At the end of April 2025 an expert council meeting was held, devoted to the discussion of the uncontrolled blood pressure, role of aldosterone dysregulation in pathogenesis of uncontrolled and resistant hypertension, and new therapeutic options targeting aldosterone- aldosterone synthase inhibitors.

Aim. To study the effect of endovascular closure of patent foramen ovale (PFO) on the severity of symptoms of migraine attacks in patients with migraine with a history of aura.Materials and Methods. We analyzed the data of 74 patients with migraine with a history of aura who underwent endovascular closure of the PFO for the period from 2018 to 2022 at the E.I. Chazov National Medical Research Center of Cardiology. All patients underwent examinations that complied with clinical recommendations. The presence of a history of migraine with aura was determined through a patient interview, previous hospital history, and was confirmed by a neurologist. The severity of migraine symptoms was assessed using the MIDAS (Migraine Disability Assessment) scale before occluder implantation and after 36,9 [22,7; 50,8] months the intervention as part of a telephone contact.Results. 49 patients before the intervention had pain syndrome assessed on the MIDAS scale <11 points, in 25 patients the MIDAS score was ≥11 points. The technical success of the intervention was 100%. In the long–term period, the average MIDAS score in the group of patients with baseline MIDAS <11 was 0.00 [0.00; 5.00] points, and in the group with baseline MIDAS ≥11 was 15.00 [14.00; 15.00] points (p<0,0001). After 36,9 [22,7; 50,8] months occluder implantation, the average MIDAS score decreased by 75.0% in both groups (p<0,0001). The number of patients in the group with an initial MIDAS ≥11 points decreased by 80.0% compared to baseline values (p<0,0001).Conclusion. Endovascular closure of the PFO in patients with migraine with a history of aura promotes significant regression of the pain syndrome.

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.

Despite the existing recommendations for the diagnosis and treatment of arterial hypertension, a wide selection of antihypertensive drugs, the efficacy of treatment of arterial hypertension remains low. The main cause for unsatisfactory control of arterial hypertension is patients’ non-adherence to treatment, which adversely affects the prognosis for cardiovascular complications. The first step in increasing adherence to antihypertensive therapy is to determine its level. There are various methods characterized by their accessibility and accuracy for assessing adherence. There are several categories of factors influencing the level of adherence. Identifying the cause in a subsequent patient is a significant step in reducing adherence to antihypertensive therapy. In addition, it’s necessary to use strategies to increase adherence to antihypertensive therapy, including both “simplification” of the treatment regimen and strengthening the doctor-patient interaction. The aim of this consensus is to summarize and supplement knowledge about the prevalence of adherence to antihypertensive therapy in patients with arterial hypertension, methods for assessing the level of adherence, the reasons for low adherence to the treatment of arterial hypertension and approaches to improving adherence to antihypertensive medications.

Purpose of the study. To study the effect of prophylactic antibiotic therapy on the course of the postoperative period in patients undergoing endovascular closure of patent foramen ovale (PFO). Material and methods. The study included 276 patients who were submitted to endovascular closure of PFO. The follow-up duration was 12 months. Depending on prophylactic antibiotic therapy the patients were divided into 2 groups - those who did not receive and those who received prophylactic antibiotic therapy (115 and 161 patients, respectively). Results. Cephalosporins were prescribed to patients as prophylactic antibiotic therapy, and in the presence of allergic reactions they were replaced by glycopeptides. In total, patients received 1 to 2 drugs per prophylaxis course. Postoperative complications were present in 37 (22.98 %) patients who received prophylactic antibiotic therapy and 12 (10.43 %) who did not receive prophylaxis (p = 0.007). Access site complications were the most identified, but they were not inflammatory in nature. An elevation of body temperature over 37.1 °C was observed in 19 (11.80 %) patients receiving prophylactic antibiotic therapy compared to 5 (4.35 %) who did not receive prophylaxis (p = 0.03). Meanwhile, marked leukocytosis was absent in both groups. The duration of body temperature elevation did not differ between the groups. They also had a longer duration of hospitalization, 7.00 [6.00; 8.00] bed days, compared to 6.00 [4.00; 7.00]. Discussion. It has been suggested that hyperthermia may be associated with prophylactic administration of antibacterial drugs causing death of persistent microflora. In patients who did not receive prophylactic antibiotic therapy, their concentration was lower, which did not lead to an increase in body temperature. Since there are no indications on the necessity of prophylactic antibiotic therapy before endovascular closure of PFO in clinical recommendations, it is suggested to evaluate its appropriateness for each patient individually.

The aim was to study the medical history, laboratory and instrumental data, the trends of arterial hypertension (AH), risk factors for cardiovascular events, target organ damage (TOD), and the development of cardiovascular complications in patients with NSAA (Non-Specific Aortoarteritis).Materials and Methods. The study included 33 women with confirmed NSAA who had been treated at the 5th Cardiology Department of the E.I. Chazov National Medical Research Center of Cardiology since 2005. Complete blood count, biochemical blood analysis, urine analysis, the following instrumental examinations, such as, ECG, echocardiography, ultrasound of the brachial, femoral, aortic, and renal arteries, MRA or CT angiography with contrast, blood pressure measurement in the arms and legs were performed for all patients. Telephone interviews were conducted to assess some patient's condition over time.Results. The most common symptom (84% of patients) was AH, the average age of AH onset was 30 [19; 40] years and the AH average duration is 7,5 [2; 13] years. Nearly half of the patients (45%) had AH as the leading symptom that led them to perform the examination that helped to the diagnosis of NSAA. The average systolic and diastolic blood pressure values were 123±35 mmHg and 66±17 mmHg in the upper extremities, and 166±31 mmHg and 78±18 mmHg in the lower extremities, respectively. About half of patients (51%) had stage 3 AH, and almost all of them had type 3 according to E. Lupi-Herrera classification. The most common risk factors for cardiovascular events were dyslipidemia (82%), a family history of early cardiovascular events (51%), resting heart rate above 80 bpm (25%), and carbohydrate metabolism disorders (21%). When assessing cardiovascular risk, moderate risk of developing cardiovascular events was observed in 3 patients (10,7%), high risk in 16 patients (57,1%), and very high risk in 9 patients (32,1%). The most common TODs were nervous system damage (53%), including cerebrovascular ischemic events (14%) and left ventricular hypertrophy (42%). This group of patients was characterized by resistant hypertension, and combination with other risk factors for cardiovascular events, it leds to severe TOD and influenced survival rate. In terms of antihypertensive therapy, 61% of patients received combination therapy, with CCB, beta-blockers, and imidazoline receptor agonist being the most prescribed. Two fatal cases were identified in the long-term follow-up, and cardiovascular events, most frequently stroke, were the main complications observed. Additionally, AH progression and its uncontrolled course despite going through multiple drug therapy were characteristic.Conclusion: AH is often difficult to diagnostic in patients with NSAA, and it significantly contributes to the structure of complications and mortality in this patient cohort, progressively worsening over time. It is important to measure blood pressure in both arms and legs to detect elevated values early. The main goals of treatment are achieving NSAA remission and blood pressure control and preventing cardiovascular events.

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 antihypertensive therapy and adherence to treatment in patients with uncontrolled arterial hypertension. Materials and М ethods. The study included 297 patients hospitalized at the E.I. Chazov National Medical Research Center of Cardiology over the period from September 2019 to March 2022. Patients were spread into two groups depending on the increase in the frequency of BP: group 1 (n=149) – increase in BP above 140/90 mm Hg 1 or more per week while taking antihypertensive therapy with clinical manifestations, and group 2 (n=148) – increase in blood pressure more than 140/90 mm Hg less than 1 per week while taking antihypertensive therapy clinical manifestations. Antihypertensive therapy and medication adherence were assessed at hospital discharge and after 12 months. Results. Initially, the number of antihypertensive drugs was greater in patients with group 1 versus the patients with group 2 (p<0,001). The frequency of taking antihypertensive therapy initially and after 12 months was greater in group 1 (p<0,001). After 12 months, the number of antihypertensive drugs decreased in the group 1, and remained the same in group 2. When comparing the different classes of antihypertensive drugs, all classes, except angiotensin-converting enzyme inhibitors were most frequently prescribed in group 1 (p<0,05). After 12 months, a lower level of adherence was observed in group 1 patients compared to group 2 (6 [5-8] points vs. 8 [6-9] points) (p<0,001), as evidenced in the reduced intake of different classes of antihypertensive therapy. Conclusion. Uncontrolled arterial hypertension is a release of hypertension associated with more antihypertensive medications to be prescribed and adherence to be monitored more closely.

Aim. To study clinical and diagnostic data, risk factors, the state of target organs damage (TOD) and prevalence of clinical associated conditions in patients with a hypertensive crisis and uncontrolled arterial hypertension. Materials and methods. The study included 297 patients hospitalized at the E.I. Chazov National Medical Research Center of Cardiology over the period from September 2019 to March 2022 with the presence of uncontrolled hypertension (blood pressure (BP) above 140/90 mm Hg while taking antihypertensive therapy). Patients were spread into two groups depending on the increase in the frequency of BP: group 1 (n=149) – uncontrolled hypertension with a hypertensive crisis (increase in BP 1 or more per week and/or the presence of severe clinical symptoms), and group 2 (n=148) – uncontrolled hypertension (increase in blood pressure more than 140/90 mm Hg less than 1 per week and/ or without severe clinical symptoms). The presence of risk factors in these groups was analyzed. At the baseline and after 12 months, the presence and severity of TOD (left ventricular mass index (LVMI), chronic kidney disease (CKD), severe retinopathy), history of/occurrence of clinical associated conditions were assessed. Results. There are significant elevated levels of uric acid, triglycerides, body mass index, heart rate, blood pressure indicators among the risk factors in the group of patients with hypertensive crisis. Patients in the group 1 showed higher rates of LVMI at the baseline and during follow-up for 12 months (baseline – 107±28 g/m2, after a year of follow-up 112±27 g/m2). The glomerular filtration rate (GFR) is lower in patients with hypertensive crisis (initially – 81.5±19.04 ml/min/1.73m2, after 12 months of observation 74.8±18.06 ml/min/1.73m2). There are significant differences in coronary artery disease, atherosclerosis of the brachiocephalic arteries, type 2 diabetes mellitus (DM 2) among clinical associated conditions. After 12 months of observation, acute cerebrovascular accident, coronary artery disease and diabetes occur more often in group 1. Conclusion. Uncontrolled hypertension with a hypertensive crisis manifestation is a release of hypertension associated with severe TOD and a high prevalence of clinical associated conditions.

Objective: To identify factors associated with an increased risk of adverse cardiovascular events in patients with arterial hypertension Design and method: We analyzed the results of 455 patient case files of patients with arterial hypertension included in the database in the period from January 2016 to May 2020. We made a phone call to all patients to identify new cases of adverse cardiovascular events (ischemic heart disease, stroke, transient ischemic attack, atrial fibrillation, chronic heart failure, death). 371 (81.5%) of 455 patients answered. Results: 45 adverse cardiovascular events occurred in 371 patients with arterial hypertension. Such factors as the age of the onset of hypertension, the duration of hypertension, gender, obesity, dyslipidemia, hyperuricemia, left ventricular hypertrophy, and severe retinopathy were analyzed to assess the relationship with adverse cardiovascular events. According to the Kaplan-Meier survival analysis in the presence of severe retinopathy, the risk of complications after 36 months of follow-up was 50% (p = 0.018). The hazard ratio for complications in the presence of severe retinopathy was 7.88 (CI 1.05–58.98; p = 0.044). Besides only 8 (1.75%) of 455 studied patients with arterial hypertension had severe retinopathy (retinal hemorrhage, microaneurysm, cotton wool spot, hard exudates or optic disc swelling). All 8 patients had a resistant arterial hypertension. No other evidence of interaction was found between other factors and the risk of adverse cardiovascular events. Conclusions: Severe retinopathy is more common in patients with resistant hypertension. Severe retinopathy is associated with an increased risk of adverse cardiovascular events in patients with arterial hypertension

Objective: To assess the state of target organs damage and prevalence of clinical associated conditions in patients with a hypertensive crisis and uncontrolled arterial hypertension. Design and method: The pilot study included 20 patients hospitalized at the National Medical Research Center of Cardiology over the period from September 2019 to September 2021. The all patients had uncontrolled hypertension (BP < 140/90 mmHg while taking antihypertensive drugs). Among them there are 11 men (55%), 9 women (45%) aged 34 to 80 years old (the average age is 60.9 years). The examination was carried out according to the standard examination protocols for patients with hypertension. After the patients had been followed up to 1 year, the damage of target organs (left ventricular hypertrophy, chronic kidney disease, carotid atherosclerosis), as well as the presence of associated clinical conditions (myocardial infarction, stroke, chronic heart failure, aortic aneurysm, retinal haemorrhages) were assessed. Results: 10 patients formed a group with a hypertensive crisis (BP increased > 140/90 mmHg 1 per week), another 10 patients formed a comparison group (BP increased less than 1 per week without pronounced clinical symptoms). The level of LVMI in patients of the study group was 125.5 ± 52.4 g/m2, and in the comparison group was 93.8 ± 16.0 g/m2. Calculated GFR (using the CKD-EPI formula) in the study group was 69.1 ± 18.4 ml/min/1.73 m2, and in the comparison group was 75.9 ± 21.5 ml/min/1.73 m2, carotid atherosclerosis was 44.5 ± 22.8% and 37.5 ± 13.6% respectively. Associated clinical conditions occurred in 43% of patients with a hypertensive crisis, and in the group of patients with uncontrolled hypertension in only 29%. But future randomized control studies are necessary to proof our preliminary results. Conclusions: Patients with hypertensive crisis have more pronounced damage of target organs, as well as the most frequent prevalence of associated clinical conditions.

The purpose. Assessment of the presence of the cardiovascular risk factors, associated clinical conditions, the degree of target organ damage in patients with arterial hypertension depending on the new coronavirus infection. Material and methods. In a retrospective cohort study 284 patients with arterial hypertension were identified, 162 of them had a novel coronavirus infection and 122 patients didn’t have a history of a new coronavirus infection. Patients who had a new coronavirus infection were divided into groups depending on the disease. Inclusion criteria were the presence of arterial hypertension in history and taking antihypertensive therapy. Results. Patients with hypertension who’ve had a new coronavirus infection are more likely to have risk factors such as smoking, overweight, early menopause as opposed to patients with hypertension without indication of past COVID-19. Comparing patients with increased severity of the novel coronavirus infection elevated uric acid levels and hypercholesterolemia were associated with more severe COVID-19 (p < 0.05). Patients with chronic kidney disease, cerebrovascular disease, detection of atherosclerotic lesions of the brachiocephalic arteries and diabetes mellitus have an increased probability of deaths occur from the novel coronavirus infection (p < 0.05). There was no significant difference between the compared groups of coronary heart disease, atrial fibrillation, chronic heart failure and also the daily blood pressure profile and a severe course of COVID-19. Сonclusion. The presence of diabetes mellitus, cerebrovascular disease, chronic kidney disease, detection of atherosclerotic lesions of the brachiocephalic arteries, and also hyperuricemia or hypercholesterolemia in patients with hypertension revealed a risk of severe coronavirus infection.

Aim. To assess the incidence of cardiovascular and cerebrovascular events in patients with controlled and uncontrolled hypertension, controlled resistant and uncontrolled resistant hypertension, refractory hypertension, and probably resistant and probably refractory hypertension. Materials and methods. A telephone call was made to 256 patients with hypertension included in the database to assess the incidence of cardiovascular and cerebrovascular diseases. All responding patients were divided into 7 groups according to the classification of hypertension based on the achievement/non-achievement of target blood pressure values and the number of drugs taken (controlled and uncontrolled hypertension, controlled resistant and uncontrolled resistant hypertension, refractory hypertension, and probably resistant and probably refractory hypertension). The target blood pressure was considered to be less than 140/90 mm Hg. Patients not adhering to medication were not included in the analysis. Results. The group of controlled hypertension included 146 (57%) patients out of 256, controlled resistant hypertension 36 (14%) patients, uncontrolled hypertension 6 (2.3%) patients, resistant uncontrolled hypertension 22 (8.6%) patients, refractory hypertension 31 (12.1%) patients. The group of probably resistant hypertension 6 (2.3%) patients, probably refractory hypertension 9 (3.5%) patients. Of the 28 events that occurred, 6 were attributed to coronary artery disease (including 3 acute myocardial infarction and 2 coronary artery stenting), 3 strokes, 6 episodes of transient ischemic attack and 10 new cases of atrial fibrillation, and 2 patients had sudden cardiac death. Significantly more often, patients with refractory hypertension developed any event compared with patients with controlled (38.7% versus 3.4%; p=0.005) and resistant hypertension (38.7% versus 13.6%; p=0.04). Also, patients from the group of probably refractory hypertension were more likely to develop events than patients with controlled hypertension (33.3% versus 3.4%; p=0.045). Patients with probably refractory hypertension significantly more often had a stroke than patients with controlled hypertension (22.2% versus 0%; p0.05), and patients with refractory hypertension significantly more often had a transient ischemic attack compared with patients from the group of controlled hypertension (12.9% versus 0.7%; p=0.03). Conclusion. Patients with refractory and probably refractory hypertension are significantly more likely to develop cardiovascular and cerebrovascular complications than patients with controlled hypertension.

COVID-19 can destabilize blood pressure in patients with hypertension. Taking an ACE inhibitor / ARB does not worsen the course of coronavirus infection in patients with both controlled and uncontrolled hypertension.

Aim. To study the main risk factors, clinical, laboratory and instrumental data, concomitant cardiovascular diseases (CVD) and associated clinical conditions in patients with controlled and uncontrolled hypertension, controlled resistant and uncontrolled resistant hypertension, refractory hypertension, and probably resistant and probably refractory hypertension based on retrospective analysis. Materials and methods. The study included 455 patients with hypertension. All patients were divided into 7 groups. The group of controlled hypertension included 240 patients (52.75%), controlled resistant hypertension 61 (13.4%), uncontrolled hypertension 10 (2.2%), uncontrolled resistant hypertension 53 (11.65%), refractory hypertension 63 (13.8%), probably resistant hypertension 15 (3.3%), probably refractory hypertension 13 (2.9%). Anamnesis (assessment of the duration and age of the onset of arterial hypertension, assessment of the presence of CVD), risk factors for the development of hypertension (obesity, dyslipidemia, impaired glucose tolerance and fasting glycemia, hyperuricemia, family history of CVD, early menopause in women; heart rate 80 beats/min, smoking), laboratory parameters (creatinine, glucose, total cholesterol, LDL cholesterol, HDL cholesterol, triglycerides, uric acid) and instrumental methods of examination (ECG, echocardiography, clinic mean 24h BP, Holter monitoring, duplex BCA scanning) were assessed in all groups of patients based on the analysis of the medical history. Results. In this article we presented the results of a comparative analysis of patients with controlled hypertension, uncontrolled resistant hypertension, refractory and probably refractory hypertension. Patients with refractory hypertension were significantly more young, non-smokers and females compared with patients with uncontrolled resistant hypertension and controlled hypertension. Patients with refractory hypertension had greater prevalence of left ventricular hypertrophy according to ECG and echocardiography (p0.05). Fundus lesions were found exclusively in patients with uncontrolled hypertension, 55% of cases were found in the group of refractory hypertension (p0.05). There were no significant differences in the presence of BCA atherosclerosis between the groups. Patients with refractory hypertension were significantly more likely to have heart failure, a history of stroke and transient ischemic attack compared with patients from the group of controlled hypertension (p0.05). There was no significant difference in the presence of chronic kidney disease, type 2 diabetes mellitus, coronary heart disease, atrial fibrillation between the groups. Conclusion. Patients with refractory hypertension are significantly more likely to have target organ damage and concomitant cardiovascular, cerebrovascular diseases than patients with controlled hypertension.

Patients with arterial hypertension represent a special population group with a high risk of developing cardiovascular diseases. The most difficult to control are resistant and refractory hypertension. It is known that patients with uncontrolled hypertension have a worse prognosis, both in terms of cardiovascular events and all-cause mortality. This review presents topical issues related to the features of pathogenesis, treatment and prognosis in patients with refractory and refractory hypertension.

The arterial pressure is an important physiological indicator. The review describes the different techniques of measurement of arterial pressure, their advantages and limitations. Moreover, it also represents a historical reference about the main stage of the development of clinical sphygmomanometrya that nowadays is a relevant method for measuring arterial pressure. The emergence and the development of devices for daily monitoring of arterial pressure and modern techniques for non-invasive arterial pressure measurement are described too.

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.

Background. The prevalence of obesity in patients with stable coronary artery disease (CAD) and arterial hypertension (AH) is increasing each year. As the number of percutaneous coronary interventions requiring contrast media administration is rising in this group of patients, the risk of contrast-induced acute kidney injury (CI-AKI) remains high. The most important risk factors of CI-AKI in this group of patients remain to be determined as well as their prognostic significance. Aim. The aim of the study was to assess the role of obesity as a risk factor of CI-AKI in patients with stable CAD and AH. Materials and methods. 863 patients with stable CAD and AH were included in the prospective open observational cohort study (ClinicalTrials.gov ID NCT04014153). 398 patients were obese and 465 had body mass index (BMI) below 30 kg/m2. CI-AKI was defined as the 25% rise (or 0.5 mg/dl) of serum creatinine from baseline assessed 48 hours after administration of contrast media. The primary endpoint was the development of CI-AKI. Results. The rate of CI-AKI in patients with obesity was 12.6%, without obesity 12.7%, but the difference between groups was not statistically significant (p=0.935, 95% CI -0.0430.046). The rate of CI-AKI in male patients with obesity was higher than in female ones. The logistic regression model of CI-AKI development in patients with stable CAD, AH and obesity was build (AUC 0.9928, р0,0001, 95% CI 0.98191) and included age, weight, body mass index, female gender, heart failure, diabetes mellitus, proteinuria, anemia, baseline creatinine, contrast volume and the difference between baseline serum creatinine and creatinine level after the contrast media exposure. The baseline level of creatinine and the difference between the levels of creatinine before and after contrast media administration were statistically significant risk factors in the model. Conclusion. The rate of CI-AKI in patients with stable CAD, AH and obesity was 12.6%. The main risk factors of CI-AKI development in multiple logistic regression model were the baseline level of creatinine and the difference between levels of serum creatinine before and after contrast media administration.