Objective. To evaluate the efficacy and safety of tadalafil in 24-week mono- and initial combination therapy in newly diagnosed patients with pulmonary arterial hypertension (PAH).

Material and Methods. A single-center, open-label, prospective study at the E.I. Chazov National Medical Research Center of Cardiology of the Ministry of Health of the Russian Federation in 2024-2025 enrolled patients over 18 years of age with newly diagnosed idiopathic pulmonary arterial hypertension (IPAH) and PAH associated with systemic sclerosis (PAH-SSc) in functional class II-III (WHO) who were prescribed tadalafil-based therapy (Tadacardil Canon, Canonpharma Production, Russia). A total of 47 pts aged 43.8 [37.5; 53.6] yrs were enrolled (28 IPAH pts, 19 PAH-SSD pts). The dose of tadalafil 20 mg once daily, if well tolerated and without hypotension, was increased to 40 mg once in all patients after 4 weeks. Starting monotherapy with tadalafil was prescribed to 11 low-risk patients, combination therapy with tadalafil and macitentan 10 mg/day – to 36 intermediate risk patients. Clinical and instrumental data [functional class, 6-minute walk test (6MWT) with determination of the degree of dyspnea according to Borg, capillary blood oxygen saturation (SpO2); NT-proBNP assessment, echocardiography (Echo), right heart catheterization (RHC)] were assessed at baseline and after 24±2 wks of therapy.

Results. After 24 wks of treatment, the 6MWT distance in IPAH and PAH-SSD groups increased by 49.9 m (p=0.00003) and 30.7 m (p=0.024), respectively. At the control point, as at baseline, significant differences in FC, 6MWT distance, and SpO₂ before and after 6MWT remained between the IPAH and PAH-SSD groups, indicating more pronounced functional impairment in PAH-SSD. In IPAH group, both at baseline and after 24 wks, Echo revealed significantly higher pulmonary artery systolic pressure (SPAP) values and greater right chambers dilation with a lower proportion of patients with pericardial effusion. Tadalafil therapy in IPAH group resulted in a significant increase in stroke volume (SV) and cardiac index (CI), resulting in a decrease in pulmonary vascular resistance (PVR), as well as an increase in SvO₂. In patients with PAH-SSD, in addition to a significant improvement in SV, CI, PVR, a significant decrease in mean pulmonary artery pressure (mPAP) was observed. By week 24, IPAH group maintained higher mPAP and PVR and higher SV and CI compared to the PAH-SSD group.

At baseline, 23.4% of patients in the overall group (35.7% in IPAH group) and 5.3% of patients (PAH-SSD group) had a low-risk profile; the remaining patients had an intermediate risk of 1-year mortality. After 24 wks, a significant increase was observed in the proportion of patients in the overall group who achieved low risk (53.2%). Moreover, the improvement of risk profile in the overall group was achieved primarily in patients with IPAH, in whom the percentage of low risk patients increased to 71.4% after 24 wks of treatment. High risk at the control point was observed in one patient with IPAH and one patient with PAH-SSD, both of whom received initial therapy with tadalafil and macitentan, which required the addition of a third drug.

Tadalafil monotherapy led to a significant improvement in functional capacity without a significant increase in the 6MWT distance; a significant decrease in the percentage of patients with persistent pericardial effusion according to Echo and positive RHC parameters dynamics – SPAP, PVR, CI, SV, SvO₂. In the initial dual therapy group the improvement in functional capacity was accompanied by the 6MWT distance increase +32 m (p<0.05). Despite the absence of Echo changes, as in the tadalafil monotherapy group, improvements were observed in NT-proBNP and a wide range of parameters of the RHC-SPAP, PVR, CI, SV, SvO₂, and mean right atrial pressure.

Conclusion: 24-wk tadalafil-based therapy in newly diagnosed IPAH and PAH-SSD patients resulted in significant improvements in clinical, functional, and hemodynamic status, as well as the risk profile, with treatment goals achieved in the majority of patients with IPAH (71.4%) and 26.3% of pts with PAH-SSD. Tadacardil Canon (Canonpharma Production) was shown to be highly effective and well-tolerated when administered both as monotherapy and in combination with macitentan.

Objective. To determine the influence of different daily administration regimens of azilsartan medoxomil and nitrendipine on the main parameters of 24‑hour blood pressure monitoring, central hemodynamics, and vascular wall stiffness in patients with arterial hypertension who have experienced a transient ischemic attack.

Materials and methods. The study included 80 patients: 30 men and 50 women, with a mean age of 60,18±11,59 years. 24‑hour ambulatory blood pressure monitoring (ABPM) was performed before and after 24 weeks of treatment, with assessment of the main ABPM parameters. Patients were randomly assigned to 2 groups depending on the regimen of combined antihypertensive chronopharmacotherapy: Group 1 (n=40): patients receiving azilsartan medoxomil at a starting dose of 40 mg in the morning and nitrendipine 10 mg in the morning and evening; Group 2 (n=40): patients receiving azilsartan medoxomil at a starting dose of 40 mg in the evening, also with twice‑daily administration of nitrendipine 10 mg.

Results. After 24 weeks, with dose adjustments of the medications used, target blood pressure levels were achieved in 95 % of cases (38 patients) in Group 1 and 97.5 % (39 patients) in Group 2. After 24 weeks of treatment, in patients who achieved target blood pressure levels, both groups showed a statistically significant improvement (p<0,05) in ABPM parameters, central blood pressure (CBP), and arterial stiffness. However, the degree of change varied depending on the prescribed therapy regimen. Administration of azilsartan medoxomil in the evening with twice‑daily nitrendipine intake provided a statistically more significant reduction in mean daytime and nighttime systolic blood pressure (SBP) and diastolic blood pressure (DBP), as well as SBP and DBP variability during daytime and nighttime hours. Additionally, a more pronounced improvement in vascular stiffness parameters and central hemodynamics was observed compared to morning administration of azilsartan medoxomil.

Conclusion. In patients with arterial hypertension (AH) who have experienced a transient ischemic attack (TIA), evening administration of azilsartan medoxomil together with twice‑daily intake of the calcium channel blocker (CCB) nitrendipine provided a more pronounced antihypertensive and vasoprotective effect than morning administration of the angiotensin II receptor blocker. Thus, a chronotherapeutic approach may enhance treatment efficacy in this patient population and, potentially, reduce the risk of recurrent cerebrovascular complications in the future.

Relevance. Arterial hypertension (AH) is a common and independent risk factor for atrial fibrillation (AF). It contributes to AF onset and maintenance, while AF itself increases cardiovascular risk and represents the most common arrhythmia [3]. Hypertension and AF often coexist, and their incidence rising with age [1,3]. Current guidelines define blood pressure (BP) thresholds for diagnosing and when assessing the effectiveness of hypertension treatment in AF [1,3]. However, accurate BP measurement in this group of patients is challenging due to rhythm variability, which disrupts ventricular filling, stroke volume [3,4] and, consequently, pulse pressure. As a result, most used automatic BP monitors are not recommended for this patients [11,12]. However, additional errors and inaccuracies that are possible even when blood pressure is measured by a medical professional remain largely unstudied, highlighting the relevance of this research.

Objective. To assess the frequency and magnitude of BP overestimation and underestimation in AF patients using both Korotkov auscultatory and oscillometric methods, and to propose solutions.

Materials and Methods. This retrospective study analyzed digital signal archives from microphones and pressure sensors in arm and finger cuffs during synchronous BP measurements (auscultatory, oscillometric, and noninvasive continuous beat-by-beat) in 100 patients with permanent non-valvular AF and 92 patients with regular sinus rhythm.

The analyzed digital archive consisted of data from patients with permanent non-valvular AF undergone routine examination and treatment at the North-West Center for Arrhythmia Diagnostics and Treatment (St. Petersburg), as well as patients who had participated in prospective studies at the National Medical Research Center of Cardiology of the Russian Ministry of Health (from 2020 to 2025). Each of the latter studies was approved by the Independent Ethics Committee of the E.I. Chazov National Medical Research Center of Cardiology of the Russian Ministry of Health, and all participants signed an informed consent form.

For each patient, a «correct mean» BP value was calculated as follows. To compensate for large variations in individual BP values, as well as known physiological BP variability, the average value was calculated from ≥1000 «beat-by-beat BP values» obtained noninvasively over the entire measurement period (15 minutes). The average value of five BP readings was determined at the same time using the Korotkov or oscillometric methods. Differences between the «correct average» BP values and the average Korotkov and oscillometric methods values were analyzed statistically in MATLAB.

Results. It was shown that, in a regular sinus rhythm, Korotkov BP measurements had a high correlation and did not differ from correctly averaged «beat-bybeat» BP readings over several minutes, with no significant differences > 10 mmHg. However, in patients with AF, Korotkov systolic BP was overestimated by an average of 6.4±6.2 mmHg, and in 25% of patients overestimation can increases up to 25-30 mmHg. Korotkov diastolic BP was underestimated by −3.0±4.4 mmHg (p<0.005), and in 6% of cases this underestimation was > 10 mmHg. These discrepancies occurred mainly in patients with a pulse deficit >16% (low-amplitude BP pulsations). The oscillometric method did not reduce these discrepancies, indicating the need for noninvasive continuous beat-by-beat BP monitoring.

The urgency of the problem of comorbidity of peptic ulcer disease and arterial hypertension is due to their high prevalence in the population, the commonality of some pathogenetic mechanisms and the difficulties of pharmacotherapy, when treatment of one pathology can negatively affect the course of another. The combination of peptic ulcer disease and arterial hypertension poses serious diagnostic and therapeutic challenges for the clinician, requiring a comprehensive and measured approach. Numerous epidemiological studies confirm that peptic ulcer disease and arterial hypertension often occur in the same patient. This association is not random and can be explained by both common risk factors (psychosocial stress, smoking, poor diet, etc.) and direct pathophysiological interactions. The presence of hypertension in a patient with peptic ulcer disease aggravates its course, increases the risk of complications (bleeding), and the need for constant use of antihypertensive and antiplatelet drugs dictates the need for a special gastroprotective strategy. This article is devoted to a literature review of current data on pathogenetic relationships, drug interactions and optimal strategies for managing patients with this comorbidity. 

The combination of insomnia and obstructive sleep apnea (COMISA) is a common clinical phenomenon. However, its impact on the cardiovascular system has long been underestimated. This review systematizes data on the pathophysiological mechanisms of COMISA and cardiovascular disease (CVD), assesses the impact of these sleep disorders on the course and prognosis of CVD, and presents information on existing and promising treatment strategies. An analysis of various studies shows that COMISA is associated with a higher risk of developing hypertension and cardiovascular complications compared to isolated insomnia or sleep apnea. This condition is potentially modifiable: a comprehensive approach including cognitive-behavioral therapy for insomnia and PAP therapy demonstrates greater efficacy in improving sleep quality and treatment adherence compared to monotherapy. Timely diagnosis of both sleep disorders and their combined treatment remain underestimated. Therefore, this issue is relevant, and its resolution could help to reduce cardiovascular risk.

SCHEDULE OF SCIENTIFIC ACTIVITIES
Август 2026 -  December 2026