The article considers the most common causes of renal artery patency, diagnostic process algorithms and differential diagnosis for renal artery stenosis at different ages. The first significant clinical manifestation of renal artery stenosis of various etiologies is arterial hypertension (AH). It is poorly controlled AH, including resistant AH, developing at a young age, that is the basis for the diagnostic search for secondary causes of high blood pressure, including narrowing of the renal arteries. The article presents a clinical case of uncontrolled AH in a young man. A comprehensive assessment of clinical manifestations, laboratory and instrumental examination results made it possible to diagnose unilateral renal artery stenosis of atherosclerotic genesis.

Expert Council opinion describes emergency care in a sudden individually significant blood pressure (BP) increase without clinically overt target organ damage. In the new guidelines of the Russian Society of Cardiology, the term “hypertensive urgency” was abolished, and the management of a sudden BP increase was changed. At the same time, a sudden individually significant BP increase may be accompanied by symptoms that reduce patients’ quality of life and ability to work. According to experts, individually significant BP increase accompanied by symptoms requires outpatient treatment using oral rapid-onset drugs with an optimal duration of action, in particular captopril. It has a much evidence-based data on the BP increase use and sublingual administration, and also has a favorable safety profile, which allows prescribing to patients with comorbid diseases. The rationale for the use of angiotensin-converting enzyme inhibitor Capoten (captopril) as a drug for self-management of a sudden individually significant BP increase accompanied by symptoms in hypertension patients is describes.

The agreement of experts of the Eurasian Association of Therapists (EAT) discusses pathogenesis and treatment of COVID-19. Modern data on the characteristics of cardiovascular, kidney, respiratory damage in SARS-infected CoV-2 are presented. The tactics of managing patients initially having cardiovascular diseases, diabetes mellitus, chronic obstructive pulmonary disease, bronchial asthma, chronic kidney disease are discussed in detail. The article presents data on drug interaction of drugs.

Aim. To determine the features and main problems of statin therapy, as well as assess the possibility of achieving the target level of lipid pattern in patients with high and very high cardiovascular risk (CVR) in real clinical practice. Material and methods. The design of the “PRIORITET” observational program is an open observational study. Patients with high and very high CVR were divided into 3 groups in accordance with the initial data: (1) not taking statins, (2) taking statins, but not reaching the target low-density lipoprotein cholesterol (LDL-C) level, (3) taking statins with the achievement of the target LDL-C level, which is justified in replacing the statin inside the class — adverse effects (AE), high price, etc. Within 12 weeks 3 visits of patients to hospitals were carried out: baseline visit (B0), visit 1 month after the study initiation (B1) and visit 3 months after the study initiation (B3). The choice of atorvastatin or rosuvastatin was assessed by the doctors. Results. Groups 1, 2 and 3 included 112, 170 and 16 people, respectively. At B0, 145 (48,7%) patients were prescribed atorvastatin, and 153 (51,3%) — rosuvastatin. Three people dropped out of the study to B3, 295 patients completed the program. Lipid pattern of 285 patients were analyzed: 121 (41%) people (101 with very high CVR and 20 with high CVR) achieved the target LDL-C level, the remaining 164 (59%) patients (CVR — 156 and 8, respectively) — no. The most pronounced dynamics of LDL=C level was revealed in group 1, the differences between group 1 and groups 2 and 3 are highly statistically significant (p<0,0001). There were no differences in the frequency of reaching the target LDL-C level between patients taking atorvastatin or rosuvastatin. The target level of LDL-C (p=0,003) in the treatment of rosuvastatin in patients with high CVR was reached significantly more often than in patients with very high CVR. Also 3 non-serious AEs were reported. On average, in 9% of cases, reaching the target level of LDL-С during visits B1 and B3 was wrong interpreted by the attending physicians. Conclusion. The main problems of statin therapy in real clinical practice are the wrong interpretation of reaching the target level of LDL-C, inertness of doctors in titrating of statins doses and achieving the target level of lipid pattern. It may be the cause of reduced efficiency and deterioration of lipid-lowering therapy results in patients with high and very high CVR. The results of the “PRIORITET” study demonstrated the possibility of improving the practice of statins use and its accordance with clinical guidelines. Skibitsky V. V. on behalf of the working group of the “PRIORITET” research Working Group of the “PRIORITET” study: Voronina V. P. (Moscow), Zelenova T. I. (Moscow), Sladkova T.A. (Moscow), Alekseeva A. I. (Tula), Barabanova T. Yu. (Tula), Zotova A. S. (Tula), Kolomeitseva T. M. (Tula), Prikhod’ko T. N. (Tula), Pazelt E. A. (Nizhny Novgorod), Khramushev N. Yu. (Nizhny Novgorod), Skibitsky A. V. (Krasnodar), Alekseeva V. V. (Saratov), Lazareva E. V. (Saratov).

The review analyzes materials devoted to the study of various forms of celiac disease. Particular attention is paid to the systematization of clinical manifestations and features of diagnosis of atypical forms of celiac disease. Data are given on the incidence and mechanisms of progression of disorders in the combination of celiac disease and a number of autoimmune diseases, including type 1 diabetes mellitus. This literature review promotes a better understanding of the problem of celiac disease by specialists, which will improve early diagnosis and determine the rational tactics of managing patients with different forms of the disease.

Aim. To compare effects of isolated antihypertensive therapy (AHT) and AHT combined with anxiolytic and antidepressant on parameters of 24-hour blood pressure (BP) profile, severity of affective disorders, and quality of life (QL) in patients with uncontrolled arterial hypertension (AH) and anxiety or depressive disorders. Material and methods. We randomized 140 patients (age 48.6±5.9 year, 72 women) into 2 groups. During 1 year patients of each group received 2 variants of pharmacotherapy: isolated AHT and AHT combined with psychotropic medication (PM) - anxiolytic for persons with anxiety disorder and antidepressant for persons with depressive disorder (AHT+PM). Patients of group I received AHT for first 6 months and AHT+PM for remaining 6 months. Group II patients started with AHT+PM and after 6 months switched to AHT. In each group we selected subgroups of patients with prevailing anxiety (I-A, II-A) and prevailing depression (I-D, II-D). In the end of each 6 months period we compared parameters of 24-hour BP monitoring, severity of affective disorders, and QL in subgroups IA vs. II-A and ID vs. IID. Same comparisons were done for each sub-group in the end of the first and second stages of treatment. Results. Starting with combination AHT provided more rapid achievement of low values of average diurnal and nocturnal systolic (S) and diastolic (D) BP, lower parameters of BP variability. In patients with comorbid depression it led to lowering of magnitude and velocity of morning increment of SBP and DBP. Only combination AHT demonstrated adequate reduction of affective disorders. Both combination and isolated AHT in 6 months resulted in significant improvement of QL, however combination AHT provided significantly better estimates of QL. Conclusion. In patients with AH and anxiety or depressive disorders effectiveness of AHT combined with anxiolytic or antidepressant was higher compared with isolated AHT.

Aim. In the circumstances of real clinical practice, to evaluate the changes in life quality (LQ) parameters of the patients with coronary heart disease and stable angina with addition of nicorandil to standard treatment. Material and methods. Study design — prospective, observational, multicenter. In the trial, the physicians participated, from 14 institutions in a range ofRussia regions. Totally, 590 included: 261 (44,2%) females, 329 (55,8%) males. All patients, in addition to the standard antianginal treatment, were prescribed with nicorandil. At the visits V0 (baseline) and V3 (3 months of therapy) they completedSeattle questionnaire (SAQ) of LQ assessment. Five parameters were assessed: exercise intolerance, attacks frequency, stability, attitudes toward disease, treatment satisfaction. At the visit V0 417 questionnaires were completed (response 71%), at V3 — 454 (response 82%). Results. The significant increase was demonstrated, for parameters by SAQ in 3 months of observation, the highest parameters, except the scale exercise intolerance, were found in the group taking nicorandil during 3 months of follow-up (p<0,05 for all scale SAQ comparing to the group refused taking nicorandil at baseline or stopped at various stages of the study). By 3 months of follow-up, 3 times increase was noted of the patients with minimal number of angina attacks or absence, and the part of patients found that their life quality is “excellent”. Almost 4 times the part of patients raised by the stability parameter, and the amount by the score “treatment satisfaction” increased to 50,2%. Comparison of ranged SAQ parameters at V0 and V3 visits with Wilcoxon criteria, showed significant differences by all the scales of SAQ (р<0,0001). Conclusion. Under the real practice circumstances there was significant increase of all LQ parameters by SAQ in 3 months of observation. Most prominent positive changes were noted in patients taking nicorandil during whole follow-up period, comparing to those not taking nicorandil or discontinued at various stages of the study.

Aim. To assess the dynamics of the main structural and functional parameters of the left ventricle myocardium condition (LV) in postmenopausal women with arterial hypertension (AH) and different types of obesity: abdominal (AO) and gluteofemoral (GFO), taking combination hypotensive therapy: angiotensin-converting enzyme inhibitor (ACEi) or direct renin inhibitor (DRI). Material and methods. Totally, 168 women studied with AH in postmenopause: 97 with AO and 71 with GFO. Women with different obesity types were randomized to therapy groups as ACEi+diuretic and DRI+diuretic. Follow-up lasted for 24 weeks. Results. Combination therapy that included DRI, led to target values of BP in 90,2% of patients with AO and 90,9% with GFO. Usage of DRI in AO and GFO was followed by significant decrease of wall thickness, left ventricle myocardium mass (MMLV) — by 22,6% and 17,9%, MMLV index — by 23,1% and 18,8%,  respectively, (рu003c0,05), and parameters of diastolic function of LV. On therapy by ACEi+diuretic target values of BP were recorded in 71,4% of AO patients, and in 84,4% with GFO. In 24 weeks of ACEi usage with diuretic in AO and GFO, there was significant change of diastolic LV function (pu003c0,05). Comparative analysis showed that DRI therapy was better comparing to ACEi in AO patients with AO in the sense of the LV structural-functional improvement. Conclusion. Usage of ACEi or DRI in combination with diuretic in postmenopause led to significant cardioprotection not depending on obesity type. In addition, in AO the usage of DRI+diuretic was advantageous comparing to ACEi+diuretic in the sense of hypertrophy regression and LV diastolic function improvement.

Aim. To compare the influence of monoand combined with antidepressant antihypertension therapy (AHT) on the parameters of 24-hour blood pressure (BP) profile, severity of depression and life quality of patients with non-controlled arterial hypertension (AH) and depression. Material and methods. 71 patients, aged 48,7±5,2 y.o., 37 females, were randomized to two groups. Each group during a year consequently received two types of pharmacotherapy for 6 months twice: mono AHT and AHT with antidepressant fluvoxamine (AHT+A). Group 1 (n=35) for the first half-year received AHT, then AHT+A; group 2 (n=36) in reversed order. At the end of each half-year, we compared 24-hour blood pressure, and severity of depression by Beck score, with life quality. Same comparisons were done in the group by endings of two periods. Results. Starting with combination AHT led to faster achievement of relatively low values of mean day and mean night systolic and diastolic BP, lower BP variability. Combination AHT made to reach significantly higher level of the value and velocity of morning BP raise. Only combination therapy showed adequate reduction of depression symptomathics. Combination, as monotherapy in 6 month led to significant improvement of life quality; however, combination therapy was significantly better. Conclusion. Efficacy of antidepressant-combined AHT with fluvoxamine in AH patients with depression better than mono AHT.

Objective. To evaluate the effectiveness of combination treatment with antihypertensive drugs and antidepressant in patients with uncontrolled hypertension (UHTN) and depressive disorders (DD). Design and methods. The study involved 160 patients with UHTN and DD and prescribed a combination therapy including an angiotensin-converting enzyme (ACE) inhibitor (perindopril 10 mg/day) and a thiazide-like diuretic (indapamide SR, 1,5 mg/day). Patients were randomized into 2 groups: 1st group recieved antihypertensive treatment with an antidepressant (selective serotonin reuptake inhibitors, escitalopram 10 mg/day); 2nd group received calcium channel blocker (CCBs, amlodipine 5–10 mg/day). At baseline and after 24 weeks all patients underwent clinical examination, ambulatory blood pressure monitoring (ABPM) (“Petr Telegin”, BPLab Vasotens, Russia) with 25‑minute intervals between the measurements during the day and 50‑minute intervals at night. We assessed the average 24‑hour, daytime and nighttime systolic blood pressure (SBP), diastolic blood pressure (DBP), variability of blood pressure (BP), hypertension time index, the size and speed of morning rise in BP, daily index, pulse pressure. In addition, we evaluated arterial stiffness: the propagation time of the reflected wave (RWTT, ms), the estimated PWV in the aorta (PWVao, m/s) adjusted to systolic BP 100 mm Hg and heart rate 60 beats/min (RWTT ms, PWVao m/s), augmentation index. We also assessed central aortic pressure: systolic aortic pressure, aortic diastolic pressure, mean pressure in the aorta, aortic augmentation index. All the patients filled in the Hospital Anxiety and Depression Scale (HADS), Tsung depression scale, Spielberger’s scale of the anxiety, Wayne questionnaire and the SF‑36 questionnaire for the assessment of quality of life. Results. Combined antihypertensive therapy with escitalopram provided the target BP achievement in half of patients after 4 weeks, while in the control group an increase in the amlodipine dose to 10 mg per day was required to achieve target BP in 75.6 % of patients. After 24 weeks, group 1 showed better ABPM parameters compared to the control group. In addition, daily BP profile was normalized in a larger number of patients than in control group. Antidepressants led to a comparable to the calcium antagonist therapy regression of the indicators of arterial stiffness and the central aortic pressure. After 24 weeks, a positive change in DD was registered in the group treated with escitalopram, while in the group 2 depression indicators remained at a high level. The use of antidepressant resulted in a significant decrease in anxiety disorders and autonomic disturbances, whereas in patients treated with “traditional” antihypertensive therapy, an increase of anxiety level and baseline autonomic dysfunction remained unchanged. Also, the group of antidepressant showed greater improvement of the quality of life assessed by the SF‑36 questionnaire. Conclusions. The use of escitalopram in combination therapy provided a rapid achievement of target BP and more significant improvement in the main ABPM indicators, normalization of daily BP profile, a significant improvement in the emotional status and autonomic function, reduction of the depression and anxiety symptoms, improvement in quality of life compared to the treatment without antidepressant.