Aim . To analyze the level of biomarkers of inflammation and endothelial dysfunction in elderly patients with myocardial infarction (MI), hypertension (HTN) and frailty. Material and methods . Three following clinical groups were formed: patients aged 60-74 years with MI+ grade 1-2 HTN (n=80); patients aged 60-74 with MI+HTN+prefrailty (n=52); patients aged 60-74 years with MI+HTN+frailty (n=114). In patients of all groups 2-4 months after MI, the levels of high-sensitivity C-reactive protein (hsCRP), intercellular adhesion molecule 1 (ICAM-1), nitric oxide (NO) metabolites — nitrates and nitrites, endothelin-1, desquamated endotheliocytes, vascular endothelial growth factor (VEGF) were determined. Results . Patients with MI+HTN+frailty had a higher hsCRP — 6,4 mg/l compared with patients with MI+HTN+ prefrailty (4,2 mg/l; p<0,01) and patients with MI+HTN (3,2 mg/l; p<0,01). The level of ICAM-1 was 315,6, 242,7, and 213,5 ng/ml, respectively, in these groups (p<0,01). Patients with MI+HTN+prefrailty, MI+HTN+frailty and MI+HTN had following levels of nitrite (NO 2 - ) and nitrate (NO 3 - ) — 6,7, 5,4, and 7,2 pmol/l (p<0,01). A similar ratio is inherent in NO 3 - . On the contrary, the content of desquamated endotheliocytes and VEGF was significantly higher in patients with MI+HTN+frailty compared with patients with MI+HTN+ prefrailty (p<0,01). The level of endothelin-1 was also significantly higher in patients with MI+HTN+frailty compared with the MI+HTN+prefrailty group: 18,85 vs 13,41 fmol/l (p<0,05). Conclusion . The levels of inflammation and endothelial dysfunction in patients with MI+HTN are significantly higher than those in patients with MI+HTN+frailty compared with patients with MI+AH+prefrailty and MI+HTN, with the exception of nitric oxide metabolites.

Metabolic syndrome among different age groups is one of the priority problems of modern health care in many countries. Currently, the medical and social significance of the metabolic syndrome is related o the high specific weight among the causes of disability and mortality, which, along with this, is the leading risk factor for cardiovascular, cerebrovascular, diseases, diabetes mellitus and their complications. The high prevalence of metabolic syndrome in the world ranges from 44.9% in Japan to 50.9% in Spain. Due to the continued increase in the proportion of the elderly and senile population, a further increase in the incidence of metabolic syndrome is predicted, and a pronounced gain in health care costs for outpatient and inpatient medical care. The purpose of the study is to analyze the prevalence of the metabolic syndrome and its components according to the data of domestic and foreign reports. Russian and foreign scientific reports, monographs, and collections of articles for 2003–2019 were retrospectively studied using computer search engines and peer-reviewed journals in international databases (Scopus, Web of Sciences). As a result of the search, 164 articles were selected for analysis, from which 128 works and materials were excluded due to incomplete information, unrepresentative sampling, and other reasons.36 publications served as the basis for this study. An enlargement in the prevalence of metabolic syndrome in various countries, including Russia, with an increase in the age of the population in combination with arterial hypertension, diabetes mellitus, in the risk of developing cardiovascular complications by 2–3 times in the combination of metabolic syndrome with arterial hypertension and by 5 times-with diabetes mellitus. Data on the prevalence of the metabolic syndrome will allow health care managers implementing preventive measures and, above all, to correct modifiable risk factors for the metabolic syndrome, such as obesity and hypertension, which are the most common components of the metabolic syndrome

Aim. To analyze Barthel Index of Activities of Daily Living (ADL) in elderly patients with hypertension (HTN) and frailty 6 months after non-ST segment elevation myocardial infarction non-STEMI).Material and methods. ADL was studied in 114 elderly patients (60-74 years old) with non-STEMI, HN and frailty and 80 patients of the same age with non-STEMI and HTN, but without frailty. ADL was determined 6 months after suffering non-STEMI.Results. ADL in patients with frailty was reduced to a greater extent (55,8 [52,4-57,9]) than in non-frail patients (72,9 [70,3-78,6]) (p<0,01). According to factor analysis, ADL reduction in frail patients compared with non-frail patients was mainly due to bed-chair transfer — 6,4 [6,2- 6,8] vs 9,8 [8,1-11,5] (p<0,001), walking test — 8,1 [8,0-8,5] vs 10,6 [9,4-12,7] (p<0,001), stair climbing — 5,3 [5,1-5,7] vs 7,4 [6,8-8,9] (p<0,001). ADL in patients with frailty and blood pressure (BP) <160/100 mm Hg was 62,1 [60,3-69,9], which is significantly higher than in frail patients with BP ≥160/100 mm Hg (48,0 [36,3-53,2]) (p<0,01).Conclusion. In frail patients aged 60-74 years, compared with non- frail patients, 6 months after non-STEMI, ADL was significantly lower in such components as stair climbing, walking, and bed-chair transfer. In patients with frailty and BP <160/100 mm Hg, ADL is significantly higher than in patients with higher blood pressure.

Background. Hypertension (HTN) in metabolic syndrome (MS) in the elderly contributes to the formation of cognitive disorders and anxiety-depressive disorders. Objective. To study the psychological state of elderly patients with HTN and MS treated by evening versus morning dosing of a fixed combination (FC) of amlodipine, lisinopril and rosuvastatin. Design and methods. In a randomized, double-blind, controlled trial 63 patients aged 60–74 years with HTN and MS received a FC of amlodipine, liiznopril and rosuvastatin at a dose of 5/10/10 mg in the evening (after 20:00 hours) (study group) And 58 patients aged 60–74 years with HTN and MS took the drug in the morning (control group). Cognitive dysfunction was assessed by Mini-Mental State Examination (MMSE), anxiety and depressive disorders were assessed by State-Trait Anxiety Inventory adapted by Yu. Khanin and scale of the Center for Epidemiologic Studies-Depression (CES-D). Results. In evening dosing group, MMSE result increased from 17,8 ± of 0,3 to 23,5 ± 0,4 points (р = 0,13) vs. 16,9 ± of 0,3 to 20,4 ± 0,4 points (р = 0,148) in morning dosing. Situational anxiety score decreased from 40,0 ± 2,2 to 30,6 ± 1,8 points (р = 0,009) vs. from 40,8 ± of 2,5 to 33,5 ± 1,9 points (р = 0,011), and personal anxiety score from 48,8 ± 2,0 to 26,4 ± of 1,9 points (р = 0,003) and from 44,9 ± of 1,9 to 30,7 ± of 1,7 points (р = 0,008) in evening and morning dosing, respectively. Depressive disorders decreased similarly and slightly in both groups (14,1% versus 7,7% in evening and morning dosing, respectibely, p = 0,214). Conclusions. The results indicate that chronotherapy is more effective than the traditional use of a FC of amlodipine, lisinopril and rosuvastatin in HTN associated with MS.

Aim. To study the psychological continuum of elderly hypertensive patients with metabolic syndrome (MS) receiving chronotherapy with a fixed-dose combination of amlodipine, lisinopril and rosuvastatin.Material and methods. In a clinical setting, 63 hypertensive patients with MS aged 60-74 years (experimental group) received chronotherapy with fixed-dose combination of amlodipine, lisinopril and rosuvastatin (Ekvamer®) at a dose of 5/10/10 mg in the evening (8 pm). The control group of hypertensive patients with MS aged 60-74 years old (n=58) received Ekvamer® in the morning (conventional therapy) at the same dosage.Results. With fixed-dose combination of amlodipine, lisinopril and rosuvastatin, the severity of psychological continuum abnormalities significantly decreases after 1 year in the chronotherapy regimen (evening intake) than with morning intake with an equivalent dosage of 5/10/10 mg per day in both cases. The dynamics of cognitive impairments in hypertensive patients aged 60-74 years with MS using chronotherapy regimen is characterized by a significant increase in the mean MMSE score from the initial 17,8±0,3 to 23,5±0,4 points (p±0,001) vs 16,9±0,3 to 20,4±0,4 points (p<0,001) when taking the drug in the morning. Situational anxiety decreased from 40,0±2,2 to 30,6±1,8 points (p<0,05) vs 40,8±2,5 to 33,5±1,9 points (p<0,05), personal anxiety from 48,8±2,0 to 26,4±1,9 (p<0,001) vs from 44,9±1,9 to 30,7±1,7 (p<0,01) points, respectively. Depressive disorders slightly decreased with chronotherapy (14,1%) vs 7,7% than with the conventional scheme, but despite this, they corresponded to depressive spectrum disorders in both groups.Conclusion. The results obtained indicate a greater efficiency of chronotherapy than the conventional use of fixed-dose combination of amlodipine, lisinopril and rosuvastatin in hypertensive patients with MS.

Metabolic syndrome (MS) is among the main public health challenges worldwide, leading to significant labor losses, increased costs for treatment and rehabilitation of the patients. The aim of the present study was to identify the informative serum interleukins, by determining the odds ratio in elderly patients with MS and hypertension. The main group of 86 patients with MS and arterial hypertension (AH) aged 60-75 years was examined under clinical conditions. The inclusion criteria were as follows: age of 60-75 years, presence of MS, primary hypertension (grade II-III), absence of acute myocardial infarction, malignant neoplasms, disorders of cerebral circulation, kidney failure over last 6 months. Diagnostics of MS and hypertension was carried out in accordance with Expert Guidelines from the Russian Research Society of Cardiology on the MS Diagnosis and Treatment. Our first study of a large range of serum interleukins in elderly patients with MS and hypertension allowed us to reveal the inversely directed changes in pro- and anti-inflammatory cytokine contents. Combined AH/MS in elderly persons is accomplished by sufficient increase of the most proinflammatory cytokines, and vice versa, by significant decrease in anti-inflammatory cytokines in blood serum. This finding clearly points to importance of immunological regulatory systems for initiation of AH with MS at older age. Pro- and anti-inflammatory serum interleukins are actively involved into the AH/MS development in elderly accompanied by their pronounced imbalance. The mentioned immune reactions could underlie the MS/AH condition. High risk of this disorder is connected with changed production of proinflammatory cytokines (IL-8, IL-1β), like as anti-inflammatory serum interleukins (IL-4, IL-10), with predominance of the former. The above interleukins should be considered dominant diagnostic markers of AH/MS in elderly persons. Measurement of serum interleukins and discriminant-based approach allows highly reliable differentiation of elderly patients with AH/MS from similar individuals without this disorder.

Традиционные схемы терапии больных артериальной гипертензией не всегда являются эффективными и нуждаются в совершенствовании на основе принципов хронобиологии. Цель работы - анализ влияния хронотерапии фиксированной комбинацией амлодипина, лизиноприла и розувастатина на показатели суточного мониторирования АД. У 62 больных 60-74 лет с инфарктом миокарда в анамнезе и артериальной гипертензией использована фиксированная комбинация амлодипина, лизиноприла и розувастатина в дозе 5/10/10 мг за 2 ч до достижения максимального САД (превентивная хронотерапия), 63 больных с аналогичными заболеваниями и возрастом этот препарат в дозе 5/10/10мг принимали вечером, а 58 человек - в утренние часы (традиционное лечение). Суточное мониторирование АД до и через 6 мес после лечения выполняли аппаратом «SpaceLabsMedical»(США) с расчетом общепринятых показателей. Установлена наибольшая эффективность превентивной хронотерапии по сравнению с другими вариантами лечения по достижению уровня целевого АД, снижению индексов времени и вариабельности САД, что позволяет рекомендовать данную фиксированную комбинацию в гериатрической практике. Traditional treatment regimens for patients with hypertension are not always effective and need to be improved based on the principles of chronobiology. The purpose of this work is to analyze the effect of preventive chronotherapy with amlodipine, lisinopril, and rosuvastatin on daily blood pressure monitoring. In 62 patients with a history of myocardial infarction and hypertension at the age of 60-74, a fixed combination of amlodipine, lisinopril and rosuvastatin at a dose of 5/10/10 mg 2 hours before reaching maximum systolic blood pressure (preventive chronotherapy), in 63 patients with similar diseases and age, this drug is taken at a dose of 5/10/10mg in the evening, and in 58 people - in the morning (traditional treatment). Daily monitoring of blood pressure before and 6 months after treatment was performed by the «SpacelabsMedical» device (USA) with the calculation of generally accepted indicators. The greatest effectiveness of preventive chronotherapy in comparison with other treatment options for achieving the target blood pressure level, reducing the time indices and the variability of systolic blood pressure has been established, which allows us to recommend this fixed combination in geriatric practice.

85 patients (43 with a stomach ulcer of a duodenal gut and 42 with a syndrome of the angry intestines) are surveyed. At 20 of patients in everyone nosology to group to standard therapy it was in addition appointed afobazol in a doze of 30 mg day within 10 days of hospitalization. Quality of a life was compared by means of test SF-36. As a result of use parameters of test SF-36 have authentically increased in treatment afobazol at sick of a stomach ulcer on scales a pain, the general health, viability, social functioning, mental health, and at patients with a syndrome of the angry intestines a pain, viability, mental health that testifies to positive influence of the given preparation on quality of a life. The rate of therapy afobazol within 10 days on a background of standard therapy allows to receive authentic improvement of quality of a life (a physical and psychological component) at gastroenterology patients at the most widespread nosology forms.

85 patients (43 with a stomach ulcer of a duodenal gut and 42 with a syndrome of the angry intestines) are surveyed. At 20 of patients in everyone nosology to group to standard therapy it was in addition appointed afobazol in a doze of 30 mg day within 10 days of hospitalization. Quality of a life was compared by means of test SF-36. As a result of use parameters of test SF-36 have authentically increased in treatment afobazol at sick of a stomach ulcer on scales a pain, the general health, viability, social functioning, mental health, and at patients with a syndrome of the angry intestines a pain, viability, mental health that testifies to positive influence of the given preparation on quality of a life. The rate of therapy afobazol within 10 days on a background of standard therapy allows to receive authentic improvement of quality of a life (a physical and psychological component) at gastroenterology patients at the most widespread nosology forms.