At the end of April 2025 an expert council meeting was held, devoted to the discussion of the uncontrolled blood pressure, role of aldosterone dysregulation in pathogenesis of uncontrolled and resistant hypertension, and new therapeutic options targeting aldosterone- aldosterone synthase inhibitors. 

Pulmonary arterial hypertension is a severe progressive disease with a high mortality risk, requiring an accurate prognosis assessment to optimize therapy. Risk stratification plays a key role in predicting survival and choosing treatment tactics. Modern approaches in risk stratification are based on an integrated assessment of clinical, hemodynamic, laboratory and instrumental parameters to identify patients with low, intermediate and high risk of death within 1 year, which allows to personalize treatment: from monotherapy to aggressive combination regimens and referral for transplantation.

Relevance. The high prevalence of diabetes mellitus among patients with hypertension and the increased risk of cardiovascular complications necessitate a more detailed study of the characteristics of this patient group in order to optimize their management approach.

Objective. To identify clinical features of comorbid patients with hypertension and diabetes mellitus, as well as to assess their treatment.

Materials and methods. 57396 ambulatory patients from the national registry of hypertension were included in this study. They were divided into 2 groups based on the presence of absence of diabetes mellitus. The assessment of social and anthropometric factors, medical history, modifiable cardio-vascular risk factors was conducted. Statistical analysis was done using R 4.3.3 environment (R foundation for Statistical Computing, Vienna, Austria).

Results. Type 2 diabetes mellitus (T2DM) was detected in 15.3% of patients with hypertension (HTN). The group of patients with HTN and type 2 diabetes mellitus was predominantly represented by women (66.6%), who most often had risk factors such as obesity (55.4%) and low physical activity (40.3%). Compared to hypertensive patients without T2DM, those with hypertension and T2DM had significantly higher rates of chronic heart failure (64.4% vs 46.0%), coronary artery disease (54.9% vs 39.0%), chronic kidney disease (35.8% vs 28.3%), and prior cerebrovascular events (7.0% vs 4.1%). Patients with hypertension combined with T2DM demonstrated greater treatment resistance, with more frequent prescriptions of angiotensin receptor blockers (24.7% vs 16.7%), beta-blockers (59.5% vs 51.5%), and calcium channel blockers (22.3% vs 15.1%).

Conclusions. The identified changes reflect an additional negative impact of type 2 diabetes on the course of hypertension and the development of cardiovascular complications. Due to the high burden of cardiac and non-cardiac pathologies in this patient group, a more aggressive and multicomponent approach to therapy is required. The obtained results emphasize the need for the development of comprehensive programs for prevention, early diagnosis, and an individualized approach to prescribing therapy. The combination of hypertension and type 2 diabetes in the Russian federation necessitates an interdisciplinary approach with an emphasis on controlling metabolic parameters and the early prevention of complications.

Objective. To study the influence of periodontitis on the likelihood of developing and controlling blood pressure levels in patients with arterial hypertension (AH) who are undergoing antihypertensive therapy.

Materials and Methods. The study included 150 patients with a confirmed diagnosis of arterial hypertension (AH). Patients were divided into two groups based on the presence or absence of periodontitis. The main group (n=76, 50.6%) had periodontitis and was predominantly female — 47 (61.84%). The average age of this group was 61.11±10.86 years, with a body mass index (BMI) of 29.35±4.28 kg/m². The control group consisted of 74 (49.4%) patients without periodontitis: 42 (56.76%) women, with an average age of 51.7±10.48 years, and BMI of 27.84±4.18 kg/m². The study analyzed the age at which AH was diagnosed, the number of antihypertensive medications used for BP control, and their effectiveness, assessed through 24-hour ambulatory blood pressure monitoring (ABPM).

Results. In patients with periodontitis, arterial hypertension develops at a younger age — 47.5 [42; 54] years — compared to patients without periodontitis — 51.5 [48; 55] years (p=0.002). A trend toward prescribing a greater number of antihypertensive medications was observed in the group of patients with periodontitis. According to the data, 35 (46.05%) patients with periodontitis take three or more medications, whereas among patients without periodontitis, there are 29 (39.1%) cases; however, no statistically significant difference was found (p=0.051). Analysis of the ABPM data revealed significant differences in the average daytime and nighttime systolic and diastolic blood pressure values, as well as in the hypertensive index of time for diastolic blood pressure.

Conclusions. Periodontitis significantly complicates blood pressure control by contributing to the earlier onset of hypertension and increasing the number of medications required.

Introduction. Timely diagnosis of pulmonary hypertension (PH) is important for disease prognosis. The use of computational vector electrocardiography (vECG) and functional testing can facilitate earlier detection of PH.

The aim of this study was to evaluate vECG parameters reflecting right ventricular enlargement in patients with precapillary PH during quiet breathing and deep inspiration and to compare the results with structural and functional characteristics of the heart using echocardiography.

Materials and Methods. The study included 80 patients with idiopathic PH and chronic thromboembolic PH. Echocardiography assessed cardiac chamber size, ventricular systolic and diastolic function, pulmonary artery pressure, and pulmonary vascular resistance (PVR). The vECG parameter used was the proportion of the QRS loop area in the right quadrants to the total QRS loop area in the horizontal plane (%SQRSxz).

Results. The %SQRSxz values during quiet breathing were 49±23%, while during inspiration they were 55±23% (p< 0.0001). During inspiration, %SQRSxz increased in 72.5% of patients, decreased in 22.5%, and remained unchanged in 5%.

Moderate direct correlations were found between %SQRSxz and right atrial and right ventricular dimensions, eccentricity index, pulmonary artery pressure, and PVR, as well as inverse correlations with right ventricular systolic function, stroke volume, and cardiac output. Patients with decreased %SQRSxz during inspiration had higher right ventricular anterior wall thickness, eccentricity index, pulmonary artery pressure, and PVR, and worse right ventricular systolic and diastolic function, and were more likely to have severe tricuspid regurgitation and pericardial effusion.

Conclusion. In patients with precapillary pulmonary hypertension, %SQRSxz and its changes during inspiration correlated with echocardiographic parameters and reflected not only the presence of right ventricular enlargement but also its severity. further studies of the potential of vECG in assessing patients with pulmonary hypertension appear promising.