEI+MRA (22.8 % vs. 13.5 %), BB+ACEI+LD (3.6 % vs. 1.4 %), BB+ACEI+LD+MRA (27.1 % vs. 14.1 %), BB+ACEI+CCBd+MRA (19.6 % vs. 5.8 %), BB+ACEI+TD+MRA+LD (2.5 times, (23.8 % vs. 9.6 %)), BB+ACEI+CCBd+MRA+TD (5 times, (14.9 % vs. 2.9 %).

   Сonclusions. Further escalation of the use of combination therapy is necessary given the high rate of failure to achieve target values.

   The problem of comorbidity of cardiovascular diseases (CVD) and anxiety-depressive disorders is actively discussed in modern scientific literature. Taking into account the widespread prevalence of anxiety and depressive disorders in the population, their negative impact on the quality of life and functioning of patients, prerequisites are accumulating for the diagnosis and treatment of these conditions by non-psychiatric doctors. The review presents current data on risk factors, relationships and principles for diagnosing resistant arterial hypertension (RAH) and anxiety-depressive disorders. The prevalence of resistant arterial hypertension is about 10–20 %, with a significant proportion of cases accounting for secondary arterial hypertension and pseudoresistance. The incidence of anxiety and depressive disorders in patients with arterial hypertension is 42 % and 52 %, respectively. The prevalence of anxiety and depressive disorders in RAH is 36.8 %. Such comorbidity contributes to the progression of PAH, worsens the patient’s prognosis, and reduces adherence to therapy. Given the close relationship between psychoemotional factors and CVD, patients with RAH are advised to undergo screening for anxiety and depression.

   Introduction. A deep breath causes a whole range of physiological effects that are reflected in the electrocardiogram.

   The purpose of the study is to assess the position of the electrical axis of the heart during deep inspiration compared to quiet breathing in patients with precapillary pulmonary hypertension and compare these data with echocardiographic characteristics of the structural and functional state of the heart.

   Materials and methods. The study included 40 patients with idiopathic pulmonary hypertension and 40 patients with chronic thromboembolic pulmonary hypertension. Echocardiography assessed the size of the heart chambers, systolic and diastolic function of the right and left ventricles, pulmonary artery pressure, pulmonary vascular resistance and indicators of cardiovascular coupling.

   Results. The values of the electrical axis of the heart during free breathing were 106° [84°; 123°], on inspiration – 89° [87°; 120°] (p = 0.68). In 50 (62.5 %) patients, during a deep inspiration, the electrical axis of the heart shifted to the left from the original one, and in 30 (37.5 %) patients – to the right. In patients with a displacement of the electrical axis of the heart to the left from the original, compared with the others, the end-diastolic size of the left ventricle, end-diastolic and end-systolic volumes of the left ventricle, stroke volume, cardiac output were statistically significantly lower, and the eccentricity index, pulmonary vascular resistance and effective aortic stiffness – significantly larger.

   Conclusion. In patients with precapillary pulmonary hypertension, two variants of changes of the heart electrical axis during deep inspiration were identified: a shift to the right from the original and to the left from the original. Patients with a displacement of the electrical axis to the left from the original were characterized by a significantly greater increase in pulmonary vascular resistance, a decrease in left ventricular volumes, stroke volume and cardiac output.

   Background. The difficulty of achieving target blood pressure (BP) levels in patients with arterial hypertension (AH) is often due to their type 2 diabetes mellitus (T2DM) and non-alcoholic fatty liver disease (NAFLD). In turn, taking into account the individual genetic characteristics of the body helps to personalize treatment and make it more effective.

   Aim. To compare the antihypertensive efficacy of a fixed combination of amlodipine and olmesartan medoxomil (Aml/Ol-M) in patients with hypertension and T2DM, with and without NAFLD, depending on the polymorphism of the CYP2C9 gene.

   Materials and methods. The study included 139 patients with uncontrolled hypertension and concomitant T2DM; after diagnosis of NAFLD, they were randomized into 2 groups: without NAFLD (group 1, n=70), with NAFLD (group 2, n = 69). After discontinuation of previous ineffective antihypertensive therapy, they were prescribed a combination of Aml/Ol-M in doses of 5-10/20-40 mg/day. At baseline, 4, 8, 12 and 24 weeks, their office BP levels were determined; Also, at the initial visit and after 24 weeks of treatment, the main indicators of 24-hour blood pressure monitoring (ABPM) were measured. Patients who did not reach the blood pressure target within 12 weeks of therapy were excluded from the study. Those who continued to participate in the amplifierThe Rotor Gene-Q allele discrimination method revealed the following distribution of polymorphic variants of the CYP2C9 gene: *1/*1 was found in 52 and 47, *1/*2 – in 6 and 5, *1/*3 – in 5 and 6 subjects, for groups 1 and 2, respectively.

   Results. The initial levels of office BP values were significantly higher in patients of group 2 and amounted to 153,5 mm Hg for systolic and 93 mm Hg for diastolic blood pressure, compared with 145 mm Hg and 88 mm Hg those included in group 1. After 12 weeks of therapy, the achievement of target blood pressure was registered in 63 (90 %) patients of group 1 and in 58 (84,1 %) of group 2. After 24 weeks of observation, in both groups a beneficial effect of the studied combination of drugs on all indicators of ABPM was noted, but a more pronounced improvement was noted in patients with NAFLD. Along with this, significant improvements in daily blood pressure profiles were registered in both groups 1 and 2: an increase in the number of patients with the “dipper” profile and a decrease in the number of patients with the pathological “non-dipper” profile. The antihypertensive effectiveness of Aml/Ol-M has been demonstrated for all isolated allelic variants of the CYP2C9 gene.

   Conclusions. A 24-week study with the use of Aml/Ol-M demonstrated a high incidence of achieving office BP target values in patients with hypertension and T2DM, with and without NAFLD. However, a more pronounced decrease in ABPM levels was found in patients with NAFLD. Carriage of any of the identified polymorphic gene variantsCYP2C9 had no effect on the clinical effects of the studied combination.

   Relevance. In patients with coronary artery disease (CAD) it is necessary to evaluate the functional significance of coronary tree lesion for determining of
management and indications for myocardial revascularization. During invasive coronary angiography (ICA) it can be made by measurement of fractional flow
reserve (FFR), which is called the «gold standard» of functional significance of coronary artery (CA) evaluation. For noninvasive visualization of CA is used coronary computed tomography angiography (CTA). The method of definition of FFR based on CTA data (FFRCT) – HeartFlow FFR-CT (HeartFlow, Redwood City, СА) has proved diagnostic accuracy and includes in clinical guidelines of American College of Cardiology. In Russian Federation there is no a software for FFRCT estimation, so algorithms are developed for this computation.

   Purpose. To provide comparative analysis of FFRCT and invasive measuring FFR (FFRINV) in patients with moderate stenoses of CA.

   Materials and methods. In trial included 20 patients with chest pain and suspected or known ischemic heart disease (IHD). As usual clinical and instrumental care was provided and acute myocardial infarction was excluded CTA on 640-slises computed tomography was performed. If CTA determine in one CA a moderate stenosis (50-85 %) the three-dimensional mathematical model of coronary tree was created with domestic algorithms of FFRCT calculation. FFRCT compared with FFRINV data, the mean of FFRINV equal or less than 0,8 indicated the functional significance of CA stenosis.

   Results. In final analysis of FFRCT and FFRINV parameters were included 13 patients. In 35 % cases a mathematical model for FFRCT calculation was not created because of severe calcification of CA. Correlation analysis shows the strong and statistically significant association between FFRCT and FFRINV parameters. Pearson coefficient is 0,86.

   Conclusions. Derived results revealed a good correlation between FFRCT and FFRINV in identifying of functional significance of CA stenoses. Despite of some limitations, method of noninvasive FFR calculation based on CTA data is a perspective direction of noninvasive examination development in patients with IHD. For future studying and using of method it is necessary to make algorithm of FFRCT calculation automatically and to provide trials with more including participants.

   The aim is to study the prognostic potential of the parameters of the pulmonary function tests parameters in determining the risks of developing comorbid pathology.

   Material and methods. The study included 102 people, with an average age of 47 [43-52.7] years. Questionnaires, anthropometry, blood sampling for biochemical analysis, and spirometry were conducted. Cardiovascular risk (CVR) was calculated on the SCORE2 scale, stratification of the subjects by risk groups was carried out in accordance with the gradation on the scale used. Statistical processing was performed using nonparametric methods.

   Results. According to the calculation of the SSR on the SCORE2 scale, all the subjects were in the range of moderate (58.7 %) and high risk (41.3 %). The obtained data from the study of the respiratory function of the general sample were slightly lower in women than in men, with significant differences in the obtained FVC, FEV1, FEF2575. Depending on the presence of arterial hypertension (AH) it was found that the median values of both the actual and calculated lower limits of the norm (LLN) of spirometry indicators among people with AH were lower than those studied without hypertension. At the same time, significant differences depending on the presence of AH were revealed only in the case of LLN for FEV1, FEV1/FVC, FEF2575. In individuals with hypertension, the LLN-FEV1/FVC index was significantly lower than 70 %. In the group of subjects with hypertension, an inverse reliable relationship was found (p = −0.4; p < 0.001) between LLN-FEV1/FVC and the level of uricemia – a decrease in the index by 0.008 % will lead to an increase in uric acid by 1 mmol/l. A decrease in LLN-FEV1/FVC by 0.2 l and LLN-FEF2575 by 0.03 l/sec will increase the CVR on the SCORE2 scale by 1 % ((p = −0.5; p < 0.001) (p=−0.3; p=0.002), respectively).

   Conclusion. An assessment of the prognostic potential of the pulmonary function tests parameters in determining the risks of comorbid pathology, namely a combination of cardiovascular diseases and respiratory pathology, was carried out. A combined approach to the examination of the able-bodied population, taking into account spirometry data, will help to personify and in-depth assess the risks of developing significant diseases that affect the quality and life expectancy of the patient, his ability to work.