[The demographic, social and professional factors affecting choice of employment place and labor motivation of general practitioners and districts therapists].

The article considers social, demographic and professional factors determining choice by general practitioners and district therapists of place of employment and their professional motivation. The special questionnaire was developed to be applied in sociological survey. The sampling included general practitioners and district therapists of outpatient medical organizations of the Health Department and the private health care sector of Moscow. The final analysis included 399 questionnaires. It is established that possibility of job combining depends on number of children physician has. The significance of conditions for career growth increases with physician age and availability of adult children. The opportunities for research and education activities are of great value for physicians of private health sector who obtained higher education in Russia and having adult children. The preferred management style of line manager and model of communication with patient are affected by level of workload, working conditions and income level. The preferences regarding type of organizational culture are affected by place of birth. For physicians who graduated from Russian universities, significant factor of non-material incitement is possibility of additional rest. The physicians of older age working in private health sector more often consider career advancement as professional development goal. The factors influencing choice of place of employment and professional motivation in general practitioners and district therapists are summarized. The proposals for attracting, retaining and stimulating physicians are formulated.

[The social, demographic and professional characteristics of general practitioners and district therapists of state and private sectors of health care].

The article presents comparative analysis of demographic, social and professional characteristics of general practitioners and district therapists in state and private medical organizations. Sociological, statistical and analytical research methods were applied. The study was carried out on the basis of polyclinics of both Moscow Health Department and Moscow private health care sector. The sampling consisted of 399 questionnaires subjected to statistical processing. It is established that in state and private medical organizations, in this group of physicians prevail women 36-55 years old, born in the Russian Federation, in Moscow, married, having children and assessing one's income level as average. Most of them received their higher education in Moscow, graduated residency in therapy and have no medical category or academic degree. The professional experience consists 10 years or more. All physicians in state polyclinics hold more than one position and in private polyclinics 8.6% of physicians are underemployment. In the state sector, paternalistic model of communication with patient is preferable, in the private sector - a collegiate one. In the state sector, the collegiate management style of CEO is convenient and in the private sector - collegiate or dynamic one. In both sectors, adhocratic organizational culture is comfortable. Against the background of readiness to proceed working in current conditions, work in another sector is not excluded. The material factor is considered as main driver of professional motivation. The social, demographic and professional characteristics of general practitioners and district physicians in both sectors of health care in the main are similar, but have their own characteristics.

[The effect of characteristics of patient on satisfaction with medical care rendered by general practitioner and district therapist].

The patient satisfaction is one of the key criteria of quality of medical care and indicator of patient-oriented approach and factor determining competitiveness of medical organization. The purpose of the study - the comparative analysis of patient satisfaction with primary health care provided by general practitioner and district physician, taking into account their gender, age characteristics, frequency and goals of visiting polyclinic. Sociological study was carried out on the basis of out-patient medical organizations in Moscow, Kemerovo and Belgorod. The final analysis included 415 questionnaires of respondents aged 18 years and older. The patients with different rate and purposes of visiting medical institution are equally satisfied with medical care provided by general practitioner and district physician. The satisfaction with general practitioner may have gender characteristics. The satisfaction with district physician may have age characteristics. The satisfaction with both specialists may depend on health status of patient. The model of providing primary health care according to principle of general practitioner may be more universal, while according to principle of district physician more acceptable for elder patients. In order to increase satisfaction with primary health care for all categories of patients, it is necessary to consolidate best organizational approaches of both models.

[The rise of attractiveness of specialty "General Practice" for graduates of medical universities].

The choice of specialty by graduate of medical university can be promoted by particular social, demographic and personal characteristics. Purpose of the study is to investigate demographic, social and personal characteristics of students in residency on specialty "General Medical Practice" in the Russian Federation. The sociological, statistical and analytical methods are applied. The sampling for survey consisted of 81 respondents. The specialty "General Medical Practice" is chosen mainly by women residing in city, non-married and without children. They are not characterized by participation in public life and they are characterized by the presence of hobbies (hobbies). The choice is conditioned by multidisciplinary nature of medical care and scope of professional horizons. They are attracted by treatment work and are less interested in pedagogy and science. In perspective, 80% of female respondents are going to get another specialty. More than 70% of respondents plan to work in out-patient conditions and predominantly in state sector of health care. For women, main goals of further professional training are improvement in main and adjoining specialties and career promotion. And in educational program, internal diseases are of greatest interest. The preferred forms of training are internships and e-learning. The main direction of improving educational process is increasing of scope of practical training. The comparative analysis of study results with data of previous publications was implemented. The factors influencing commitment to specialty are revealed. The proposals increasing attractiveness of general medical practice for graduates of medical universities and keeping in specialty after residency are formulated.

[The influence of gender, age and length of service on educational preferences of general practitioners in Russia].

In conditions of active development of medical and pharmaceutical sciences and dynamically changing work environment the education of physician is to be both continuous and personalized. Purpose of the study. To investigate effect of gender, age and work experience on educational needs and on preferences of forms and methods of training in the system of continuing medical education of Russian general practitioners. The research bases were Chairs occupied with issues of personnel training for general medical practice in Moscow, Belgorod and Kemerovo. The sociological, statistical and analytical research methodologies were applied. The overall analysis covered 402 questionnaires for general practitioners. The sampling of respondents included 19.1% of men, 80.9% of women; 52.4% were aged 36-55 (60) years, 29.3% - 24-35 years and 18.3% - 56 (61) years and older; 45.0% had experience in general medical practice up to 2 years, 16.3% - 3-4 years, 27.0% - 5-6 years, 11.7% - 7 or more years. The results of comparative analysis of opinions of physicians of both genders and various age with different time of experience concerning level of significance for practice of various areas of competence within the framework of specialty and their preferences regarding organizational forms, training methods and its duration are presented. It is established that gender, age and length of service had no significant effect on the studied parameters. However, certain characteristics associated with these factors are identified. The further study of possible influence of other internal and external factors can contribute in the future into formulation of scientifically grounded approach to choosing personalized trajectory of education of general practitioner.

[The gender and age characteristics of general practitioners in Moscow].

The feminization and middle age decreasing in general practitioner profession is a worldwide trend.Purpose of the study is to explore gender and age structure, professional characteristics of general practitioners in Moscow.The retrospective analysis of personal records of students of the Chair of General Medical Practice of the Institute of Professional Education of the The I. M. Sechenov First Moscow State Medical University trained from 2016 to 2020 (n = 400).It is established that women made 80.5% out of them. The average age was 50.7 ± 0.7 years; average general professional experience - 28.8 ± 0.8 years, in general medical practice - 9.7 ± 0.3 years. The internship/residency in therapy was graduated by 84.2% of students. Up to 96.3% worked in state medical organizations. The majority (97.0%) had no academic degree. Indicators with positive dynamics: share of women, physicians with internship/residency in therapy, employees of state medical organizations, without an academic degree. Indicators with negative dynamics: age, professional experience. Differences between men and women were established for residency and professional experience in general medical practice.The average social and professional portrait of general practitioner in Moscow: woman 50 years old graduated internship/residency in therapy, professional experience of more than 20 years, with professional retraining about 10 years ago, working in state medical organization, no academic degree.The activities were proposed considering gender and age specifics, professional characteristics of general practitioners, directed to increasing efficiency and comfort of training.

[In-hospital Myocardial Infarction: Scale of the Problem].

All cases of acute myocardial infarction (AMI) can be divided into outpatient-onset AMI and in-hospital-onset AMI depending on the place and circumstances of their development. In this review we consider the problem of in-hospital AMI. Special attention is paid to specific features of its clinical manifestations and the scale of the clinical problem. Possible causes of difficulties in the diagnosis and treatment of this condition are presented in comparison with those in patients with outpatient-onset AMI.

[Pharmacogenetic approaches to predicting the efficiency and safety of amlodipine in patients with arterial hypertension]. / Farmakogeneticheskie podkhody v prognozirovanii éffektivnosti i bezopasnosti amlodipina u bol'nykh arterial'noi gipertenziei.

An open, non-comparative, prospective clinical study was conducted to evaluate the antihypertensive efficacy and tolerability of amlodipine, a calcium antagonist, in patients with arterial hypertension (AH) I-II stages, depending on the genotype for the polymorphic marker C3435T of the ABCB1 gene. The study included 100 patients with AH I-II stages, aged from 45 to 58 years. The initial dose of amlodipine was 5 mg, duration of treatment was 12 weeks. General clinical examination methods, office measurement and daily blood pressure monitoring, tolerance evaluation, and genotyping using the ABCB1 polymorphic marker C3435T by the PCR-RFLP method (polymerase chain reaction and restriction fragment length polymorphism) were used. The statistical analysis of results was carried out using the Mann-Whitney U test for quantitative variables, Kruskal-Wallis one-way analysis of variance (ANOVA) for three independent groups of quantitative data. Excellent antihypertensive efficacy with the CC genotype was found in 11.8% patients, with CT - 33.9%, with TT - 43.3%; good - 35.3%, 32.1%, and 33.3% respectively, satisfactory - 52.9%, 34,0% and 23.4% respectively. Six patients with the CT genotype and nine patients with the CC genotype required the increase in the dose to 10 mg. The number of patients with Adverse drug reactions (ADR) were found in 35.3% of patients with the CC genotype, 6.7% with the TT genotype and 11.3% with the CT genotype. The Kruskal-Wallis test revealed significant differences between CC and TT genotypes in the degree of decrease in SBP (p=0.02), antihypertensive efficacy parameter (p=0.02), an increase in dose requirements (p = 0.04) and the incidence of ADR(p=0.05). In AH patients (I-II stage) with the TT genotype of the C3435T gene polymorphism one can expect higher rates of antihypertensive efficacy of amlodipine in combination with a good safety profile and the lowest ADR percentage, while patients with the CC genotype more likely to develop ADR and lower antihypertensive responsiveness.

[CURRENT ISSUES IN THE CHOICE OF ANTIHYPERTENSIVE THERAPY IN PATIENTS WITH METABOLIC SYNDROME AND RELATED NON-ALCOHOLIC FATTY LIVER DISEASE].

Widespread in clinical practice, comorbid conditions and diseases, among which is the high prevalence of metabolic syndrome (MS), determine the need for selection of the optimal pharmacotherapy. The presence of certain liver diseases, including nonalcoholic fatty liver disease (NAFLD), may interfere with the processes of transformation of drugs, the metabolism of which occurs in the liver, which has been proved by experimental investigations. The article deals with the rational choice of antihypertensive drugs as a whole, and angiotensin-converting enzyme (ACE) in particular in patients with metabolic syndrome and NAFLD. Particular attention is paid to the possibilities of certain ACE inhibitors and their pharmacological properties.

[Selection of Diuretic Therapy in Cardiology Practice].

Diuretic drugs - one of the most frequently prescribed groups of drugs in cardiology practice, primarily in patients with arterial hypertension (AH) and chronic heart failure (CHF). The article discusses the features of thiazide and loop diuretics, questions the selection of individual representatives of this class of drugs. Particular attention is paid to the loop diuretic torasemide, possessing, in addition to antihypertensive and diuretic effects, additional features such as the ability to reduce the activity of the renin-angiotensin-aldosterone system, reduce the severity of myocardial fibrosis, no negative influence on lipid and carbohydrate exchange, uric acid levels and blood electrolytes.

[NSAID GASTROPATHY IN PATIENTS WITH COMORBID DISEASES].

The widespread use in clinical practice of non-steroidal anti-inflammatory drugs (NSAIDs), largely due to the general trend towards an aging population and, as a consequence, increase the number of individuals with comorbid conditions and diseases, including the most common are diseases of the cardiovascular system, diseases of the joints and spine, requiring of therapy with, combining the anti-inflammatory and analgesic properties. However, NSAIDs not only have favorable effects, but have quite a wide range of adverse effects, an important place among which is NSAID-induced gastropathy. The article deals with the rational choice of NSAIDs in patients depending on the degree of cardiovascular risk and gastrointenstinalnogo, as well as the possibility of preventing NSAID-associated gastropathy. Particular attention is paid to the choice of individual NSAIDs with regard to their pharmacological properties.

[Chronic obstructive pulmonary disease concurrent with hypertension: Evaluation of the therapeutic effect of prolonged-release indapamide]. / Khronicheskaya obstruktivnaya bolezn' legkikh v sochetanii s arterial'noi gipertoniei: otsenka lechebnogo effekta indapamida prolongirovannogo deistviya.

AIM: To provide a rationale for the clinical efficacy and safety of prolonged-release indapamide used in the combination therapy of patients with chronic obstructive pulmonary disease concurrent (COPD) concurrent with hypertension. SUBJECTS AND METHODS: Sixty-five patients (50 men and 15 women) with Stages I-IV COPD and grades 1-3 elevated blood pressure (BP) in whom prior antihypertensive therapy had proved insufficiently effective were examined. RESULTS: Prolonged-release indapamide demonstrated a high efficacy in achieving and maintaining goal BP, in normalizing its daily profile, and in reducing increased variability and the rate of morning rise in BP, without negatively affecting the clinical manifestations of COPD, pulmonary ventilatory function, and serum potassium levels. The drug was shown to have additional pleiotropic effects in lowering the activity of inflammatory markers (high-sensitivity C-reactive protein, intercellular adhesion molecules-1) and the level of endothelial dysfunction markers (endothelin-1, sP-selectin). Another commonly clinically used diuretic hydrochlorothiazide was chosen as a compared drug. CONCLUSION: The high antihypertensive efficacy and additional pleiotropic properties of prolonged-release indapamide that exerts no negative effect on the clinical manifestations of COPD, bronchial patency, and serum potassium levels demonstrate that it is expedient to incorporate prolonged-release indapamide into the combination therapy of patients with COPD concurrent with hypertension.

[Principles of choice of an angiotensin-converting enzyme inhibitor: specific features of perindopril].

Angiotensin-converting enzyme (ACE) inhibitors, a large and heterogeneous group of drugs whose representatives have significant intergroup differences, occupy a special place among many classes of antihypertensive agents. This review focuses on the properties and effects of perindopril, which set off it from other ACE inhibitors, going beyond the scope of the classic effects of this group of drugs.

[Ibuprofen: safety and efficiency of its use in wide clinical practice].

The paper presents data on the pharmacokinetics of the nonsteroidal anti-inflammatory drug ibuprofen and a review of the evidence base that suggests its clinical efficacy and safety in different categories of patients and discusses new, potentially possible indications for the use of this drug. Ibuprofen has marked anti-inflammatory, analgesic, and antipyretic effects, which along with its good tolerability, predictability of side effects, and a low risk of complications, allows it to be widely use in clinical practice. There are various ibuprofen formulations on the drug market. There may be not only an oral formulation of ibuprofen, but its topical (gel), rectal (suppositories), and parenteral (solution for intravenous injection) ones. More than 40 years' experience with ibuprofen used as an over-the-counter drug in wide clinical practice in approximately 80 countries worldwide serves as an illustrative example of the efficacy and safety of this agent.

[Clinico-economical aspects of application of trimetazidine MB in patients with chronic heart failure and cardiac rhythm disturbances].

AIM: To study clinical and pharmacoeconomical aspects of trimetazidine MD as a component of complex therapy of chronic heart failure (CHF) in patients with cardiac rhythm disturbances. MATERIAL AND METHODS: In 82 patients (67 men, 15 women, mean age 62.2+/-7.3 years) with II-III functional class (FC) of CHF we studied effect of addition of therapy with trimetazidine MB to standard therapy on CHF FC, parameters of Holter monitoring (HM) of ECG and treadmill test. In analysis of HM we considered number of isolated and paired ventricular extrasystoles (VE), episodes of nonsustained ventricular tachycardia (VT), duration of episodes of ST segment depression on 24-hour ECG. Pharmacoeconomical analysis of 2 therapy regimes was conducted by the method of calculation of cost/efficacy ratio for each parameter. Stabilization of state was achieved before study in all patients at the background of standard therapy with angiotensin converting enzyme inhibitors, cardiac glycosides, diuretics, beta-adrenoblockers. At the background of this therapy trimetazidine MB in the dose of 70 mg/day was added to 40 patients of group 1 while 42 patients of group 2 received standard therapy without trimetazidine MB. RESULTS: After 16 weeks of treatment CHF FC lowered 11% (<0.05) 10% (<0.05) in groups 1 and 2, respectively. According to data of HM numbers of VE decreased in group 1 by 57.6% (<0.05), in group 2 by 28.8% (<0.05), episodes of nonsustained VT--by 58.3% (<0,05) and 36.8% (<0.05), isolated VE--by 23.6% (>0.05) and 6.9% (>0.05), respectively. Duration of episodes of ST depression decreased 55.5% (<0.05) in group 1 and 23.3% (<0.05) in group 2. According to treadmill test maximal power of load in patients of group 1 rose 12.3% (<0.05), of group 2-6.7% (<0.05), total exercise duration rose 16.8% (<0.05) and 82% (<0.05), respectively. Cost/efficacy ratio expressed in roubles per 1% efficacy calculated for CHF FC was 2694 in group 1, 4095--in group 2; for maximal load power--2409 and 3667, respectively; for duration of episodes of ST segment depression--1665 and 1934, respectively; for dynamics of VE number--514 and 853, respectively. CONCLUSIONS: Supplementation of standard CHF therapy with therapy with metabolic cytoprotector trimetazidine MB allows to achieve more pronounced positive effect on CHF FC, exercise tolerance, and lowering of cardiac ectopic activity. Smallest cost efficacy ratio after addition of trimetazidine MB to standard therapy from pharmacoeconomical point of view evidence for advantages of this regime of therapy possessing smaller expenditures per unit of efficacy.

[An experience of the use of angiotensin II receptor blocker losartan in patients with metabolic syndrome and chronic kidney disease].

Aim of the study--to assess efficacy and safety of one of angiotensin II receptor blockers in patients with metabolic syndrome (MS) and I-V stage chronic kidney disease. We studied cardiodynamic and renal effects of losartan in average daily dose 50 +/- 13.06 mg in 20 patients (9 men and 11 women aged 32-79 years) with MS and I-V stage chronic kidney disease. Cardiodynamic effects of losartan were assessed by office blood pressure (BP) measurements, 24-hour BP monitoring (24-HBPM), echocardiography. Laboratory investigations included biochemical analysis of the blood with measurement of creatinine levels, lipid blood composition, fasting glucose, and glucose under conditions of oral glucose tolerance test. Renal function was assessed by glomerular filtration rate and microalbuminuria (MAU). Parameters of quality of life were analyzed with the use of questionnaires "Quality of life of patients with hypertensive disease" and EuroQol EQ-5D VAS thermometer. Duration of follow up was 12 weeks. 24-HBPM revealed significant lowering of systolic and diastolic BP in all temporal intervals, significant decrease of elevated diurnal systolic and diastolic BP burden, tendency to lowering of variability and normalization of 24-hour BP profile. We also noted tendency to lowering of MAU from 5.60 mg/dl (median) (3.50; 9.20 [25th and 75th percentile]) to 3.25 mg/dl (0.40; 7.83); significant lowering of levels of triglycerides and glucose under conditions of glucose tolerance test; improvement of parameters characterizing quality of life namely reduction of integral assessment by the "Quality of life of patients with hypertensive disease" questionnaire and improvement of EQ-5D VAS (thermometer) score related to arterial hypertension. We conclude that losartan in patients with MS and early signs of impairment of kidney function in addition to antihypertensive action exerts favorable effect on parameters of 24-hour BP profile, has good safety profile, causes favorable metabolic effects, lowers level of MAU and improves parameters of quality of life.

[An experience of the use of a fixed atenolol amlodipine combination in real clinical practice: results of multicenter Russian study].

AIM: To assess clinical, hemodynamic efficacy and tolerability of a Fixed Atenolol Amlodipine Combination (FAAC) in patients with arterial 1-3 degree arterial hypertension as mono- or combination therapy. MATERIAL AND METHODS: Antihypertensive efficacy and tolerability of FAAC was investigated in open noncomparative study in 22 centers in 17 cities of Russia on 570 patients (246 men, 324 women) aged 18-65 years (mean 55,53+8,55 years) with 1-3 degree arterial hypertension. Methods of control included office blood pressure (BP) measurement, 24-hour BP monitoring, electrocardiography, control of biochemical parameters, assessment of efficacy and tolerability. RESULTS: Achivement of target BP level at the background of treatment was noted in 401 patients (70.35%) including 171 (30%) patients on monotherapy with FAAC and 230 (40,35%) patients on combination therapy with FAAC and other antihypertensive drug. After 60 days of monotherapy with FAAC according to data of office measurements systolic BP (SBP) decreased from 161.90+/-14,51 to 129.96+/-8,76 mm Hg (p<0.01), diastolic BP (DBP) decreased from 97.61+/-7.45 to 80.04+/-6.44 mm Hg (<0.01). Significant lowering of heart rate from 79.25+/-9.78 to 65.24+/-7.35 bpm (p<0.01) was also noted. After use of combination of FAAC with other antihypertensive drugs according to data of office measurements SBP decreased from 168.24+/-16,78 to 129.77+/-9.55 mm Hg (p<0.01), DBP decreased from 99.66+/-10.03 to 81.36+/-6.51 mm Hg (<0.01). Heart rate decreased from 80.79+/-10.51 to 66.09+/-8.37 bpm (p<0.01). According to data of 24-hour BP monitoring significant lowering of mean 24-hour, diurnal and nocturnal systolic and diastolic BP as well as of hypertensive burden were also noted. No statistically significant dynamics of laboratory parameters was registered during 60 days of therapy with Tenochek. Tolerability was good in 94% of patients, adverse events with premature withdrawal of the drug took place in 1.4% of patients.

[Possibilities of correction of coronary and myocardial reserves in patients with ischemic heart disease by Angiotensin converting enzyme inhibitor perindopril].

UNLABELLED: AIM. Assessment of possibilities of correction of coronary and myocardial reserves in patients with ischemic heart disease (IHD) by angiotensin converting enzyme inhibitor perindopril included into combination antiischemic therapy. MATERIAL AND METHODS: Antianginal and angioprotective effects of perindopril (8 mg/day) were studied in 37 patients (22 men, 15 women, mean age 62,2 +/- 5,3 years) with IHD and functional class (FC) I - III angina. Methods of control included assessment of severety of angina, 24-hour Holter ECG monitoring, bicycle exercise test, echocardiographical investigation at rest, stress-echocardiography (SEchoCG) with physical work load, investigation of endothelium dependent vasodilation of brachial artery (BA) and Doppler study of blood flow velocities. Duration of treatment was 6 weeks. RESULTS: Antianginal effect of perindopril was noted in 73% of patients mostly with FC I - II with decrease of number of attacks per week by 11.3% (p < 0.05). According to data of ECG monitoring number of episodes of myocardial ischemia per day diminished 19.3% ( < 0.05), including 10.1% decrease of painless ( " silent " ) episodes. Total duration of episodes of ischemia decreased 22.4% ( < 0.05). According to results of veloergometry increase of total duration of work from 261.2 +/- 93,5 to 305.9 +/- 98.7 s (by 17.1%, < 0.05) was noted. EchoCG at rest revealed disturbances of local contractility of left ventricular (LV) myocardium (hypo- and akinesia) in 73%, sings of LV diastolic dysfunction - in 92% of patients (E /A =0.83). After therapy with perindopril improvement of local systolic LV function was noted: at rest and at exercise number of segments of hypokinesis decreased 11.3 ( < 0.05) and 5.9% ( < 0.05), respectively. In patients with initial signs of LV diastolic dysfunction prescription of perindopril led to significant 17.3% ( < 0.05) increase of DE/A at rest. In 7 patients index E/A at rest normalized. Number of patients with endothelial dysfunction decreased 26 and 8% in angina FC I - II and III, respectively. In patients with FC I - II angina significant 9.8% increase ( < 0.05) of BA diameter, increases of linear and volume blood flow velocities from 5.0 +/- 1.9 to 41.5 +/- 2.1cm/s ( < 0.05) and from 2.1 +/- 0.5 to 6.9 +/- 0.5 ml/s ( < 0.05), respectively, were noted. CONCLUSION: Perindopril in the dose of 8 mg/day in patients with IHD with stable effort angina FC I - III in combination antiischemic therapy exerts positive influence on the state of coronary and myocardial reserves of the heart and decreases degree of dysfunction of endothelium what denotes antianginal and vasoprotective effects of the drug. Enhancement of coronary blood flow leads to betterment of diastolic function of the myocardium in patients with disturbances of relaxation and to improvement of local contractility of the myocardium appearing as decrease of quantity of hypokinetic segments.

[Blood pressure 24-hour rhythms and variability in adolescents with hypertension]. / Osobennosti sutochnykh ritmov arterial'nogo davleniia i ego variabel'nosti u podrostkov s arterial'noi gipertenziei.

Twenty-four hour blood pressure (BP) monitoring was used for the study of BP 24-hour rhythms and variability in adolescents with hypertension and their normotensive counterparts. The data obtained evidenced for active participation of sympatho-adrenal system in genesis of juvenile hypertension: hypertension was predominantly systolic, BP elevation as a rule was associated with increased heart rate and pulse pressure. Episodes of BP elevation were registered mostly during day time. Desynchronization of 24-hour rhythms due to pronounced BP lowering during sleep characteristic for this age group found its reflection in values of nocturnal BP dipping. More than 1/3 of adolescents with episodes of elevated BP had 'white coat' hypertension.

[Peculiarities of blood pressure rhythms and blood pressure variability in adolescents with hypertension (in accordance with twenty-four monitoring of blood pressure)]. / Osobennosti sutochnykh ritmov arterial'nogo davleniia i ego variabel'nosti u podrostkov s arterial'noi gipertenziei (po dannym sutochnogo monitorirovaniia AD).

Registration of 24-hour blood pressure in adolescents with and without hypertension revealed active participation of sympathetic nervous system in genesis of juvenile hypertension. Hypertension in adolescents was mainly systolic, blood pressure elevation as a rule was accompanied by accelerated heart rate and increased pulse pressure. Episodes of blood pressure elevations occurred mostly during day time. Desynchronization of 24-hour rhythms due to excessive nocturnal blood pressure lowering was found to be typical for this age group. More than two thirds of adolescents with episodes of blood pressure elevation had also 'white coat hypertension'.