[Cognitive impairment in heart failure: the role of microcirculation abnormalities]. / Kognitivnye rasstroistva pri serdechnoi nedostatochnosti: rol' narusheniya mikrotsirkulyatsii.

Heart failure is one of the most frequent causes predisposing to cognitive impairment where its prevalence varies from 25 to 80% of cases. In this review, the mechanisms of microcirculatory abnormalities, which play a potential role in the development of cognitive impairment in patients with heart failure, are considered. Understanding of these mechanisms will help in the development of targeted therapy of cardiovascular and cerebrovascular diseases.

[DYNAMICS OF THE CIRCADIAN BLOOD PRESSURE PROFILE DURING COMBINED AMLODIPINE-VALSARTAN THERAPY IN FAR NORTH RESIDENTS].

The aim of the work was to study dynamics of daily arterial pressure profile during combined antihypertensive therapy starting from calcium and angiotensin II antagonists (amlodipine-valsartan) in Far North employees suffering arterial hypertension engaged on different working schedules. A total of 137 patients with grade I-III AH were divided into 2 groups. Those in group 1 worked day shifts (n=70) and the remaining ones worked night shifts (group 2). 129 patients completed the course of therapy. The final mean daily doses of amlodipine-valsartan were 8.2 ± 1.1/144.8 1.8 and 9.4 ± 1.6/197.8 ± 3.5 mg in groups I and 2 respectively. AP monitoring was performed before, 4 weeks and 6 months after therapy. Six months after the onset of amlodipine-valsartan therapy 97.2 and 97.6% of the patients in groups 1 and 2 respectively showed the target AP level and normalization of daily AP profile. Daily variability of AP in group 2 (excepting night-time variability) was also normal. Morning AP dynamics markedly improved in both groups. Most patients demonstrated excellent compliance with therapy due to its high efficacy and good tolerability.

[Five year dynamics of the characteristics of left ventricular diastolic function in patients with arterial hypertension in the Far North].

The work was aimed to study five-year dynamics of characteristics of left ventricular diastolic function in patients with arterial hypertension (AH) under conditions of continuous shiftwork in the Far North. The first stage of the study (2003-2005) involved 95 patients including 53 day-shift ones and 42 subjects working alternately on day and night shifts. At the second stage (2007-2011), prospective observation of both groups using Doppler echocardiography was organized. The patients were divided into 2 subgroups (with treated and untreated AH). It was shown that AH patients in the Far North frequently suffer disturbances of left ventricular diastolic function manifest as increased contribution of left atrial systole to left ventricular filling. This phenomenon was more pronounced in nightshift workers.

[Diurnal profile of arterial pressure in healthy residents of northern regions].

Five-year observations yielded diurnal profiles of arterial pressure (AP) in practically healthy residents of the north of Tyumen region. Their analysis revealed the enhancement of AP variability in day- and nighttime (especially diastolic AP), elevated rise of morning AP in the absence of adequate decrease of nocturnal AP.

[The dynamics and prognostic value of cerebral natriuretic peptide and C-reactive protein under acute cardiac infarction depending on tactic of treatment].

The sampling consisted of 102 patients with acute cardiac infarction with ST elevation up to 6 hours from the onset of disease. The subjects were divided into three groups: group I with primary stent procedure, group II with deferred stent procedure during 24 hours after effective thrombolytic therapy and group III with isolated effective thrombolytic therapy. The Doppler-echocardiography was applied to all patients. In every group the evaluation was carried out to dynamics NT-proBNP and C-reactive protein. In group III with isolated effective thrombolytic therapy in sub-acute period of cardiac infarction NT-proBNP increased more than twice in comparison with groups of patients with stent procedure. The values of C-reactive protein were lower than in groups I and II. The dynamics of NT-proBNP and C-reactive protein depend on mode of regeneration of coronary blood flow and level of increase of NT-proBNP corresponds the type of diastolic dysfunction of left ventricle of heart.

[The influence of combined therapy with calcium antagonist and angiotensin-converting enzyme inhibitor on the circadian profile of arterial pressure in patients with arterial hypertension in the Far North].

AIM: To study effect of combined therapy with amlodipine with ramipril on the circadian profile of arterial pressure in patients with arterial hypertension in the Far North depending on the shiftwork regime. MATERIALS AND METHODS: 130 patients with grade 2-3 AH were divided into 2 groups depending on the work-time schedule. Group 1 included 67 daywork patients group 2 consisted of 63 patients working in the alternating daywork and nightwork regime. 24 hr AH monitoring was performed before, 4 weeks and 6 months after the onset of the study. RESULTS: Six months after the onset of therapy practically all patients reached the target AD level (94.4% in group 1 and 94.7% in group). The patients fairly well tolerated therapy AD circadian profile was normalized 1.9 times in group 1 and 3.2 times in group 2. Recovered AP variability in group 1 resulted in a decreased frequency of target organ affection. In group 2, the initially higher variability accounted for the normalization of only diastolic AP variability after 6 month therapy. It suggests the necessity of prescription of a third anti-AH preparation to these patients. Morning AP dynamics improved in both groups.

[Left ventricular diastolic function in subjects with arterial hypertension living in the Far North depending on the work schedule].

Left ventricular diastolic function (LVDF) was studied in subjects with arterial hypertension (AH) living in the Far North in relation to their working regime. A total of 95 patients with grade I-II AH were divided into two groups, one including 53 dayworkers the other comprising 42 patients working in shifts. The control group included 25 practically healthy subjects. All the patients were examined by Doppler echocardiography. Analysis of the results demonstrated that patients with AH working night shifts more frequently experienced LVDF disturbances than subjects of other groups. These disturbances included increased contribution of the left atrial systole to left ventricle filling. Patients with AH exhibited the well-apparent dependence of left ventricle diastolic filling on the degree of its hypertrophy. LVDF was related to the elevation of nocturnal arterial pressure due to a rise in systolic AP.

[Features of arterial hypertension course in north regions of the country].

Arterial hypertension (AH) is a great part of general mortality and invalidism. The AH problem is especially topical problem for the north Russian regions. In the article was shown, that extremal conditions of Tyumen North played a great role in forming of cardiovascular diseases, especially AH. Features of AH development and clinical course in northerners are reflected.

[Hemodynamic types in arterial hypertension, and their changes under physical exercise].

Mismatch between the volume of blood entering the arterial circulation and the capacity of the latter presents the direct cause of arterial hypertension (AH), regardless its ethiology and pathogenesis. In most cases, it results from arteriolar spasm and increased blood flow resistance, or with increased cardiac output, which determines the type of hemodynamics. The aim of this investigation was to study central and peripheral hemodynamics in AH as well as to assess cardiovascular system reactivity under graduated physical exercise taking into account the type of hemodynamics and examinees" age. One hundred and nine patients aged 18 to 40 years with stage I to II AH were examined; 32 young healthy volunteers constituted the control group. All the subjects underwent veloergometry; vascular wall condition and hemodynamics were studied by volume compression oscillometry. The study found that in young AH patients hyperkinetic hemodynamic type prevailed; mismatch between arteriolar passability and increased cardiac output was obvious, which demonstrated that pathological changes in microcirculation were primary, while the tone of large vessels had not changed yet. AH patients with the hypokinetic variant of hemodynamics were most intolerant to physical load. The study also revealed that an excessive blood pressure response during veloergometry was more frequent in older patients (30 to 40 years).