The сlinical guidelines present the main approaches to the management of patients with arterial hypertension (aH) using the principles of evidence-based medicine. The guidelines include sections containing expanded and updated information on the main aspects of diagnosis, treatment, prevention methods and follow-up patients with hypertension, taking into account the phenotypes of disease and various clinical situations, as well as secondary forms of hypertension of various origins.

The aim of this guideline is to assist physicians in the management of patients with cardiovascular pathology and obstructive sleep-disordered breathing. The article consists data on diagnostic tactics for patients with possible sleep-breathing disorders, describes the basic principles of obstructive sleep apnea treatment, and substantiates the clinical significance of obstructive sleep apnea therapy initiating in the management of patients with cardiovascular diseases.

Relevance. Chronic thromboembolic pulmonary hypertension (CTEPH) is a rare severe form of pulmonary hypertension due to pulmonary artery obstruction. According to a number of previously published studies, sleep-disordered breathing (SDB) was frequently observed in patients with CTEPH. However, despite the high incidence both in the general population and in this group of patients, the aggravating effect of SDB on the clinical picture of CTEPH has not been sufficiently studied. Aim: to analyze the occurrence of various sleep-disordered breathing, as well as to study the aspects and relationships of identified disorders with the parameters of the clinical and hemodynamic status in patients with chronic thromboembolic pulmonary hypertension. Materials and methods. It was included 67 patients with a verified diagnosis of CTEPH, hospitalized from February 2021 to December 2023. The general clinical condition (anamnesis, examination, anthropometric data), echocardiography and right heart catheterization (RHC) data were assessed. Questionnaire survey was conducted using international questionnaires (STOP-Bang, Epworth Sleepiness Scale, Pittsburgh Sleep Quality Index) and one of the methods of multifunctional sleep study was performed. Statistical data processing was performed using MedCalc Statistical Software and Microsoft Office Excel. Results. In the sample, the median age was 59.0 years, 48 (71.6%) people were overweight, the incidence of any sleep-disordered breathing was 83.6%. A significant relationship (classical correlation) was determined between the distance in the six-minute walking distance and apnea-hypopnea index (AHI) (r=−0.447; p=0.0015), minimum night saturation (r=0.373; p=0.009) and average night saturation (r=0.341; p=0.0176). The total score on the STOP-Bang scale ≥3 shows a sensitivity of 52.2% and a specificity of 69.1% (AUC=0.653; p=0.02;), that doesn’t allow considering the STOP-Bang scale as an effective screening method in this category of patients. Сonclusion. The revealed reliable correlations between the apnea-hypopnea index and the six-minute walking distance, daytime saturation at rest and after exercise in patients with CTEPH may indicate the influence of various SDB severity on the clinical picture of the underlying disease.

Aim. To assess frequency and severity of sleep breathing disorders in patients with uncontrolled hypertension among patients referred to a sleep laboratory. Materials and methods. 113 patients aged 18-80 years with arterial hypertension (AH) were included. All patients underwent sleep cardiorespiratory monitoring, general clinical and laboratory diagnostics. Uncontrolled hypertension was defined as systolic blood pressure (BP) >140 mm Hg, or diastolic BP >90 mm Hg. in case of permanent antihypertensive therapy (AHT) taking. Results. Among all patients with uncontrolled hypertension (Group 1; n=42, 37,2%), 95,2% had obstructive sleep apnea syndrome (OSA). Compared with the controlled hypertension group (Group 2), AHI and ODI were higher in Group 1 (AHI 28,0 events/hour [14,8; 51,8] vs. 17,5 events/hour [8,7; 39,0], p=0,03; ODI 25,3 events/hour [14,4; 50,6] versus 17,1 events/hour [8,5; 37,0], p=0,04). In addition, these parameters turned out to be markers of uncontrolled hypertension (AHI >19,9 events/hour, AUC=0,62, p=0,03; OR 3,23, 95%; CI 1,7-6,1, p=0,00; ODI >19,5 events/hour, AUC=0,62, p=0,03; OR 3,07, 95% CI 1,7-5,7, p=0,01). The level of systolic BP >146 mm Hg. turned out to be a marker of the moderate or severe OSA (AUC=0,66, p=0,00; OR 4,45, 95% CI 1,811,2, p=0,00). Conclusion. High incidence of moderate or severe OSA in patients with uncontrolled hypertension emphasizes the importance of sleep breathing disorders examining in these patients. Timely diagnostics and treatment of OSA probably will allow to provide better BP levels control and thus will lead to reducing of cardiovascular risk.

Cardiovascular diseases are one of the most common causes of death in both developing and developed countries of the world. Despite the improvement in primary prevention, the prevalence of cardiovascular diseases has continued to grow in recent years. Therefore, it is extremely important both to study the molecular pathophysiology of cardiovascular diseases in depth and to find new methods for early and appropriate prevention, diagnosis and treatment of these diseases. In the last decade, a large amount of research has focused on the study of microRNAs as potential diagnostic biomarkers, as well as their role in the treatment of cardiovascular diseases. microRNAs are endogenous small (21-23 nucleotides) ribonucleotides involved in the regulation of protein synthesis from amino acids based on matrix RNA. microRNAs are involved in the regulation of the expression of the majority (>60%) of genes encoding proteins, mainly due to its suppression, modulate numerous signaling pathways and cellular processes and participate in intercellular communication. Along with this, the important role of microRNAs in the cardiovascular system has been proven: participation in the regulation of processes such as angiogenesis, contractility of heart cells, control of lipid metabolism, the rate of fibrosis and atherosclerosis, which makes it possible to use microRNAs as therapeutic agents. Thus, the article considers the issue of the availability of several approaches to treatment involving microRNAs: overexpression of exogenous microRNAs to reduce the expression of genes with undesirable properties, overexpression of microRNA inhibitors, the use of «false» microRNAs or «sponges» that act as competitive inhibitors. The use of viruses with a positive (semantic) RNA chain resembling endogenous mRNAs is also considered. The author pays special attention to the important role of microRNAs in a number of cardiovascular diseases: microRNA-based therapy has been demonstrated in the treatment of diseases such as heart failure, dyslipidemia, acute coronary syndrome, arterial hypertension, as well as arterial hypertension caused by OSA. Studies proving the positive effect of microRNAs on slowing down the development of atherosclerosis are considered, which may allow them to be used as new therapeutic agents that can lead to optimization of approaches to the treatment of cardiovascular diseases. Particularly active is the development of drugs based on RNA interference (RNAi), which use recently discovered pathways of endogenous short interfering RNAs and become universal tools for effective suppression of protein expression. Thus, the use of certain drugs based on RNA interference in a number of clinical studies has shown a significant decrease in the level of non-HDL cholesterol and triglycerides in the treatment of dyslipidemia and NT-proBNP in the treatment of hereditary transtyretin amyloidosis. This article touches upon the issue of such an important problem as myocardial infarction. Thus, hypertrophy and fibrosis of the heart significantly contribute to thickening and increasing the rigidity of the ventricular walls, leading to remodeling of the heart and worsening the prognosis. For this purpose, a biocompatible patch with microneedles (MI) with antifibrotic activity based on microRNA can be used to prevent excessive cardiac fibrosis after myocardial infarction. Summarizing the above, it is certainly worth noting that this problem has been little studied and requires further research. Identifying a safe and effective strategy for microRNA-based therapy remains a difficult task, but the new approaches considered have enormous potential for the treatment of cardiovascular diseases.

Cardiovascular diseases are the main cause of death and disability in economically developed countries in the world. In response to the impact of various factors, the structure and function of several types of cells changes, contributing to the occurrence and progression of cardiovascular diseases. Search for sensitive and specific biomarkers is one of the most important problems in the field of diagnosis of cardiovascular diseases. In the last decade, microRNAs have more often been considered as potential biomarkers of a wide range of cardiovascular diseases, such as myocardial infarction, ischemic heart disease, heart failure, hypertension, diabetes mellitus and obstructive sleep apnoea. Early diagnosis of these diseases is essential to initiate immediate treatment, which can lead to improved outcomes. MicroRNAs are endogenous small (21-23 nucleotides) ribonucleotides involved in the regulation of protein synthesis from amino acids based on matrix RNA. MicroRNAs are involved in the regulation of expression of the majority (>60%) of genes encoding proteins, mainly due to its suppression, modulate numerous signaling pathways and cellular processes and participate in intercellular communication. There are different advantages of these biomarkers: low invasiveness during research, stability, resistance to destructive factors, for example, freeze-thaw cycles, enzymes in the blood. Some microRNAs are expressed everywhere, while others are specific to certain tissues and/or stages of development of the organism. At the same time, microRNAs were detected in various biological fluids: blood plasma, urine, seminal fluid, saliva, breast milk. Changes in both the amount and functional activity of microRNAs can lead to the development of various diseases. In the cardiovascular system, microRNAs control the functions of various cells, such as cardiomyocytes, endothelial cells, smooth muscle cells and fibroblasts. Thus, due to the stability of microRNAs, the tissue­specific nature of expression and secretion into specific fluids, it becomes possible to consider them as an attractive diagnostic. It is also particularly important that the expression levels of certain microRNAs reflect not only the presence of diseases in the early stages, but also the dynamic development of diseases in the later stages. This review presents the features of various microRNAs as biomarkers and their influence on some molecular pathways underlying cardiovascular diseases and describes the significant potential of supplementing traditionally used markers in clinical practice with microRNA biomarkers. Prospects for the development and limitations of the use of microRNAs as potential biomarkers are also described.

Arterial hypertension is both the cause and the result of the progression of chronic kidney disease, which affects about 10-15% of the population worldwide and the prevalence of which is steadily increasing. As the glomerular filtration rate decreases, the blood pressure level rises respectively. Arterial hypertension (AH) and chronic kidney disease (CKD) are independent and well-known risk factors for the development of cardiovascular diseases, and their combination significantly increases the incidence and mortality from cardiovascular disease. Blood pressure control is the most important factor in slowing the progression of CKD and reducing cardiovascular risk. Currently, there is a place for discussions in the scientific community regarding the target blood pressure levels in patients suffering from CKD. Non-pharmacological methods of treatment can reduce the level of blood pressure in some cases, but do not help to achieve the target values in most of the cases. Patients with hypertension and CKD need combined drug therapy. Certain modern drugs have additional cardio- and nephroprotective properties and should be considered as the first line of therapy. A personalized approach based on evidence-based principles makes it possible to achieve blood pressure control, reducing cardiovascular risk and slowing the progression of CKD. This consensus summarizes the current literature data, as well as highlights the main approaches to the management of patients with hypertension and CKD.

Aim. To evaluate the effect of non-invasive ventilation (NIV) in CPAP (continuous positive airway pressure) mode on the development of reperfusion pulmonary edema after percutaneous balloon pulmonary angioplasty (BPA) in patients with chronic thromboembolic pulmonary hypertension (CTEPH). Materials and methods. The study included 70 patients with CTEPH who underwent the first stage of BPA. Prevention of reperfusion edema was carried out using NIV in the CPAP mode starting from the early postoperative period in combination with oxygen and diuretic therapy (as nedeed). The presence and severity of pulmonary edema was assessed based on clinical signs and data from computed tomography or chest radiography. Results. Patients after BPA were on CPAP therapy: average pressure: 10.0±0,7 hPa. During 1st day, the average time of use was: 990±417 minutes. Prolongation of CPAP therapy >1 day occurred in 26 (37%) patients. Depending on the severity of reperfusion edema to the lungs, patients were divided into 2 groups: group 1 (grade 1, n=42) and group 2 (grade 3-4, n=12). During the observation period, there were no cases of severe reperfusion edema (grade 5), and no cases required the use of invasive ventilation or extracorporeal membrane oxygenation. No complications of CPAP therapy were recorded. The number of PA segments and ΔPFG did not differ, but the PEPSI index was higher in group 2: 41,9 [16,0; 57,9] vs 80.5 [52,5; 111,25], p=0,0146. The number of days before discharge after BPA in patients of group 2 was higher: 4.0 [3,9; 5,5] vs 7,0 [4,6; 10,0] days, p=0,013. Despite the development of reperfusion edema, before discharge the SpO2 values in group 2 were comparable to the baseline: 93,0 [89,9; 94,2] vs 93,0 [89,7; 94,4] Conclusion. Preventive use of NIV in the CPAP mode, starting from the early postoperative period, is safe and makes it possible to achieve optimal clinical results in patients even with moderate and severe lung reperfusion edema after large volumes of surgical intervention.

A large amount of genetic information is localized in microRNAs which are a class of non-coding RNAs formed from longer RNA precursors, usually having a length of 19-24 nucleotides and a specific hairpin structure. Although microRNA studies have been started relatively recently, there is no doubt that they play an important role in regulating gene expression at the post-transcriptional level in embryonic development, and are also involved in maintaining the normal functions of adult cells. For the first time, microRNA was discovered in the study of free-living nematodes Caenorhabditis elegans and then a new mechanism for suppressing expression using antisense RNA was discovered. MicroRNA may be part of protein-coding transcripts or may be located in the intergenic genome regions. Changes in the functional activity and number of microRNAs can lead to diseases such as oncological, cardiovascular, gynecological, and neurological. MicroRNA is also involved in the process of neurodegeneration and the development of mental diseases. Since part of the microRNA is specific to certain tissues and/or stages of development of the organism, microRNA molecules can be considered as a promising diagnostic tool. Among the advantages of these biomarkers are the possibility of detecting pathology in the latent stage, the low invasiveness of studies and resistance to destructive factors. At the same time, microRNAs can be detected in various biological fluids: blood serum, urine, seminal fluid, saliva, breast milk. Currently, the possibilities of using microRNAs in targeted therapy are widely discussed in connection with the possibility of regulating the expression of genes with undesirable properties or overexpression of microRNA inhibitors to prevent the negative effects of microRNAs that cause the development of the disease. The first part of the review discusses the historical aspect of the study of microRNAs, their mechanism of formation, the features of circulating microRNAs and the possible therapeutic effect of exogenous microRNAs coming from food on the human body.

Disclaimer. The EAC Guidelines represent the views of the EAC, and were produced after careful consideration of the scientific and medical knowledge, and the evidence available at the time of their publication. The EAC is not responsible in the event of any contradiction, discrepancy, and/or ambiguity between the EAC Guidelines and any other official recommendations or guidelines issued by the relevant public health authorities, in particular in relation to good use of healthcare or therapeutic strategies. Health professionals are encouraged to take the EAC Guidelines fully into account when exercising their clinical judgment, as well as in the determination and the implementation of preventive, diagnostic, or therapeutic medical strategies; however, the EAC Guidelines do not override, in any way whatsoever, the individual responsibility of health professionals to make appropriate and accurate decisions in consideration of each patient’s health condition and in consultation with that patient and, where appropriate and/or necessary, the patient’s caregiver. Nor do the EAC Guidelines exempt health professionals from taking into full and careful consideration the relevant official updated recommendations or guidelines issued by the competent public health authorities, in order to manage each patient’s case in light of the scientifically accepted data pursuant to their respective ethical and professional obligations. It is also the health professional’s responsibility to verify the applicable rules and regulations relating to drugs and medical devices at the time of prescription.

Cardiovascular diseases are the main cause of death and disability in economically developed countries in the world. In response to the impact of various factors, the structure and function of several types of cells changes, contributing to the occurrence and progression of cardiovascular diseases. Search for sensitive and specific biomarkers is one of the most important problems in the field of diagnosis of cardiovascular diseases. In the last decade, microRNAs have more often been considered as potential biomarkers of a wide range of cardiovascular diseases, such as myocardial infarction, ischemic heart disease, heart failure, hypertension, diabetes mellitus and obstructive sleep apnoea. Early diagnosis of these diseases is essential to initiate immediate treatment, which can lead to improved outcomes. MicroRNAs are endogenous small (21-23 nucleotides) ribonucleotides involved in the regulation of protein synthesis from amino acids based on matrix RNA. MicroRNAs are involved in the regulation of expression of the majority (>60%) of genes encoding proteins, mainly due to its suppression, modulate numerous signaling pathways and cellular processes and participate in intercellular communication. There are different advantages of these biomarkers: low invasiveness during research, stability, resistance to destructive factors, for example, freeze-thaw cycles, enzymes in the blood. Some microRNAs are expressed everywhere, while others are specific to certain tissues and/or stages of development of the organism. At the same time, microRNAs were detected in various biological fluids: blood plasma, urine, seminal fluid, saliva, breast milk. Changes in both the amount and functional activity of microRNAs can lead to the development of various diseases. In the cardiovascular system, microRNAs control the functions of various cells, such as cardiomyocytes, endothelial cells, smooth muscle cells and fibroblasts. Thus, due to the stability of microRNAs, the tissue­specific nature of expression and secretion into specific fluids, it becomes possible to consider them as an attractive diagnostic. It is also particularly important that the expression levels of certain microRNAs reflect not only the presence of diseases in the early stages, but also the dynamic development of diseases in the later stages. This review presents the features of various microRNAs as biomarkers and their influence on some molecular pathways underlying cardiovascular diseases and describes the significant potential of supplementing traditionally used markers in clinical practice with microRNA biomarkers. Prospects for the development and limitations of the use of microRNAs as potential biomarkers are also described.

Objective: to study long-term (more than 12 months) adherence to positive airway pressure (PAP) therapy and its effectiveness in OSA patients with arterial hypertension (AH) and to determine possible factors influencing adherence to PAP therapy Design and method: The study involved 194 patients with OSA and AH (156 men and 38 women), median age 64 [55; 69] years, who were on PAP therapy for more than 12 months. Patients had severe OSA (apnea-hypopnea index (AHI) - 49 [35,6; 63,2] events/h. The duration of the PAP-therapy usage - 2,0 years [1,0; 5,0]. Data from PAP therapy for the last year was downloaded from the device’s internal memory card, including effectiveness and adherence. The adherence criteria was the usage of PAP therapy for more than 4 hours per night for more than 70% of nights, effectiveness - residual AHI less than 5 events per hour. The main parameters of the disease and PAP-therapy were analyzed depending on the adherence to therapy. Results: All patients used PAP-therapy in auto regime with constant use of a humidifier. Average time of long-term PAP-therapy usage was 6,2 hours [4,8; 7,3] and 84,6% [61,2; 97,0] of nights. The criteria for adherence to PAP - therapy was met in 64,9% of patients. The residual AHI was 3,0 events/h [1,3; 6,0]. When comparing the clinical parameters of PAP-therapy, it was found that in the group of adherent patients, residual AHI was statistically significantly lower: 2,4 events/h [1,2; 5,0] versus 4,0 events/h [2,0; 6,4], p < 0,05. Usage of PAP therapy less than 70% of nights and less than 4 hours per night statistically significantly more often complained of daytime sleepiness (44%) and nocturia (19%) versus 24% and 8% respectively in the compared group. Adherent patients were statistically significantly more likely to use nasal masks in 81,7% of cases, compared with 64,7% of patients in the low-adherence group, p < 0,05. Conclusions: In patients with OSA and AH, 64,9% of patients meet the criteria for adherence to long-term PAP therapy. Residual daytime sleepiness and nocturia during prolonged PAP therapy are associated with low adherence.

Disclaimer. The EAC Guidelines represent the views of the EAC, and were produced after careful consideration of the scientific and medical knowledge, and the evidence available at the time of their publication. The EAC is not responsible in the event of any contradiction, discrepancy, and/or ambiguity between the EAC Guidelines and any other official recommendations or guidelines issued by the relevant public health authorities, in particular in relation to good use of healthcare or therapeutic strategies. Health professionals are encouraged to take the EAC Guidelines fully into account when exercising their clinical judgment, as well as in the determination and the implementation of preventive, diagnostic, or therapeutic medical strategies; however, the EAC Guide-lines do not override, in any way whatsoever, the individual responsibility of health professionals to make appropriate and accurate decisions in consideration of each patient’s health condition and in consultation with that patient and, where appropriate and/or necessary, the patient’s caregiver. Nor do the EAC Guidelines exempt health professionals from taking into full and careful consideration the relevant official updated recommendations or guidelines issued by the competent public health authorities, in order to manage each patient’s case in light of the scientifically accepted data pursuant to their respective ethical and professional obligations. It is also the health professional’s responsibility to verify the applicable rules and regulations relating to drugs and medical devices at the time of prescription.

The main goal in the arterial hypertension (AH) management is the target blood pressure (BP) achievement, as it leads to the cardiovascular risk reduction. At the same time, proper BP is achieved less than in 50% of all cases. In addition, there are two types of truly uncontrolled AH in population, such as resistant (RAH) and refractory (RFH) AH. Recent research suggests that RAH may be associated with changes in the renin-angiotensin-aldosterone system, while RFH appears to be more closely associated with sympathetic hyperactivation. These pathophysiological mechanisms are also active in patients with obstructive sleep apnea (OSA). Therefore, the prevalence of OSA in patients with RAH and RFH is very high, and treatment with continuous positive airway pressure (PAP-therapy) can reduce BP levels in such patients. The latter allows us to consider PAP-therapy as an additional method for the target BP achievement in patients with uncontrolled AH and OSA.

Objective: To identify the percentage of antihypertensive therapy (AHT) groups prescription in patients with and without delayed inefficiency of AHT (“escape’’phenomenon). Design and method: The study included 102 hypertensive patients (52 male, age 54.2 ± 9.8 years), whom were assigned 2–3 agents from various AHT group.In 2–3 weeks after therapy initiation (with the single correction if needed), all participants achieved the target blood pressure (BP). The latter was confirmed by office BP measurement (office BP) (<140/90mmHg, oscillometric method, OMRON, Japan), and by 24-hour ambulatory BP monitoring (ABPM) (mean 24-hour BP < 130/80mmHg, oscillometric method, BPLab, Russia). In 1 and 3 months after inclusion, the efficacy of AHT was reassessed by both measurement methods. The “escape’’ phenomenon was verified when BP became higher target by any method in any reassessment time. Adherence was calculated as the ratio of the number of correct medication intake days to the number of follow-up days multiplied by 100%. Results: 34 patients (33.3%) demonstrated the ‘escape’ phenomenon (Group 1), while BP level in 68 (66.7%) patients remained target (Group 2). There weren’t differences in the cardiovascular (CV) risk factors between groups (Table 1). Both groups received primarily fixed combinations of AHT, which resulted in 1.9 ± 0.7 tablets intake per day. There was comparably high adherence to treatment in groups (89.2 ± 3.8% in group 1, 90.2 ± 5.0% in group 2,p = 0.28). When comparing the percentage of different AHT groups, there was no difference revealed between groups, with the exception of more frequent ARA-II prescription in Group 1 (Table 2). Nevertheless, although in both groups the target BP levels were achieved, the BP in the Group 1 was higher already at the stage of inclusion (Table 2). Moreover, baseline systolic BP was found to be an ‘escape’ phenomenon predictor in univariate logistic regression model (for office BP: systolic BP> 128mmHg (OR 3.43 (95%CI 1.39–8.47,p < 0.00), for ABPM: 24-systolic BP> 124mmHg (OR 25.81 (95%CI 5.61–119.11,p < 0.00). Further studies on ‘escape’ phenomenon issue in patients with ARA-II intake are required. A higher frequency of ARA-II usage in the ‘escape’ group is likely due to overestimation of the continuing BP decline in 2–3 weeks after ARA-II prescription.

Aim. To study the frequency of clinical and radiological signs of reperfusion pulmonary edema and compare them with the volume of endovascular intervention after balloon pulmonary angioplasty (BPA) in patients with chronic thromboembolic pulmonary hypertension (CTEPH). Materials and methods. The study included 50 patients with CTEPH, who underwent stage 1 PLA. To prevent severe reperfusion edema, the number of segmental arteries planned for angioplasty was taken into account, the Pulmonary Edema Predictive Scoring Index (PEPSI) was determined, and after the intervention, noninvasive ventilation was performed in the Continuous positive airway pressure (СPAP) mode for 24 hours. Clinical manifestations of reperfusion edema were assessed 1, 24, 48 and 72 hours after BPA. Radiological signs of edema were considered based on the results of multislice computed tomography (MSCT) or chest x-ray. Results. Angioplasty was performed on 97 segmental, 6 lobar pulmonary arteries, incl. by 45 (46,4%) – with occlusive lesions. The number of arteries undergoing angioplasty ranged from 1 to 7 in each patient, on average 1,9 ± 1,4, change in pulmonary flow grade (ΔPFG) – 4,3 ± 3,4, PEPSI 58,4 ± 51,0, which exceeded the recommended value of 35,5. During the 72-hour observation period, 28 (56%) patients had grade 1 edema, grade 2 reperfusion edema was observed in 15 (30%), grade 3 – in 5 (10%), grade 4 – in 2 (4%) patients. Patients with grade 2-4 edema had higher baseline mPAP (p = 0,015) and PEPSI (p = 0,046). All manifestations of reperfusion edema of 2-4 degrees were stopped due to the prolonged regimen of CPAP therapy for 3 ± 2 days. None of the patients reached grade 5 edema, and there were no deaths. Clinical manifestations of reperfusion injury were observed in 25 (50%) patients, their highest frequency was observed after 24 hours Conclusion. Balloon pulmonary angioplasty of the pulmonary arteries is a safe method for the treatment of inoperable patients with chronic thromboembolic pulmonary hypertension, provided that recommendations for the prevention of reperfusion pulmonary edema are observed. CPAP therapy can successfully prevent and stop the development of severe reperfusion injuries after BPA even when the risk index for reperfusion pulmonary edema is exceeded.

The diagnosis of resistant arterial hypertension allows us to single out a separate group of patients in whom it is necessary to use special diagnostic methods and approaches to treatment. Elimination of reversible factors leading to the development of resistant arterial hypertension, such as non-adherence to therapy, inappropriate therapy, secondary forms of arterial hypertension, leads to an improvement in the patient's prognosis. Most patients with resistant hypertension should be evaluated to rule out primary aldosteronism, renal artery stenosis, chronic kidney disease, and obstructive sleep apnea. The algorithm for examining patients, recommendations for lifestyle changes and a step-by-step therapy plan can improve blood pressure control. It is optative to use the most simplified treatment regimen and long-acting combined drugs. For a separate category of patients, it is advisable to perform radiofrequency denervation of the renal arteries.

Abstract Introduction The aim to evaluate the prevalence of pulmonary hypertension according to echocardiography in patients referred for sleep apnea diagnostics. Methods We included 145 patients referred to Sleep laboratory for sleep apnea diagnostics. Mean age 63,8 ± 10,4 years, BMI 34,0 ± 5,7 kg/m2, AHI 31,3 ± 20,3/h, ODI 3% 28,2 ± 19,5/h, min SpO2 77,4 ± 9,8%, systolic pulmonary artery pressure (systolic PAP) 25,9 ± 16,4 mmHg. All patients underwent cardiorespiratory and respiratory diagnostics for sleep apnea and echocardiography. Results From the random sample of patients referred to Sleep laboratory 14,5% (21) had systolic PAP > 40 mmHg (by echocardiography). Patients with higher levels of systolic PAP (Systolic PAP, mmHg 49,9 [43,6; 56,2] vs 20,7 [19,9; 23,5],p=0.000) had more severe OSA (AHI 35,7 [27,1; 44,3] vs 26,6 [22,6; 30,6], p = 0.029, ODI 3%, /h 35,8 [25,1; 46,4] vs 23,8 [19,8; 27,8], p= 0.017) and were more obese (BMI 37,1 [33,8; 40,4] vs 33,4 [32,4; 34,5], p=0.024). Prevalence of AHI > 30 /h was 62% in group with systolic PAP > 40 mmHg vs 23% in the group with systolic PAP < 40 mmHg. We observed differences in echocardiography, in group with systolic PAP > 40 mmHg: left atrium (4.6 ± 0,5 vs 4,2 ± 0,4 cm, p=0.012), left atrium volume (94.0 ± 23.6 vs 71.7 ± 16.5 ml, p=0.001) and right atrium area (24.5 ± 4.9 vs 18.4 ± 3.8cm2, p=0.000) were higher. Though ejection fraction (58.2 ± 3.8 vs 59.0 ± 3.8%, p=0.268), interventricular septum thickness (1,13 ± 0,2 vs 1,06 ± 0,3 cm, p=0,654) and left ventricular posterior wall thickness (1,05 ± 0,08 vs 1,00 ± 0,13 cm, p=0,117) didn’t differ. In terms of excessive daytime sleepiness, snoring and nocturia groups didn’t differ, as well as for the prevalence of arterial hypertension, coronary artery disease, chronic heart failure, diabetes mellitus and chronic obstructive pulmonary disease. Conclusion Pulmonary hypertension is frequently observed in patients with OSA and appears to be related to the severity of sleep apnea and obesity. PH should be considered in the regular clinical assessment of all patients with sleep apnea, especially with severe form. Support (if any):