Aim. To assess the safety and efficacy of a single intravenous bolus of non-immunogenic staphylokinase compared with alteplase in patients with massive pulmonary embolism and hemodynamic instability. Non-immunogenic staphylokinase is a modified recombinant staphylokinase with low immunogenicity, high thrombolytic activity and fibrin selectivity.Material and methods. This multicenter, open-label, randomized, comparative clinical trial FORPE in two parallel groups was conducted in 23 clinical centers in Russia. A total of 310 patients aged 18 years and older with hemodynamic instability and computed tomography pulmonary angiography verified massive pulmonary embolism and right ventricular dysfunction were included. The patients were randomly assigned in either non-immunogenic staphylokinase (15 mg) or alteplase (100 mg) group. Both medicines were administered intravenously. An independent biostatistician created a randomization sequence using computer-generated random numbers. Randomization was performed using the envelopes. The study was open-label, and emergency unit staff, investigators, and patients were informed about the assigned drug. The primary efficacy endpoint was 7-day all-cause death after randomization. The non-inferiority margin was set at 10% for the difference in 7-day all-cause mortality after randomization between the compared groups. Non-inferiority was tested using the Welch t-test for the primary efficacy endpoint. Secondary efficacy endpoints were analyzed in both the intention-to-treat and per-protocol populations.Results. Of 348 patients screened between December 25, 2020, and July 31, 2023, 310 (89%) were included in the study. Of the total number, 155 (50%) patients were randomized to the non-immunogenic staphylokinase group and 155 (50%) to the alteplase group. In the non-immunogenic staphylokinase group, the primary efficacy endpoint, 7-day all-cause death, was 2% in the intent-to-treat population and 2% in the per-protocol population, whereas in the alteplase group it was 3% (odds ratio (OR) 0,75, 95% confidence interval (CI) 0,11-4,49; p=1,00) and 3% (OR 0,75, 95% CI 0,11-4,52; p=1,00), respectively. The difference in the primary efficacy endpoint was 0,6% (95% CI -2,8 to -4,0) in the intent-to-treat population and 0,6% (95% CI -2,9 to -4,2) in the per-protocol population. Thus, the lower limit of the 95% CI did not cross the non-inferiority margin (p<0,001). There were no cases of hemorrhagic stroke in the non-immunogenic staphylokinase group, whereas there were three cases (2%) of hemorrhagic stroke in the alteplase group (p=0,25). Serious adverse events were experienced by 11 patients (7%) in the non-immunogenic staphylokinase group compared with 12 patients (8%) in the alteplase group (p=1,00).Conclusion. Non-immunogenic staphylokinase is at least as effective as alteplase in the treatment of patients with massive pulmonary embolism with hemodynamic instability and has a higher safety profile. Future observational studies of non-immunogenic staphylokinase are needed to continue assessing its safety and efficacy. Given the high safety and efficacy of non-immunogenic staphylokinase, its use should be studied in patients with moderate-to-high risk pulmonary embolism.

Introduction: In the context of cardiology and neurology, special attention is paid to the problems of cardiovascular and cerebrovascular pathologies, often caused by vascular dysfunction. Haemodynamic parameters, in particular arterial stiffness (AS), and epicardial fat thickness (EFT), play a significant role in the assessment of cardiovascular health. The aim of the study was to evaluate the correlation between arterial stiffness, pulmonary hypertension (PH), epicardial fat thickness and diastolic myocardial dysfunction in comorbid patients. Materials and Methods: The comparative study was conducted in three groups of patients with the most frequent comorbid pathology. The first group (n=75) included patients with ischaemic heart disease (IHD), arterial hypertension stage II-III and chronic obstructive pulmonary disease (COPD) stage II-III. The second group (n=50) consisted of patients with IHD and arterial hypertension without COPD. The third group (n=33) included patients with IHD without comorbidities. Results: The study revealed a significant correlation between indices of AS, blood pressure (BP), EFT and PH in patients with comorbid conditions. The study found that the addition of the combined antihypertensive drug amlodipine-perindopril to standard therapy contributed to normalization of AS, PH and BP during three months of treatment. There was also a significant improvement in the patients’ quality of life, reduction of dyspnoea and heart failure symptoms. Conclusion: The obtained data confirm the presence of correlation between AS, BP, PH and EFT in patients with IHD, AH and COPD, which may serve as indicators of comorbid diseases. The use of combined antihypertensive drug amlodipine-perindopril seems reasonable and scientifically justified, especially after coronary stenting.

We present a clinical observation of an 18-year-old female patient with congenital bronchiectasis combined with congenital cystic degeneration of the upper lobes of both lungs, Williams-Campbell syndrome, long-COVID, severe course. The patient was treated in infectious disease department (three times), with subsequent transfer to pulmonology department of Kursk Regional Multi-Purpose Clinical Hospital from 31.01.2023 to 02.05.2023. The patient was going to have lung transplantation, registered in Shumakov Federal Research Center of Transplantology and Artificial Organs earlier. The patient was transported by air ambulance escorted by the resuscitation team to the Shumakov Federal Research Center of Transplantology and Artificial Organs on 02.05.2023 with negative PCR COVID-19 test. The literature data on the frequency of association of these diseases, clinical features, criteria for diagnosis and treatment, indications for lung transplantation are presented.

Sepsis with acute organ dysfunction is an urgent problem of modern healthcare. A clinical case of a 38-year-old young woman with communityacquired severe viral-bacterial pneumonia complicated by sepsis, endocarditis, and multiple organ failure is presented. On the 68th day of her stay in the intensive care unit (ICU), the patient was brought out of comatose state and transferred to the pulmonology department for rehabilitation.The purpose of the work was to demonstrate the significance of this clinical case because of the urgent need to increase the effectiveness of treatment and long-term rehabilitation of patients with this severe comorbid pathology.Conclusion. Early diagnosis is extremely important to select effective treatment. The Quick SOFA (Sepsis-related sequential Organ Failure Assessment) score should be used to identify patients with suspected sepsis outside the ICU. This score is based on simple and accessible clinical characteristics that do not require laboratory analysis of homeostatic parameters. The patient was discharged in satisfactory condition to continue rehabilitation in outpatient settings.

Introduction: Acute coronary syndrome, chronic forms of ischemic heart disease (IHD) and postinfarction cardiosclerosis are the main causes of morbidity and mortality in the world, including Russia. In the XXI century, there is an increase in comorbid pathology, especially in the combination of IHD with arterial hypertension, diabetes, chronic obstructive pulmonary disease and chronic kidney disease. Patients with IHD and chronic kidney disease have a higher incidence of coronary events and complications. The frequency of coronary events and complications indicates the need to improve the diagnosis and treatment of this group of patients. diagnosis and treatment of this group of patients. The aim of the study was to analyze the dynamics of vascular stiffness, pulmonary hypertension (PH), diastolic heart dysfunction and endothelial dysfunction indices in patients with different variants of ischemic heart disease combined with chronic kidney disease (CKD) stage 1-3 using complex therapy of combined hypotensive drug Amlodipine/Indapamide/Perindopril three months after coronary stenting and to compare them with the group of patients on conservative therapy only. Materials and Methods: 85 patients with different forms of IHD, arterial hypertension (AH) on the background of CKD 1-3 stages, as well as data of 42 patients with IHD, AH without renal pathology were analyzed. The first group – IHD, postinfarction cardiosclerosis, CKD stage 1-3 (33 patients); the second group – acute coronary syndrome with ST-segment elevation, Myocardial infarction (MI) (30 patients); the third group – ACS without ST-segment elevation, Unstable angina (UA) (22 patients). Results: The highest indices of vascular stiffness (Pulse wave velocity (PWV), Augmentation index (AI), CAVI, Central Systolic Blood Pressure (SBPao), central arterial pulse pressure (PP)) were registered in combination of ACS with ST-segment elevation and CKD 1-3 stages. These indices are markers of IHD progression in these patients; they also have increased pulmonary hypertension and diastolic dysfunction of the heart, endothelial dysfunction with vasodilation insufficiency in 88% of cases, which even without hemodynamically significant coronary artery stenoses according to coronary CT angiography data leads to the development of ACS with ST-segment elevation and ACS without ST-segment elevation with MI. Amlodipine/Indapamide/Perindopril was prescribed to all patients due to high arterial hypertension on admission against the background of basic therapy of IHD and coronary stenting. Coronary CT angiography in patients with comorbid renal pathology does not lead to aggravation of chronic kidney disease after 3 months, on the contrary; in this group of patients the most pronounced decrease of arterial stiffness (AS), AI, SBPao, PP with elevation of glomerular filtration rate (GFR) and decrease of creatinine in blood occurs in comparison with the group of patients who did not undergo coronary stenting, they were only on conservative therapy. Conclusion: Prescription of three component drug Amlodipine/Indapamide/Perindopril on the background of baseline therapy especially in combination with surgical vascularization of the heart is justified.

Осипова ОА, и др.Когнитивная функция пациентов пожилого … Osipova

Objective: to study arterial stiffness in patients with acute coronary syndrome without ST elevation, who have hypertension (AH) and stage 2-3A chronic kidney disease (CKD) and to assess the ability of angiotensin-converting enzyme inhibitor perindopril and angiotensin receptor antagonist losartan to reduce arterial stiffness in these patients. Materials and Methods. We studied 44 patients with ACS without ST elevation combined with CKD stage 2-3A, AH (the 1st group). The comparison groups were the ACS without ST segment elevation, AH patients with normal renal function (the 2nd group, n=27) and the 3rd group (n=44) of patients with chronic CHD, AH and CKD. Group 1 patients were divided into 2 subgroups taking perindopril or losartan. The parameters of vascular wall stiffness (pulse wave velocity (PWV), cardio-ankle vascular index (CAVI), ankle brachial index (ABI), aortic augmentation index (AI), central systolic and pulse aortic pressure, peripheral blood pressure (BP), estimated glomerular filtration rate (GFR) were assessed.) Results. The patients with ACS without ST elevation combined with 2-3A stages of CKD and AH had a significantly higher cPAP, AI, PWV, and CAVI than the patients of the 2nd group. During 3 months of complex therapy with perindopril, a decrease in PWV, cSAP, cPAP, AI was observed. There were no significant differences in the effects of perindopril and losartan on peripheral and central blood pressure, on renal function, on arterial stiffness parameters. Conclusion. Patients with AH and CKD stage 2-3A have more pronounced arterial stiffness compared to similar patients with normal GFR. Antihypertensive therapy with perindopril and losartan allows to reach target levels of peripheral BP, significantly reduce central aortic pressure and improve elastic properties of the arterial vascular wall.

Objective. To study the state of arterial stiffness and endothelial function in patients with coronary heart disease (CHD), arterial hypertension (AH) in combination with chronic kidney disease (CKD) and to determine the effect of Perindopril and Losartan therapy on these indices including after coronary stenting. Materials and Methods. The study involved 73 patients with coronary heart disease (CHD), AH and CHD stage 2-3a. The comparison group consisted of 30 patients with CHD and AH without renal pathology. Patients with CKD were divided into 3 subgroups: the 1st - on conservative therapy with Perindopril 10 mg; the 2nd - with Losartan 100 mg daily; the 3rd - those who underwent coronary stenting and were treated with Perindopril 10 mg daily. Arterial stiffness, plasma levels of endothelin-1 (ET-1), metabolites of nitric oxide were assessed initially and after 12 weeks of therapy. Results. The patients with CHD and hypertension had a more severe endothelial dysfunction (ED) and more significant arterial stiffness. There was a correlation between GFR and PWV levels (r = -0.75; p = 0.001), nitric oxide levels (r = 0.58; p<0.01), ET-1 (r = -0.72; p < 0.01). After 12 weeks of therapy, all three subgroups showed a statistically significant decrease in ET-1 and vascular wall stiffness. Conclusion. Patients with CHD and AH, CKD had more profound ED and the severity of arterial stiffness. The use of Perindopril and Losartan in complex therapy resulted in a glomerular filtration rate increase, was accompanied by a corrective effect on ED and decreased arterial stiffness, especially in patients undergoing coronary stenting.

Aim To study the condition of coronary vasculature by data of coronarography (CG) in patients with chronic ischemic heart disease (IHD) and arterial hypertension (AH) associated with stage 2-4 chronic kidney disease (CKD) and to evaluate the effect of a 12-week complex treatment with perindopril or with a combination of perindopril/amlodipine on changes in vascular wall stiffness, endothelial function, and structure and function parameters in this patient category after coronary stenting. Material and methods This study included 87 patients with chronic IHD and AH associated with stage 2-3 CKD for whom CG was performed due to ineffectiveness of the antianginal therapy. The patients were divided into three subgroups: subgroup 1 included 28 patients who received a conservative treatment with perindopril 10 mg/day; subgroup 2 consisted of 25 patients who underwent coronary stenting and were prescribed perindopril; subgroup 3 consisted of 34 patients who underwent stenting and were prescribed the perindopril/amlodipine combination. The reference group included 47 patients with IHD and AH with preserved kidney function. Anatomic and functional parameters of the heart, arterial stiffness, pulse wave velocity, cardio-ankle vascular index, augmentation index, central aortic systolic and pulse pressure, endothelium-dependent vasodilation, plasma concentration of endothelin-1 (ET-1), and plasma concentration of nitric oxide metabolites were evaluated at baseline and after 12 weeks of treatment. Results In patients with IHD, AH, and stage 2-3 CKD, arterial stiffness was more pronounced than in patients with preserved kidney function. Concentrations of ET-1 were significantly higher and levels of nitric oxide were lower in CKD. Supplementing the complex therapy with perindopril resulted in a considerable hypotensive effect in all subgroups, improvement of the kidney function, and positive dynamics of arterial stiffness and endothelial function. Changes in these parameters were more pronounced in patients after coronary stenting than in patients receiving only a conservative treatment. The use of perindopril/amlodipine following stenting exerted the most significant angioprotective and cardioprotective effect. Conclusion Patients with IHD and AH in combination with early CKD have pronounced impairment of the condition of arterial blood vessels and the heart. Addition of perindopril to the treatment not only exerted a hypotensive effect but also beneficially influenced mechanisms of progression of this combined pathology.

1ФГБОУ ВО «Курский государственный медицинский университет» Минздрава России, Курск, e-mail: vbFpo@mail.ru Цель: изучить особенности эндотелиальной функции у больных бронхиальной астмой в сочетании с ожирением, обосновать критерии прогнозирования формирования у них легочной гипертензии, установить особенности течения при сочетании бронхиальной астмы с ожирением. Были изучены данные 3474 пациентов с различными фенотипами бронхиальной астмы в период с 2012 по 2016 гг., обратившихся за медицинской помощью в медицинские учреждения на территории Курской области. С целью оценки эндотелиальной функции определяли концентрацию уровня эндотелина-1 плазмы, изучали эндотелийзависимую вазодилатацию плечевой артерии при проведении пробы по Celermajer и соавт. (1992). На функцию эндотелия у больных бронхиальной астмой влияют тяжесть и фаза заболевания, а также наличие и выраженность ожирения. Степень выраженности эндотелиальной дисфункции коррелировала с параметрами функции внешнего дыхания, характеризующими бронхообструкцию, и с уровнем давления в малом круге кровообращения. Зарегистрирована прямая корреляционная зависимость между высоким уровнем эндотелина-1 и средним давлением в легочной артерии (r=0,31, p=0,025). Эндотелийзависимая вазодилатация плечевой артерии у пациентов с бронхиальной астмой и ожирением была 4,4±0,6%, что достоверно ниже среднего показателя в группе лиц с астмой без ожирения (5,6±0,8%). У данных пациентов выявлена положительная корреляционная зависимость между эндотелийзависимой вазодилатацией и снижением пиковой скорости выдоха (r=0,48, p<0,05), объемом форсированного выдоха за первую секунду (r=0,56, p< 0,01). Более чем у 90% больных бронхиальной астмой и ожирением возникает эндотелиальная дисфункция, диагностированная по повышению уровня эндотелина-1 в плазме, нарушению эндотелийзависимой вазодилатации плечевой артерии. Выраженность этих изменений нарастает с утяжелением бронхиальной астмы и сопутствующего ожирения. Высокий уровень эндотелина-1 в крови и нарушения эндотелийзависимой вазодилатации плечевой артерии могут иметь прогностическое значение для выявления риска развития легочной гипертензии у больных с бронхиальной астмой в сочетании с ожирением. Ключевые слова: бронхиальная астма; ожирение; эндотелиальная дисфункция; легочная гипертензия

Жесткость сосудистой стенки -важная часть патогенеза развития ишемии миокарда.Установлено, что при наличии почечной патологии и сокращения темпа клубочковой фильтрации увеличивается жесткость стенки сосуда.Увеличение артериальной ригидности является отличительным признаком хронической болезни почек (ХБП) и связано с неблагоприятными изменениями структуры и функции сердца.Коронарные события развиваются чаще у больных ХБП.Это ведет к увеличению в смертности среди популяции этих пациентов.Таким образом, уменьшение в ригидности стенки сосуда можно рассматривать как один из параметров, нуждающихся в коррекции у пациентов, имеющих ишемическую болезнь сердца в сочетании с хронической болезнью почек.В то же время артериальная ригидность может быть определена в обычной клинической практике, что делает данный параметр возможным объективным критерием контроля эффективности терапии.В нашем исследовании, включающем 60 пациентов, впервые получены данные о том, что проведение реваскуляризации миокарда у пациентов с

The importance of vascular wall rigidity, diastolic dysfunction of left ventricle in development of coronary heart disease in patients with chronic kidney disease is investigated. The possibility of coronary heart disease development in patients with pathology of kidneys, despite the absence of hemodynamic significant stenosis of coronary arteries according to the results of coronarography is established,the importance of detecting diastolic dysfunction as an early marker of developing heart failure in patients with combined pathology is shown. Studying diastolic dysfunction and vascular wall rigidity can help to define more presisely the degree of cardiovascular risk in these patients, and their monitoring in dynamics can be used as an additional objective criterion for evaluating therapy efficiency.

The purpose of the study was to determine the contribution of RANKL/OPG transmembrane molecule system into the development of pathological arterial stiffness in rheumatoid arthritis (RA). RA patients (n=181) were randomized into 4 groups based on RF/ACCP (rheumatoid factor/antibodies to cyclic citrullinated peptide) positivity and disease duration (less than or more than 2 years). Serum osteoprotegerin (OPG) and soluble receptor activator of NF-kB ligand (sRANKL) concentrations, as well as pulse wave contour analysis were evaluated in all patients. The largest OPG level was detected in Group 1 patients; sRANKL concentration with maximal RANKL/OPG ratio was predominant in Group 4 patients. Prolonged course of RF/ACCP-seropositive RA was characterized by more significant arterial rigidity shifts (increases in augmentation (AIp), stiffness (SI), reflection (RI) indices). Correlation analysis revealed the presence of significant relations between the RANKL/OPG transmembrane molecule system and arterial rigidity parameters in RA.

The aim of this study is to measure the level of the endothelin-1 in blood samples and to assess vasoactive function of the endothelial in asthma patients with different phenotypes and to develop the methods of the objective assess of the ongoing treatment. Materials and methods. 119 asthma patients were separated into several phenotypes: patients with atopic asthma (60 pat); patients with ACOS (35 pat); asthma with obesity (24 pat). In all patients endothelium-dependent vasodilation and plasma level of endothelin-1 were assessed. Results. Endothelial dysfunction revealed in all asthma phenotypes. The highest level of the endothelin-1 shown in ACOS patients. In patients which achieved asthma control during three month of the anti-inflammatory therapy showed decreasing of the endothelin-1 level by 1,5 times in comparison with basic level (0,35 ± 0,06 fmol/ml and 0,64 ± 0,15 fmol/ml respectively, р < 0,01). But in patients with persistent symptoms and/or without lung function improvement the level of the endothelin-1 was not decreased significantly. Conclusions. Change of the functional conditions of the endothelial depend on the time and severity and phenotype of the asthma. The endothelin-1 level and the endothelium-dependent vasodilatation assess on the course of the treatment allow to reveal success of this anti- inflammatory therapy.

The aim of the research was to study the peculiarities of cardiac and pulmonary hemodynamics, the mechanisms of formation of endothelial dysfunction, as well as their correction with angiotensin converting enzyme inhibitor, Ramipril and angiotensin-II receptor blocker, Irbesartan, in patients with arterial hypertension (HTN) combined with bronchial asthma (BA). Design and methods . Altogether 80 patients with BA of moderate severity combined with HTN of 1, 2 degrees were enrolled in the study. The average age of the patients was 52,9 ± 4,2 years. The eligible patients were randomized for treatment with either Ramipril 5 mg/day or Irbesartan 150 mg/day in combination with bronchodilator inhalation and anti-inflammatory medications for BA (Formoterol/Budesonide 160/4,5 mcg 2 inhalations twice, Ipratropium bromide and Ambroxol through nebulizer devices). The program of instrumental examination included echocardiography (Aloka 1700, Japan; LOGIQ 500, Germany) with ultrasonic sensors of 3,5 MHz. The plasma level of endothelin 1 (ET‑1) was estimated by immune-enzyme assay (Biomedica set, category № 442–0052, Arkray, Japan). Results. Two-month monotherapy with Irbesartan allows to achieve the target blood pressure (BP), leads to the regression of cardiac remodeling and has a positive effect on endothelial function and bronchial patency. Conclusions. Irbesartan is able to provide a stable and reliable control of BP, and delays the progression of pathological cardiovascular changes; it has a favorable impact on the respiratory function, is well tolerated, easy to use, and may be considered as the best antihypertensive drug in patients with co-morbid HTN and BA.

The examination of 160 patients with severe asthma who were hospitalized into the pulmonology department of Kursk regional clinical hospital revealed the following phenotypes of the disease according to the GINA, 2016 .: allergic, non-allergic, steroid, asthma in smokers, asthma and obesity, asthma combined with COPD (chiasm syndrome). CHD was diagnosed in 33% of patients with non-allergic asthma and in 65% with the chiasm syndrome accompanied with rhythm disorders as well as in 50% of patients with COPD + BA. Obesity is reported in 77% of female patients with severe asthma and 80.1% of these patients had hypertension. A negative correlation between indicators of FEV1 / FVC ratio, duration of disease, and smoking experience index was established. Infection was the main trigger factor in exacerbations of severe asthma (47.4%). 33.8% of patients were given the inadequate standard asthma outpatient therapy; only 12% of patients with the chiasm syndrome receivedantibiotic therapy in exacerbations of COPD.

The aim of the research was to study the peculiarities of cardiac and pulmonary hemodynamics, the mechanisms of formation of endothelial dysfunction, as well as their correction with angiotensin converting enzyme inhibitor, Ramipril and angiotensin-II receptor blocker, Irbesartan, in patients with arterial hypertension (HTN) combined with bronchial asthma (BA). Design and methods . Altogether 80 patients with BA of moderate severity combined with HTN of 1, 2 degrees were enrolled in the study. The average age of the patients was 52,9 ± 4,2 years. The eligible patients were randomized for treatment with either Ramipril 5 mg/day or Irbesartan 150 mg/day in combination with bronchodilator inhalation and anti-inflammatory medications for BA (Formoterol/Budesonide 160/4,5 mcg 2 inhalations twice, Ipratropium bromide and Ambroxol through nebulizer devices). The program of instrumental examination included echocardiography (Aloka 1700, Japan; LOGIQ 500, Germany) with ultrasonic sensors of 3,5 MHz. The plasma level of endothelin 1 (ET‑1) was estimated by immune-enzyme assay (Biomedica set, category № 442–0052, Arkray, Japan). Results. Two-month monotherapy with Irbesartan allows to achieve the target blood pressure (BP), leads to the regression of cardiac remodeling and has a positive effect on endothelial function and bronchial patency. Conclusions. Irbesartan is able to provide a stable and reliable control of BP, and delays the progression of pathological cardiovascular changes; it has a favorable impact on the respiratory function, is well tolerated, easy to use, and may be considered as the best antihypertensive drug in patients with co-morbid HTN and BA.

The aim of the research was to study the peculiarities of cardiac and pulmonary hemodynamics, the mechanisms of formation of endothelial dysfunction, as well as their correction with angiotensin converting enzyme inhibitor, Ramipril and angiotensin-II receptor blocker, Irbesartan, in patients with arterial hypertension (HTN) combined with bronchial asthma (BA). Design and methods . Altogether 80 patients with BA of moderate severity combined with HTN of 1, 2 degrees were enrolled in the study. The average age of the patients was 52,9 ± 4,2 years. The eligible patients were randomized for treatment with either Ramipril 5 mg/day or Irbesartan 150 mg/day in combination with bronchodilator inhalation and anti-inflammatory medications for BA (Formoterol/Budesonide 160/4,5 mcg 2 inhalations twice, Ipratropium bromide and Ambroxol through nebulizer devices). The program of instrumental examination included echocardiography (Aloka 1700, Japan; LOGIQ 500, Germany) with ultrasonic sensors of 3,5 MHz. The plasma level of endothelin 1 (ET‑1) was estimated by immune-enzyme assay (Biomedica set, category № 442–0052, Arkray, Japan). Results. Two-month monotherapy with Irbesartan allows to achieve the target blood pressure (BP), leads to the regression of cardiac remodeling and has a positive effect on endothelial function and bronchial patency. Conclusions. Irbesartan is able to provide a stable and reliable control of BP, and delays the progression of pathological cardiovascular changes; it has a favorable impact on the respiratory function, is well tolerated, easy to use, and may be considered as the best antihypertensive drug in patients with co-morbid HTN and BA.