[Vascular age in patients with arterial hypertension]. / Sosudistyi vozrast u patsientov s arterial'noi gipertoniei.

Ageing is considered to be the major and non-modifiable risk factor for the development of hypertension and cardiovascular diseases. During ageing, the vascular system undergoes structural and functional alterations, including endothelial dysfunction, thickening of the vascular wall, reduced distensibility and increased arterial stiffness. Vascular rigidity results from fibrosis and remodelling of the extracellular matrix, processes that are associated with ageing and are amplified in hypertension. These events may be induced by vasoactive agents, such as angiotensin II, endothelin-1, and aldosterone, which are increased in the vasculature during aging and hypertension. Complex interaction between the process of ageing and prohypertensive factors results in accelerated vascular remodelling and fibrosis, as well as increased arterial stiffness. Hypertension accelerates and augments age-related vascular remodelling and dysfunction, and ageing may impact on the severity of vascular damage in hypertension, thus strongly suggesting close interactions between biological ageing and blood pressure elevation. Molecular and cellular mechanisms underlying vascular alterations in ageing and hypertension are common and include aberrant signal transduction, oxidative stress and activation of pro-inflammatory and pro-fibrotic transcription factors. Strategies to suppress age-associated vascular changes can ameliorate vascular damage associated with hypertension. This article looks into vascular alterations occurring during ageing and hypertension, focussing particularly on arterial stiffness and vascular remodelling, also emphasizing the importance of diagnostic methods.

[CLINICAL AND PHARMACOLOGICAL FACTORS INFLUENCING RESISTANCE TO CLOPIDOGREL IN PATIENTS WITH CARDIOVASCULAR DISEASES].

We analysed clinical and pharmacological factors influencing resistance to clopidogrel in 250 patients with cardiovascular diseases during 18 months. It was shown that the risk ofresistance depends on the form of coronary heart disease, carbohydrate metabolism, the AA genotype of CYP2C19*2 and TBS1 genes. The cardiovascular events significantly morefrequently occurred during 12 and 18 months in resistant diabetics and in the patients with an allele lacking the *2/*3 CYP2C9 gene function and AT/TT polymorphism of the thromboxane synthase gene TBS1.

[Anxiety and polymorphism Val66Met of BDNF gene--predictors of depression severity in ischemic heart disease].

In a framework of search for early predictors of depression in patients with ischemic heart disease (IHD) we studied effect of molecular-genetic factors (polymorphism of brain-derived neirotrophic factor--BDNF), personality traits (anxiety, neuroticism), IHD severity, and psychosocial stressors on manifestations of depression in men with verified diagnosis of IHD. Severity of depression was assessed by Hamilton Depression Rating Scale 21-item (HAMD 21), anxiety and neuroticism were evaluated by the Spielberger State-Trait Anxiety Inventory and "Big Five" questionnaire, respectively. It wa shown that personal anxiety and ValVal genotype of BDNF gene appeared to be predictors of moderate and severe depression.

[Effect of original and generic clopidogrel on prognosis in relation to different gene polymorphisms].

AIM: To analyze the influence of clinical and pharmacogenetic factors on the risk of resistance to original or generic clopidogrel and that of cardiovascular events (CVE) during 12 months of follow-up. SUBJECTS AND METHODS: Two hundred and fifty patients admitted to Moscow hospitals in October 2011 to September 2012 were examined. All the patients received clopidogrel. During their stay at hospital, venous blood samples were collected twice (before and 7-10 days after continuous clopidogrel intake). Platelet function was determined by optical aggregometry. A less than 10% reduction in platelet aggregation was taken as a resistance criterion. In addition, CYP2C9 and CYP2C19 gene polymorphisms were investigated. RESULTS: Whether original or generic clopidogrel is used, the level of baseline or post-7-day ADP-induced platelet aggregation (ADP aggregation) fails to affect the risk of its resistance. Evaluation of ADP-induced platelet aggregation in patients with different CYP2C9 and CYP2C19 gene polymorphisms during the administration of original or generic clopidogrel also showed no significant differences in its resistance. During the 12-month follow-up, CVE significantly less frequently occurred as a result of the intake of original versus generic clopidogrel. CONCLUSION: The use of original clopidogrel does not affect the risk of resistance to antiplatelet drugs, but it is associated with the lower incidence of CVE during a year.

[Hyponatremia in chronic heart failure].

Hyponatremia - lowering of sodium in blood serum below 135 mmol/l - is a frequent disorder of electrolyte metabolism in patients with chronic heart failure (CHF). Hyponatremia is a risk factor of elevated mortality, repetitive hospitalizations, and worsening of kidney function in patients with decompensation of CHF. In this review we present pathophysiology of hyponatremia and propose therapeutic approach to correction of this disorder.

[The results of application of the rapid quantitative assay for fatty acid-binding protein at the onset of acute coronary syndrome].

Fatty acid-binding protein (FABP) appearing in blood within a few hours of acute coronary syndrome (ACS) is a marker of myocardial necrosis. We estimated the diagnostic value of rapid immunochromatographic test for FABP in patients with ACS and compared it with other cardiomarkers: troponin 1 (Tn1), myoglobin and creatin phosphokinase-MB (CPK-MB). The study included 100 patients aged 61.3 +/- 12.9 yr hospitalized with ACS within 2 hr after beginning of anginous pain. FABP was detected by CardioFABP test, Tn1, myoglobin and CPK-MB by quantitative assays. Blood samples were taken 2, 6, and 24 hr after the onset of anginous pain. Acute myocardial infarction was diagnosed in 79 patients, unstable angina in 9, FC 3-4 angina of effort in 4, vasospastic angina in 1, non-coronary pathology in 7. Sensitivity of FABP, Tn1, myoglobin and CPK-MB 2 hr after onset of pain was 84.8; 34.2, 65.8; 22.8% respectively: it was 98.7: 92.4; 96.2; 82.3% in 6 hr and 56; 100; n/d; 86.7% in 24 hr. Specificity of FABP was 100% in all time intervals. It is concluded that FABP level determined by rapid qualitative assay within 2-6 hr after onset of ACS is a more sensitive cardiomarker than Tn1, myoglobin and CPK-MB for diagnostics of ACS.

[Pathology diagnostics by human breath analyze].

Modern medicine experiences deficit of inexpensive rapid screening technologies despite progress in the development of diagnostic methods for various diseases. A promising approach is the analysis of exhaled air known to contain thousands of volatile organic substances whose composition differs considerably in health and disease. We isolated certain compounds that may be used as biomarkers of cardiovascular pathology (nitric oxide, carbon monoxide, pentane, isoprene, acetone). There is a variety of methods for the detection of substances in the exhaled air; such as gas spectrography, mass spectrometry, etc. However, ion mobility spectrometry appears the most suitable technique for the purpose of screening studies due to its high speed and sensitivity, small size of the apparatus, and possibility to measure trace amounts of the substances of interest. Possibilities to diagnose lung cancer based on exhaled air composition are considered.

[Fatal coronary artery spasm in a patient with thyrotoxicosis].

According to some data up to 20% of patients with thyrotoxicosis suffer from vasospastic angina. But presence of coronary artery spasm can be rarely confirmed. We describe a case of development of spasm of coronary arteries in a patients with severe thyrotoxicosis. Despite active treatment of thyrotoxicosis and use of drugs aimed at prevention of coronary spasm this patient with minor changes in coronary arteries (according to autopsy data) developed episode of acute myocardial ischemia leading to lethal outcome. This clinical case shows that patients with thyrotoxicosis and documented transitory myocardial ischemia should receive therapy with thyrostatics and drugs preventing coronary spasm in maximal doses until stable normalization of levels of thyroid hormones.

[Clinical and psychosomatic peculiarities of essential hypertension under the conditions of chronic stress].

The investigation was dedicated to associations between anxious or depressive conditions and clinical features of essential hypertension (EH) on a model of in-patients undergoing treatment in Groznyy Municipal Hospital No 1. The study found a high frequency of depressive and anxious disturbances in this group of patients (36.4% and 41.6%, respectively). Comparison of patients with mental disorders with mentally healthy controls showed that anxious (to a greater degree) and depressive disorders were in a strong association with crises within the course of EH as well as high prevalence of left ventricular hypertrophy and elevated level of blood catecholamines.

[Treatment of benign prostatic hyperplasia in patients with ischemic heart disease].

The aim of the study was to elucidate influence of alpha1A adrenoblocker tamsulosine (omnique) on ischemic heart disease (IHD) symptoms in patients with benign prostatic hyperplasia (BPH). As shown by Holter monitoring, 15 patients of group 1 having IHD, BPH and impaired miction, demonstrated ECG changes before voiding (ST depression, higher rate of supraventricular and ventricular extrasystoles); 28 patients of group 2 had ECG changes unrelated to miction. Subjective and objective effects were registered in a month in all the patients. ECG parameters improved in 11 and 20 patients of group 1 and 2, respectively. Patients without ECG improvement had severe cardial pathology (three-vessel affection of the coronary arteries, effort angina of a high functional class, cardiac failure). Thus, miction impairment due to BPH aggravate IHD. Early administration of tamsulosine (omnique) for BPH improves the course of concomitant IHD in 72% patients.