Linking Cardiovascular Risk With Estradiol Level in Men.

Aim      To study the relationship between the cardiovascular risk and the level of estradiol in men of young and middle age. The main group included 71 patients with newly diagnosed hyperestrogenia (HE) (serum estradiol >41.2 pg/ ml). Using pseudorandomization, 68 men with normal estradiol level and age- and body weight index (BWI)-matched with the main group were included into the control group. Anthropometric data, bioimpedance variables, blood pressure (BP), and concentrations of estradiol, testosterone, glucose, and total cholesterol were analyzed in both groups.Results Patients of the main and control groups did not differ in age, BWI, and smoking status. Testosterone concentration was 10.18 nmol/l in the HE group and 12.18 nmol /l in the control group (p=0.006). Systolic BP was 142.0 mm Hg in the HE group and 135.2 mm Hg in the control group (p=0.011); diastolic BP was 90.3 mm Hg in the HE group and 86.2 mm Hg in the control group (p=0.008). Total cholesterol was 5.87 mmol/l in the HE group and 5.33 mmol/l in the control group (p=0.023). Blood glucose did not differ between the groups. The presence of HE in men 2.11 times (р=0.038) increased the probability of arterial hypertension. The intergroup difference by the SCORE scale did not reach statistical significance (р=0.172). BWI, waist and hip circumferences, and bioimpedance body composition parameters did not differ between the groups.Conclusion      In the studied cohort of young and middle-aged men, HE was an independent predictor for the presence of arterial hypertension. There were no significant intergroup differences in the total risk of cardiovascular diseases calculated with the SCORE scale.

[Androgenic status of men with severe COVID-19: the role of testosterone and dihydrotestosterone [within the program FOUNDER (features of a new coronavirus infection course and options therapy depending on the androgenic status)]].

PURPOSE: The aim of this study was to assess the mens androgen status influence on the severity and outcomes (transfer of patients to the ICU or death) of COVID-19 required hospital hospitalization. MATERIALS AND METHODS: The study included 151 hospitalized men with a confirmed diagnosis of COVID-19. To measure the severity of disease have been used Symptomatic Hospital and Outpatient Clinical Scale for COVID-19 (SHOCS-COVID). It includes the severity of the clinical condition (hyperthermia, shortness of breath, oxygen saturation, need for ventilation), the degree of inflammation (CRP), markers of thrombosis (D-dimer), the degree of lung damage according to CT. The patients underwent a study of full blood count, some biochemical parameters, lung CT, and a study of testosterone (T) and dihydrotestosterone (DHT) levels. RESULTS: T deficiency was observed in 46.4% of patients (70/151 men). At the same time, DHT deficiency was observed only in 14.4% of patients (18/125 men). In patients with a T level below the median, there was a significant increase in inflammatory factors (CRP, lymphocytes/CRP index), markers of thrombosis (D-dimer and fibrinogen), extensive lung damage at admission according to CT 25.75% vs. 11.95% (p<0.001), the elevated number of points for SHOCKS-COVID 7 (IQR 5-10) versus 5 (IQR 3-7) (p<0.001) and the longer duration of hospital treatment (3 days difference, p<0.001) in comparison with a group of patients with a T level above the median. At the same time, the T level had no correlation with age. The level of DHT had a weak inverse correlation with the age of patients, but not with the main markers of the severity of COVID-19, including the number of SHOCK-COVID scores. During multivariate regression analysis, it was shown that SHOCKS-COVID is the most significant predictor of admission to the ICU while no association of T and DHT levels with outcomes in COVID-19 was found. However, it was found that the concentration of T, even adjusted for age, has a significant inverse association with the severity of the course of the disease and the number of SHOCK-COVID scores (p=0.041). An analysis of the evaluation of directed acyclic graphs suggests the main role of COVID-19 severity in reducing androgenic function and T concentration, at which its anti-inflammatory effects are lost. There were no correlations between the concentration of DHT and the number of SHOCK-COVID scores and the COVID-19 prognosis. CONCLUSION: SHOCK-COVID is the most sensitive predictor of the COVID-19 outcome in hospitalized men, including adjusting to age. T and DHT do not directly affect the outcomes of the disease. The greater severity of the infection and an increase in SHOCK-COVID scores are associated with a decrease in the concentration of T, and a weakening of its anti-inflammatory and anti-cytokine effects, which indirectly worsens the prognosis of male patients with a new coronavirus infection undergoing hospital treatment. There are no such relationships for DHT.

[Features of a new corOnavirUs infection course and optioNs therapy DEpending on the andRogenic status (FOUNDER): androgenic status in men with COVID-19 and its relationship with the disease severity].

OBJECTIVE: Analysis of androgen status in men hospitalized with a moderate COVID-19 and its relationship with the severity of the disease. MATERIALS AND METHODS: The study included 152 males with a confirmed diagnosis of COVID-19 based on the results of a positive PCR for the SARS-CoV-2 virus and/or computed tomography of the lungs hospitalized at the MSU University Clinic due to the moderate and severe COVID-19. Examination of the level of biochemical blood parameters (CRP, creatinine, urea, glucose, total testosterone (T)); CT of the lungs. To objectify the severity of the clinical symptoms, the NEWS2 distress syndrome severity scales and the original scale for assessing the clinical condition of patients with COVID 19 (SHOCS-COVID) were used. RESULTS: The median T level in 152 examined patients was 2.14 [1.21; 3.40] ng/ml. In patients with a T level below the median, the CRP level was more than two times higher, and the D-dimer value was almost two times higher than in patients with T level above median. The duration of treatment in the hospital was longer in men with COVID 19 and an initial T level below the median than in patients with T about the median (13 days vs 10.5 days, p=0.003). Low T level was correlated with lung damage by lung CT. After improving the clinical condition, there was a linear increase in the level of T independent of its initial level. CONCLUSION: Among men with moderate and severe COVID-19, a decreased testosterone level is detected in 46.7% of cases. Patients with low testosterone levels on admission have more severe COVID-19. A significant increase in testosterone level was observed after successful COVID-19 treatment without any special action regarding testosterone level.

Features of diagnostics and treatment of chronic heart failure in elderly and senile patients. Expert opinion of the Society of Experts in Heart Failure, Russian Association of Gerontologists, and Euroasian Association of Therapists.

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[Osteoporosis and arterial stiffness: study of 103 women with mild to moderate risk of cardiovascular disease].

OBJECTIVE: to evaluate the relationship between arterial stiffness and bone metabolism in women with mild to moderate risk of cardiovascular disease (CVD). METHODS: In 103 postmenopausal women (mean age 57.0 years, 95% CI 50.0-64.0) with mild to moderate risk of CVD (SCORE<5), no more than mild hypertension, normal function of thyroid gland, without coronary artery disease, diabetes mellitus and secondary causes of osteoporosis pulse wave velocity between carotid and femoral sites (cfPWV, by applanation tonometry) and ankle and brachial sites (baPWV, by volume sphygmography) as well as bone mineral density at lumbar spine and femoral neck (by dual-energy X-ray absorptiometry) and blood serum levels of markers of bone turnover (total procollagen type I amino-terminal propeptide (PINP), osteocalcin, collagen type 1 cross-linked C-telopeptide (-CTX) by electrochemilumininescence immunoassay) were assessed. RESULTS: Compared with patients with normal mineral bone density (BMD) (n=27), patients with osteoporosis (n=31) had higher cfPWV and baPWV values (p<0.05). Patients with osteopenia did not differ from other groups (p>0.05). In osteoporosis group there were greater years since menopause, less body mass index than in normal BMD (in all cases p<0.05; ns between osteoporosis and osteopenia groups). Between all three groups there were no significant differences in age, smoking status, visit blood pressure, lipid levels and medication. CfPWV and baPWV values significantly positively correlated with age, systolic arterial pressure, years since menopause, procollagen type I N propeptide (all p<0.05), and significantly negatively correlated with BMD at hip neck (all p<0.05). Relationship between cfPWV and BMD at lumbar spine did not reach significant value (r=-0.18, p=0.068). No relationship was found between parameters of arterial stiffness and CTX and osteocalcin (all p>0.05). In the multivariate analysis cfPWV was significantly and independently associated with systolic blood pressure (=1.03, 95% CI 1.00-1.06, p=0.03) and BMD at hip neck (=0.01, 95% CI 0.001-0.07, p=0.003). CONCLUSION: Revealed association between arterial stiffness and bone metabolism may probably explain general mechanisms of arterial and bone damage in postmenopausal women with mild to moderate risk of cardiovascular disease.

[The vascular wall in postmenopausal women with hypothyroidism and hypertension].

AIM: To study a relationship between thyroid function and the stiffness of great arteries in postmenopausal women with arterial hypertension (AH). SUBJECTS AND METHODS: The trial enrolled 76 postmenopausal patients with clinical hypothyroidism (CHT) (n = 24) or subclinical hypothyroidism (SCHT) (n = 52) and AH; a control group consisted of 40 postmenopausal women with euthyroidism. Body mass index (BMI), waist and hip circumferences, blood pressure (BP), thyroid-stimulating hormone (TSH), free thyroxine, free triiodothyronine, total cholesterol, triglycerides were determines; volumetric sphygmography was performed. Brachial-ankle pulse wave velocity (baPWV) was measured; cardio-ankle vascular index (CAVI) and ankle-brachial index (ABI) were determined. RESULTS: The patients with CHT or SCHT and the controls were matched for age, BMI, BP, and heart rate. TSH levels in patients with SCHT (6.23 (5.27; 8.22) microU/ml) and in those with CHT (11.8 (9.09; 22.7) microU/ml) were statistically significantly higher than in the control group (2.25 (1.5; 2.72) microU/ml) (p < 0.05). BaPWV in the patients with SCHT (14.35 (12.5; 15.5) m/sec) and in those with CHT (13.75 (13.05; 15.25) m/sec) was also statistically significantly higher than in the control group (12.85 (12; 13.9) m/sec) (p < 0.05). Comparison of ABI and CAVI revealed no significant differences between the groups. Univariate analysis of the findings showed a significant impact on higher arterial stiffness in the SCHT and the CHT groups. Total cholesterol levels were significantly higher in the SCHT group than in the control one. CONCLUSION: The patients with AH and hypothyroidism versus their peers with AH and without thyroid function had significant rises in blood cholesterol levels and arterial stiffness. The rise in lipid levels was significantly marked only in the patients with SCHT; and baPWV equally increased in both the SCHT and the CHT groups.

[The efficacy and safety of the combination of ß-blocker bisoprolol and if inhibitor I(f) ivabradine in patients with stable angina and chronic obstructive pulmonary disease].

The study was aimed to assess the efficacy and safety of treating coronary heart disease (CHD) patients complicated with COPD using the combination of tolerable doses of -blocker bisoprolol and inhibitor If-channel ivabradine, compared with bisoprolol alone. A total of 50 patients were included (88% men, mean age 62.8+/-7.2 years) with stable angina and clinical signs of bronchoobstruction (84% with COPD and 16% with bronchial asthma in remission phase). At the study start, all patients received bisoprolol, the dose of which was titrated until the clinical signs of intolerance (most common - bronchoobstruction) appeared or worsened. Average dose of bisoprolol at the time of forced titration stop was 6.3+/-2.2 mg/day, mean heart rate (HR) decreased from 82.1+/-8.4 to 72.2+/-8.5 bpm. Then, the patients were randomized into two groups: patients of the first group (n=25) continued to take bisoprolol in tolerable dose, and patients of the second group were added ivabradine (5-15 mg, mean dose 10.7+/- 3.1 mg/day). In contrast to the bisoprolol alone, combination therapy resulted in further decrease of HR to an average of 62.6+/-4.1 bpm over 6 month of follow-up. This was associated with additional decrease of the number of angina attacks (by 4.68+/-4.40 per week vs. 2.48+/-4.70, <0.05), nitrates consumption (by 206.0+/-153.6 mg/week vs. 95.6+/-134.2 mg/week, <0.01) and score of negative components of quality of life (by 5.16+/-3.3 vs. 2.24+/-4.5, <0.05), compared with the first group, respectively. In combination therapy group there was also the decrease of the inhaled broncholytics consumption (from 2.88+/-3.23 to 1.88+/-2.65 per week, <0.05), that was not evident in the first group. Average number of hospitalizations per 1 patient decreased over 6 months of follow-up, compared to the same period before the trial, in both groups, but more prominently in the combination therapy group (-0.31+/-0.55 vs. -0.56+/-0.76, accordingly, <0.1). Therefore, in the treatment of patients with CHD, stable angina and concomitant bronchoobsrtuctive manifestations, if not possible to administer -blockers in the adequate HR-reducing dose, the addition of ivabradine to the treatment could be the treatment of choice. The combination of tolerable doses of bisoprolol and ivabradine is s afe and allows to achieve adequate HR decrease. This is a ssociated with maximal antianginal effect, decrease in the need for broncholytic therapy, improvement of the quality of life and decrease of the number of hospitalizations, compared with the treatment with bisoprolol alone.

[Arterial stiffness as a predictor of cardiovascular events in coronary heart disease].

To date, there is much evidence confirming that impaired arterial elastic properties have a direct impact on prognosis in patients with chronic renal failure, arterial hypertension, or diabetes mellitus in the general population and in the elderly. At the same time, in most cohort studies the manifestations of coronary heart disease (CHD) constitute about two thirds of developed cardiovascular events (CVE); the value of arterial stiffness after CHD manifestations has not been conclusively ascertained. There are various opinions on the mechanism and pattern of this association. Rigidity of large vessels may be a marker of cardiac artery lesion, on the one hand, and promote deterioration of myocardial ischemia in the presence of coronary atherosclerosis, on the other. This review of literature discusses the pathogenetic and clinical aspects of the impact of stiffness of the great vessels on the development of CVE.

[Effect of arterial stiffness on development of cardio-vascular complications in ischemic heart disease].

With the aim to assess effect of arterial wall stiffness on prognosis of patients with stable form of ischemic heart disease (IHD) we included 224 men (mean age 56.2+/-8.9 years) with confirmed IND in a long-term prospective study. Pulse wave velocity was measured with brachial-ankle method (PWVba), presence of left ventricular hypertrophy (LVH) was detected with electrocardiography. Coronary arteriography was carried out in 126 patients. During 3.5 years of follow-up there were 38 cardiovascular complications (CVC) (6 myocardial infarctions, 19 operations of revascularization, 11 hospitalizations because of unstable angina, 3 sudden deaths). Patients were distributed to groups (tertiles) depending on PWVba values. Elevation of stiffness of arteries from lowest to highest tertile was significantly associated with increases of age, level of arterial pressure, heart rate, level of total cholesterol, LVH, severity and extent of coronary atherosclerosis. The Cox model of proportional risks comprising 14 main risk factors allowed to reveal that only PWVba significantly (<0.001) contributed to formation of prognosis. In patients with PWVba exceeding 14.3 m/s (highest tertile) compared with those with PWVba below 12.4 m/s (lowest tertile) risk of development of CVC was 4.23 times higher (5.27 times higher after adjustment for age and systolic arterial pressure). Comparison of Kaplan-Maier survival curves confirmed that in patients with low PWVba cumulative probability of absence of CVC was greater than in patients with higher stiffness of arterial wall (<0.008). PWVba as marker of arterial stiffness in men with chronic course of IHD appears to be predictor of CVC independent on age and classic risk factors.

[Assessment of major artery stiffness: new perspectives of noninvasive diagnosis of coronary atherosclerosis].

AIM: Arterial stiffness is a predictor of atherosclerosis. This study was conducted to develop a method of coronary atherosclerosis severity assessment by means of brachial-ankle pulse wave velocity (baPWV). MATERIAL AND METHODS: We measured baPWV in 119 males (age 51.67 +/- 7.25) who received coronary angiographic examination (CAG). The baPWV was measured by Vasera VS-1000 (Fukuda Denshi). RESULTS: The patients were divided into two groups by severity of stenosis (group 1--less than 50% stenosis, group 2 > 50%). The baPWV value was significantly greater in group 2 (n = 98, baPWV 13.15 +/- 2.14 m/s, p = 0.004) than that in group 1 (n = 21, baPWV 12.13 +/- 1.17 m/s). ROC-curve demonstrated that the best cut-off point of the baPWV for predicting occlusive atherosclerosis was 12.2 m/s. The area under ROC-curve was 0.66 (p = 0.034). An univariate binary logistic regression model demonstrated that only baPWV had a significant odds ratio for coronary stenosis > 50%: 2.68 (95% CI = 1.01-7.15), p = 0.043. Other risk factors were not significantly associated with severity of stenosis. CONCLUSION: The baPWV significantly reflects the severity of stenosis in middle-aged males opening new perspectives of noninvasive detection of coronary artery atherosclerosis in middle-aged males.

[Clinical and economical effectiveness of outpatient diagnostic coronary angiography].

Introduction into clinical practice of transradial coronary angiography (CA) made it possible to conduct the procedure in outpatients and thus increase number of CA and diminish its cost. Aim of the study was to assess possibility, safety and economical efficacy of outpatient CA. Between April 2004 and August 2007 CA was carried out in 133 outpatients without overt heart failure, unstable angina, complex disturbances of cardiac rhythm or conduction. Comparison group comprised 187 patients subjected to CA within framework of short term hospitalization program. There were no complications associated with the use of either transradial or transfemoral approach. Total average cost of outpatient CA was 19% less than that of inhospital CA. Thus outpatient CA with transradial approach appears to be safe and effective procedure with low risk of complications in patients with stable ischemic heart disease.

[Effect of long term therapy with spironolactone on parameters of 24-hour heart rhythm variability and ventricular arrhythmias in patients with heart failure receiving optimal therapy].

UNLABELLED: Aim of the investigation was the study of influence of spironolactone (25-75 mg/day) on clinico-functional and neurohormonal, 24-hour variability of cardiac rhythm, and ventricular disturbances of heart rhythm in patients with chronic heart failure (CHF) receiving optimal therapy. Forty nine patients were included in the study--44 men (89,8%) and 5 women (10.2%) in the age from 28 to 75 years with II-IV NYHA functional class (FC) CHF, LV ejection fraction (EF) 35%, plasma levels of creatinine 150 micromol/L and potassium 5 mmol/L. Main causes of development of CHF were dilated cardiomyopathy, ischemic heart disease (large focal postinfarction cardiosclerosis) and decompensated hypertensive heart [25/20/4 (51%/40.8%/8.2%), respectively]. As a result of randomization 2 groups of observation were formed: group 1-19 patients receiving spironolactone in a 24 hour dose 25-75 mg, group 2-control group-30 patients without therapy with spironolactone. Inhibitors of angiotensin converting enzyme (ACE) took 100%, beta-adrenoblockers--63.2% of patients. Control examination was conducted before randomization, in 6 and 12 months of follow up. During period of observation no changes of FC were noted in control group. In the spironolactone group after 6 months f treatment in 6 patients FC improved (p=0.028). By the end of follow up the given effect lost its significance, but in 5 (38.5%) patients by termination of the study FC II of CHF was noted, what was accompanied with moderate increase of distance walked during 6-minute walk test from 354 to 378 m. Addition of spironolactone to conducted therapy was followed by increase of concentration of aldosterone by 153 (84; 426) microg/ml, p=0.009, what discriminated (p=0.007) the given patients from control group and provoked increase of plasma rennin activity. Median concentration of angiotensin II changed not substantially [0.78 (-1.84; 2.66) mg/ml] after 12 months of treatment. Changes of noradrenalin, vasopressin, and endothelin were insignificant in both groups of observation. After 12 months of treatment median of changes of concentration of atrial natriuretic peptide was -51.9 ( -87; -43.9) microg/ml. At the same time in control group was observed gradual growth of concentrations of the given peptide from initial 107.3 to 168.5 microg/ml by the moment of termination of the study. Basic influence on spectral and temporal indexes of HRV spironolactone exerted in day time of 24 hours with increase of by 24.5 (10; 34) ms (p=0.042) after 6 months of treatment. Maximal lowering of number of ventricular extrasystoles from initial 75 (39; 477) to 12 (0; 15) (p=0.043) were achieved with administration of spironolactone in combination with ACE inhibitor and beta-adrenoblocker after 12 months of treatment what was followed with decrease of number of patients with episodes of of ventricular tachycardia from 50 to 18% (p=0.035). Addition of spironolactone in a dose of 75 mg/day to optimal therapy including ACE inhibitor and b-adrenoblocker is accompanied with betterment of clinical state and FC of patients with CHF. CONCLUSION: Neurohormonal markers of application of spironolactone in combination with ACE inhibitor appear elevation of activity of plasma renin and concentration of aldosterone in combination with lowering of concentration of atrial natriuretic peptide in plasma of patients with CHF. Long term block of aldosterone at receptor level is accompanied with betterment of parameters of HRV in patients with CHF during day time. Addition of spironolactone to therapy with ACE inhibitor and beta-adrenoblocker bisoprolol decreases quantity and severity of ventricular rhythm disturbances in patients with moderate and severe CHF.

[Effects of long term therapy with angiotensin converting enzyme inhibitor quinapril, antagonist of receptors to angiotensin II valsartan, and combination of quinapril and valsartan in patients with moderate chronic heart failure. Main results of the SADKO-CHF study].

AIM: To compare effects of therapy with angiotensin converting enzyme inhibitor quinapril (Q), angiotensin II receptor antagonist valsartan (V), and their combination in patients with stable moderate chronic heart failure (CHF). MATERIAL AND METHODS: Patients (n=80) with NYHA class II-III CHF due to ischemic heart disease, dilated cardiomyopathy or decompensated hypertensive heart and ejection fraction <40% were randomized into 3 groups. Patients of group Q, V and Q+V received Q (average dose 13 mg/day, n=28), V (121 mg/day, n=26), and combination of Q and V (12 and 78 mg/day, n=26), respectively. Methods included assessment of clinical state and quality of life, echocardiography, 6 min walk test, Holter ECG monitoring with measurements of parameters of heart rate variability (HRV), and determination of neurohormones in peripheral blood. Examinations and measurements were made at baseline, in 3 and 6 months. RESULTS AND CONCLUSIONS: Six months therapy with Q, V and their combination resulted in improvement of clinical and functional state of patients. More pronounced augmentation of exercise tolerance and lowering of CHF functional class were observed in group Q. Combined use of Q and V had no significant advantages over monotherapy with Q and V when effect on parameters of left ventricular remodeling were concerned. Therapy with Q was associated with "escape" of blockade of aldosterone synthesis and "reactivation" of angiotensin II formation after 6 months. The use of V and combination of V+Q allowed to achieve more stable but incomplete control of aldosterone activity. The use of Q appears to be the preferential regimen to influence activity of sympathoadrenal system and parameters of 24 hour HRV compared with V and Q+V. Long term therapy with V does not improve main parameters of 24 hour HRV.

[Heart rate variability in chronic heart failure and its role in prognosis of the disease.].

Aim. To assess role of 24 hour heart rate variability (HRV) for prognosis of patients with chronic heart failure (CHF) and systolic dysfunction in the era of wide use of b-adrenoblockers. Material. Patients (n=135) with symptomatic CHF and ischemic (68%) or nonischemic cardiomyopathy (32%) with systolic left ventricular (LV) dysfunction and sinus rhythm (age 52+/-11.9 years; 42, 40 and 18% with NYHA class II, III and IV, respectively; mean LV ejection fraction 30.1+/-6.7%) At study entry 89 and 78% of patients received angiotensin converting enzyme inhibitors and b-adrenoblockers, respectively. Methods. Holter ECG monitoring with HRV temporal and spectral analysis. Results. During average follow-up of 2.4 years 60 patients (44.4%) died of cardiac causes (92.3% of all deaths). Other deaths were due to surgical pathology (n=1) and stroke (n=2). All standard HRV values with the exception of high frequency power were lowered, this lowering correlated with functional severity of heart failure. According to multifactorial analysis the following characteristics were independent predictors of all cause death: NYHA class III-IV (RR=1.9, 95% confidence interval 1.1-9.6, p=0.002), and SDNN value 90 ms (RR=1.5, 95% confidence interval 1.2-2.5, p=0.001). Conclusion. In CHF parameters of HRV are lowered compared to normal values and correlate with functional heart failure severity. NYHA class III-IV and lowered HRV (SDNN 90 ms) allow to identify patients with high risk of death.

[Possibility of coronary angiography without hospitalization].

Coronary angiography is the necessary investigation in the diagnostic complex of patients with ischemic heart disease (IHD). The use of trans-radial access makes it possible to do the angiography without hospitalization. The algorithm of coronary angiography in day-time clinic was proposed. Non-hospital angiography in 15 patients was successful. It is the first time this method has been used in this country.

[Primary pulmonary hypertension: activation of sympathico-adrenal system and free radical oxidation. Positive effects of carvedilol therapy].

AIM: To study the condition of the sympathico-adrenal system (SAS), synthesis of cAMP dependent on beta2-adrenoreceptors and parameters of free radical oxidation in patients with primary pulmonary hypertension (PPH); to examine efficacy of non-selective beta- and alpha1-adrenoblocker carvedilol in PPH patients. MATERIAL AND METHODS: Twenty patients with PPH had 6-minute walk test, ECG monitoring with assessment of heart rhythm variability (HRV). Tests for noradrenalin and adrenalin concentration in blood plasma, cAMP synthesis by blood lymphocytes in basal conditions and under stimulation with isoproterenol and forskolin, free radical oxidation were made initially, 1 and 6 months later. Ten patients received carvedilol in addition to standard therapy, 10 patients served control. RESULTS: PPH patients had higher NA in the blood, low cAMP synthesis, high malonic aldehyde, low activity of glutathionperoxidase, increased activity of superoxidedismutase and catalase of erythrocytes. The most pronounced changes in the above parameters were observed in patients with PPH FC III-IV. HRV declined in progression of cardiac failure. 6-months of combined treatment with carvedilol increased the distance of 6-min walk. Carvedilol had no effect on HRV, it reduced NA, stimulated cAMP synthesis, demonstrated no antioxidant activity. CONCLUSION: In PPH there is activation of SAS and desensitization of beta2-AR cells, oxidative stress develops. Addition of carvedilol to standard therapy with PPH improves clinical condition due to adrenoblocking properties of the drug.