This document is an agreed experts opinion of the Russian Medical Society of arterial hypertension, based on a thorough study of the BP measurement protocols recommended in national and international recommendations for the diagnosis and treatment of BP, other most important documents that are supported by consensus between the authors of this document. Our position is that standardization of the BP measurement protocol is necessary, ensuring its wide application in daily clinical practice, with an optimal compromise in labor costs, accuracy and reliability of measurements. We provide a rationale for the optimal standardization of the measurement procedure, barriers to its implementation and propose ways to overcome these barriers.

The ultimate goal of this joint statement is to ensure that healthcare organizations, healthcare professionals and patients using the recommended protocol have greater confidence that the BP measurement performed is a sufficiently reliable procedure and provides the best clinical outcomes.

Perivascular adipose tissue (RVT) is an important component of the vascular system, which is actively involved in the pathogenesis of cardiovascular diseases (CVD). This review is based on an analysis of clinical studies from the PubMed, Embase, Web of Science, and e-Library databases aimed at studying the mechanisms through which RVT affects the development of CVD. It has been proven that prostate is a source of various pro-inflammatory cytokines, such as TNF-α, IL-6 and MCP-1. These molecules contribute to the activation of inflammatory processes, which can lead to endothelial damage and the development of atherosclerosis. An increase in the volume of the pancreas is associated with an increase in the level of inflammatory markers in the blood, which indicates systemic inflammation. RVT is involved in the metabolism of lipids and glucose, and its excessive accumulation can lead to insulin resistance. This condition is associated with an increased risk of developing type 2 diabetes and CVD. Adipokines such as leptin and adiponectin play a key role in regulating metabolism. Low levels of adiponectin secreted by the pancreas are associated with an increased risk of CVD. RVT affects vascular tone and their response to vasodilators and vasoconstrictors. Changes in the function of the pancreas can lead to impaired regulation of blood pressure and increase the risk of atherosclerosis; promote vascular remodeling, which is also associated with the development of atherosclerosis. RVT is often associated with other risk factors such as obesity, dyslipidemia, and metabolic syndrome. These factors interact with each other, creating a complex network that contributes to the development of CVD. Genetic predispositions and epigenetic changes can also affect the development of the pancreas and its functions. Some studies indicate a link between genetic markers and the level of RVT, which may explain individual differences in the risk of CVD. Thus, RVT plays an important role in the pathogenesis of cardiovascular diseases through the mechanisms of inflammation, metabolic dysfunction, and changes in vascular function. Understanding these mechanisms can help in the development of new approaches to the prevention and treatment of CVD, as well as in identifying potential targets for therapeutic intervention. Further research is needed to better understand the role of RVT in cardiovascular health.

The use of simple functional tests can increase the electrocardiogram sensitivity for detecting pulmonary hypertension (PH).

The aim of the work is to evaluate changes in the electrical axis of the heart (EAH) during inhalation in patients with proven chronic thromboembolic PH (CTEPH) or suspected CTEPH, referred for right heart catheterization (RHC).

Materials and methods. The study included 80 patients who underwent RHC according to clinical indications: 25 men and 55 women aged 52 ± 13 years. EAH was assessed when recording electrocardiogram during quiet breathing and on deep inhalation.

Results. CTEPH (mean pulmonary artery pressure >20 mm Hg) was present in 69 patients. In the group without PH, in all cases, the EAH shifted to the right during inhalation, and in the group with PH – to the right in 33 (48%) cases and to the left in 36 (52%) cases. The difference in the EAH values during free breathing and inhalation had direct correlations with systolic, diastolic and mean pulmonary artery pressure, systolic right ventricle pressure and pulmonary vascular resistance (r=0.6-0.7; p<0.0001) and inverse correlations with stroke volume and cardiac output (r=-0.3; -0.4; p<0.01). In ROC analysis, both the EAH values during free breathing (>92°) and its changes during inhalation (>-6°) allowed us to separate the subgroups with and without PH with a sensitivity of 62-65% and a specificity of 100% (area under the ROC curve ± standard error 0.88 ± 0.04).

Conclusions. In patients with CTEPH/suspected CTEPH in the subgroup without PH, the EAH shifted to the right during inhalation, and in the group with PH in 33 cases (48%) – to the right, and in 36 cases (52%) – to the left. The difference in the EAH values during free breathing and inhalation had reliable direct correlations of moderate strength with the mean pulmonary artery pressure and pulmonary vascular resistance. The values of the EAH during free breathing and its changes during inhalation made it possible to separate subgroups with and without PH with a sensitivity of 62–65% and a specificity of 100%.

Relevance. Chronic thromboembolic pulmonary hypertension (CTEPH) is a rare severe form of pulmonary hypertension due to pulmonary artery obstruction. According to a number of previously published studies, sleep-disordered breathing (SDB) was frequently observed in patients with CTEPH. However, despite the high incidence both in the general population and in this group of patients, the aggravating effect of SDB on the clinical picture of CTEPH has not been sufficiently studied.

Aim: to analyze the occurrence of various sleep-disordered breathing, as well as to study the aspects and relationships of identified disorders with the parameters of the clinical and hemodynamic status in patients with chronic thromboembolic pulmonary hypertension.

Materials and methods. It was included 67 patients with a verified diagnosis of CTEPH, hospitalized from February 2021 to December 2023. The general clinical condition (anamnesis, examination, anthropometric data), echocardiography and right heart catheterization (RHC) data were assessed. Questionnaire survey was conducted using international questionnaires (STOP-Bang, Epworth Sleepiness Scale, Pittsburgh Sleep Quality Index) and one of the methods of multifunctional sleep study was performed. Statistical data processing was performed using MedCalc Statistical Software and Microsoft Office Excel.

Results. In the sample, the median age was 59.0 years, 48 (71.6%) people were overweight, the incidence of any sleep-disordered breathing was 83.6%. A significant relationship (classical correlation) was determined between the distance in the six-minute walking distance and apnea-hypopnea index (AHI) (r=−0.447; p=0.0015), minimum night saturation (r=0.373; p=0.009) and average night saturation (r=0.341; p=0.0176). The total score on the STOP-Bang scale ≥3 shows a sensitivity of 52.2% and a specificity of 69.1% (AUC=0.653; p=0.02;), that doesn’t allow considering the STOP-Bang scale as an effective screening method in this category of patients.

Сonclusion. The revealed reliable correlations between the apnea-hypopnea index and the six-minute walking distance, daytime saturation at rest and after exercise in patients with CTEPH may indicate the influence of various SDB severity on the clinical picture of the underlying disease.

The aim of this study is to evaluate the effectiveness of the modified DCSI questionnaire (Dyspnea, Cough, Smoking, chronic recurrent respiratory Infections) developed by us to identify broncho-obstructive diseases (BOD) (COPD and bronchial asthma) in patients with cardiovascular diseases (CvD) and to compare the indicators of spirometric research in different groups of cardiac patients formed on its basis.
Materials and methods. The sample consisted of patients over 18 years of age with arterial hypertension (AH), including chronic heart failure (CHF), coronary heart disease (CHD), heart rhythm disturbances (HRD), admitted to the National Medical Research Center of Cardiology over a two-year period. The sample consisted of 1000 cardiology patients, including 137 patients with comorbid COPD and bronchial asthma diagnosed before participation in the study, 71 patients with comorbid COPD and bronchial asthma diagnosed for the first time during the study, 792 cardiology patients without comorbid COPD and bronchial asthma. All cardiac patients filled out the modified DCSI questionnaire in the emergency room. All cardiac patients underwent pulmonary examination, which included computer spirometry (including bronchodilator test) in accordance with the recommendations of the European Respiratory Society. The main spirometric parameters were recorded: Gaensler index (modified Tiffeneau index, FEv1/FvC) (normal >70%), FEv1% (normal >80%) and FvC% (normal >80%). Patients with deviations detected in spirometry data were consulted by a pulmonologist.
Results. All cardiac patients with COPD and bronchial asthma (137 patients with previously diagnosed comorbid COPD and bronchial asthma and 71 patients with newly diagnosed comorbid COPD and bronchial asthma during the study) had ≥2 points on the DCSI questionnaire. Cardiac patients without comorbid COPD and bronchial asthma had <2 points in 41% of cases and ≥2 points in 59% of cases on the DCSI questionnaire, which is due to concomitant cardiovascular pathology. Among patients with a score of 4 on the DCSI questionnaire, the proportion of cardiac patients with newly diagnosed comorbid COPD and bronchial asthma was significantly higher (62%) than with previously diagnosed comorbid COPD and bronchial asthma (p<0.001). Using the DCSI questionnaire and spirometric testing, it was found that cardiac patients with newly diagnosed comorbid COPD and asthma had more pronounced respiratory symptoms and a higher degree of airway obstruction than patients with previously diagnosed comorbid COPD and asthma (p<0.05). In cardiac patients with <2 points of DCSI questionnaire, spirometric indices of FEv1%, FvC%, Gaensler index (p<0.05) are significantly higher than in cardiac patients with ≥2 points on DCSI questionnaire.
Conclusions. The DCSI questionnaire developed by us for screening risk factors and symptoms of broncho-obstructive pathology in patients admitted to a cardiology hospital effectively excludes comorbid COPD and bronchial asthma at <2 points (0-1) and identifies previously undiagnosed comorbid COPD and bronchial asthma at 4 points. At 2 or 3 points, the diagnosis of COPD and bronchial asthma is potentially probable, and routine computer spirometry is recommended for a cardiac patient. Cardiology patients with newly diagnosed comorbid COPD and bronchial asthma have lower spirometric parameters (FEv1%, FvC%, Gaensler index) than patients with previously diagnosed comorbid COPD and bronchial asthma.