Aim. To study the clinical status and data of laboratory and instrumental examination of patients with non-obstructive ischemic heart disease (IHD) and multifocal atherosclerosis (MFA) included in the KAMMA registry.Material and methods. The subanalysis included 1,893 IHD patients who underwent coronary angiography (CAG) and ultrasonic examination of peripheral arteries. Based on the CAG data, patients were divided into two groups: group 1, patients with obstructive coronary atherosclerosis (CA) (maximum stenosis ≥50% and/or history of percutaneous coronary intervention/coronary artery bypass grafting, n=1728; 91.3%) and group 2, patients with non-obstructive CA (maximum stenosis <50%, n = 165; 8.7%).Results. A comparative analysis based on the degree of coronary obstruction in patients with verified IHD who were included in the KAMMA registry showed that 8.7% of them had coronary artery stenosis of less than 50%. The overwhelming majority of patients with non-obstructive CA had MFA affecting the brachiocephalic arteries in 94.3% and the lower extremity arteries in 40.2%. Among patients with non-obstructive IHD, women predominated; risk factors such as smoking and type 2 diabetes mellitus were less frequent in this group than in the obstructive IHD group. Patients with non-obstructive CA more frequently had a history of dyslipidemia; they had higher total cholesterol and non-high-density lipoprotein cholesterol; and they more frequently received moderate-intensity statin therapy than patients with obstructive CA (55.8% vs. 34.5%). Characteristic features of patients with non-obstructive CA were less severe IHD and less frequent history of acute coronary syndrome. However, the incidence of stroke, peripheral arterial thrombosis, and chronic arterial insufficiency of the lower extremities did not differ in groups 1 and 2, whereas the incidence of paroxysmal atrial fibrillation was higher in the non-obstructive IHD group.Conclusion. IHD patients without coronary obstruction also require assessment of the peripheral arterial status, as they may have advanced MFA, which should be taken into account when choosing the “aggressiveness” of therapy.

Aim. To assess awareness of blood pressure (BP) level, adherence to therapy and achievement of target BP in residents of Russian regions as part of the 2023 hypertension (HTN) screening campaign. Material and methods. During May 2023, 4613 participants from 23 cities of Russia took part in the screening. Participation was voluntary without restrictions on sex. All patients aged over 18 years. During screening, BP and pulse were measured three times using automatic or mechanical BP monitors, and a questionnaire about behavioral risk factors, concomitant diseases and therapy was filled out. HTN was diagnosed with systolic BP ≥140 mm Hg and/or diastolic BP ≥90 mm Hg and/or taking antihypertensive therapy (AHT). Results. The analysis included data from 4585 respondents aged 18 to 95 years with an average age of 45 [28;59] years, of which 1729 were men (37,7%). The proportion of hypertensive patients was 49,6%. Among them, 62,8% took AHT and achieved target BP in 76,6% and 45,7% with the target BP criterion <140/90 mm Hg and <130/80 mm Hg, respectively. Most patients took dual AHT (37,4%), while monotherapy and triple therapy was registered in 27,5% and 23,4%, respectively. Initiation of therapy was performed with combination AHT in 43,7% of patients with HTN and 41,4% are currently using fixed-dose combination therapy. On-demand therapy was the most common reason for skipping medications and was more common in women, while men more often cited the high drug cost and a history of adverse reactions. Among patients with HTN, home BP measurement was associated with a higher prevalence of achieving target BP as follows: 1000 (60%) vs 100 (17%), p<0,001. Conclusion. The data obtained indicate, on the one hand, a continuing insufficient level of awareness about high BP and the use of antihypertensive drugs among the population, but there is a tendency to improve the effectiveness of the treatment of hypertension, including the use of fixed-dose combinations of antihypertensive drugs.

Aim. To investigate the prevalence and characteristics of polyvascular disease in the Eurasian region's population with one or more previously established locations of atherosclerotic arterial damage, and to evaluate the diagnostic importance of the ankle-brachial index (ABI) as a marker for polyvascular disease (PVD).Material and methods. A total of 1837 patients were included in the main branch of the KAMMA registry (patients with PVD), among which 91,6% had coronary artery disease (CAD) (n=1683). For further analysis, the group of patients with CAD was combined with 1222 patients included in the second branch of the registry — KAMMA-cardio, forming a patient population (n=2905), in which all patients had verified CAD. The mean age of patients was 66,0 [59,0; 72,0] years, with 60,3% being male. Peripheral arteries was assessed using ultrasound examination.Results. PVD was present in 95,6% of patients with coronary atherosclerosis: dual-region involvement was observed in 51,3% of patients, three-region involvement in 37,1%, four-region involvement in 3,4%, and five-region involvement in 2,0%. Stenoses of the common carotid artery were observed in 71% of patients, internal carotid artery — in 68%, lower limb artery — in 52%, and renal and mesenteric artery — in 8,3%. There were following diagnostic effectiveness of the ABI for detecting patients with lower limb artery stenosis was: sensitivity — 58,0%, specificity — 83,6%. The quality of antithrombotic and lipid-lowering therapy was insufficient.Conclusion. In the overwhelming majority (95,6%) of patients with CAD in the KAMMA registry, PVD was revealed, with nearly half of the patients having involvement in three or more arterial zones. In the patient population with CAD, there should be an active effort to identify patients with PVD, using at least the ABI determination and active modern antithrombotic and lipid-lowering therapy according to current clinical guidelines.

The purpose of the review of scientific medical literature was to evaluate the data of the epidemiology of osteoarthritis (OA) and cardiovascular diseases (CVD) with the analysis of risk factors, pathophysiological and pathobiochemical mechanisms of the relationship between OA and the risk of developing CVD in the presence of chronic pain, modern strategies for screening and management of this cohort of patients, the mechanism of action and pharmacological effects of chondroitin sulfate (CS). Conclusions were drawn about the need for additional clinical and observational studies of the efficacy and safety of the parenteral form of CS (Chondroguard) in patients with chronic pain in OA and CVD, improvement of clinical recommendations for the treatment of chronic pain in patients with OA and cardiovascular risk, with special attention to interventions that eliminate mobility restrictions in patients and the inclusion of basic and adjuvant therapy with DMOADs to achieve the goals of multipurpose monotherapy in patients with contraindications to standard therapy drugs.

Abstract: Relevance. Among cardiovascular diseases arterial hypertension (AH) in elderly people over 60 years old is the main risk factor for stroke, heart failure, terminal renal failure and lethal outcome. Today hypertension is defined as accelerated aging of the arterial component of the cardiovascular system with developing of remodeling processes due to age. Studies of a molecular phenotype of hypertension in elderly patients with obtaining molecular profiles of biological samples determining the clinical course of hypertension and its classification characteristics are topical nowadays. The aim of the study is to search correlations between structural, functional and molecular diagnostic parameters in patients with AH of Grade 2 of a moderate and high risk. Methods and materials: The study involved patients over 60 years old with a diagnosis of Grade 2, moderate and high risk hypertension (Group 2, n=200), taking into consideration the criteria of inclusion and non-inclusion into the study. The control group (KG, Group 1) included 30 elderly people with no hypertension. Central blood pressure (BP) in the aorta and pressure on the brachial artery were measured, indicators of daily blood pressure monitoring, structural and functional parameters of the heart were evaluated on the basis of echocardiography. There was fulfilled a qualitative proteomic analysis of blood plasma based on time–of–flight mass spectrometry with a laser desorption and ionization and quantitative assessment of the level of proteins in the blood with the help of enzyme immunoassay. Results: There was revealed an increase of the blood concentration of MPO, apoD, HIF1α, TGFβ1, hyaluronidase 1, kininogen 1, fibulin 5 and their significant correlations with LVMM and ACC. Conclusions: There was determined diagnostic molecular profile of blood of elderly patients with AH of Grade 2 and confirmed the involvement of proteins in myocardial and vascular remodeling in elderly patients with AH.

Repetitive quarantines and social restrictions during the coronavirus disease 2019 (COVID-19) pandemic have negatively affected the population health in general, and the control of hypertension (HTN) in particular.Aim. To evaluate the control of HTN in the Russian population during the COVID-19 period based on the results of screening for HTN May Measurement Month 2021 (MMM2021).Material and methods. During May-August 2021, 2491 participants from 11 Russian regions took part in the screening. Participation was voluntary without restrictions on sex. All participants were over 18 years of age. During the screening, blood pressure (BP) was measured three times using automatic and mechanical BP monitors. In addition, a questionnaire was filled out on behavioral risk factors, comorbidities and therapy. HTN was diagnosed with systolic BP ≥140 mmHg and/ or diastolic blood pressure ≥90 mmHg and/or taking antihypertensive therapy. The questionnaire included questions about prior COVID-19, vaccinations and their impact on the intake of antihypertensive drugs.Results. The analysis included data from 2461 respondents aged 18 to 92, of which 963 were men (39,1%). The proportion of hypertensive patients was 41,0%, while among them 59,0% took antihypertensives and 30,9% were effectively treated. In comparison with pre-pandemic period according to MMM2018-2019, the higher proportion of HTN patients in the Russian sample was revealed during MMM2021 (41,0% vs 31,3%, p<0,001) with a comparable proportion of patients receiving antihypertensive therapy (60,7% vs 59,0%, p=0,05) and treatment efficacy (28,7% vs 30,9%, p=0,36). Monotherapy was received in 44,7% of cases, while dual and triple combination therapy — in 30,9% and 14,1%, respectively. The majority of respondents (~90%) did not adjust their antihypertensive therapy during the COVID-19 pandemic.Conclusion. According to HTN screening in Russia, there is persistent ineffective control of HTN, which may be due to both the worsening pattern of behavioral risk factors, limited access to healthcare during COVID-19, and the inertia of physicians and low adherence of patients due to the asymptomatic HTN course in the majority.

Objective: to study molecular effects of thiotriasoline of the patients with coronary heart disease (CHD). Materials and methods: 60 patients with stable angina of I – III functional classes were compared regarding the effects of thiotriasoline via standard therapy regime (STR), taking into account the activity of basic products level free radical oxidation (FRO) and antioxidant systems (AOS), proteomic protein profile. Results: in 24 weeks on the background of STR and thiotriasoline there is a revealed statistically reliable growth of glutathione reductase content, reduction of malonic dialdehyde, increase of endothelial lipase detection rate, phosphomevalonatekinase, γ-butyrobetaine hydroxylase, linoleil CoA-desaturase, reduction of delta-5 desaturase. Conclusion: thiotriasoline possesses cardioprotective activity with antioxidant and cytoprotective effects, reducing free radical products content and raising the activity of antioxidant systems ferments with regard to patients with CHD.

Aim of the present study is to assess whether 1.5mg of exogenous melatonin provided under modified CR in constant light (similar to 400 lx) is capable to mimic effects of dark phase. Forty-six young adults (YA), 17-24 years old of both genders were studied under amodified CR protocol for 26 h. Initially, participants were investigated under constant light (CR-LL) and 2 weeks later under the same conditions though 1.5mg melatonin (Melaxen) was given orally at 22:30. Systolic blood pressure (SBP) and diastolic blood pressure (DBP), heart rate (HR) and body temperature (BT) were measured every 2 h. To verify the effect of constant light, formerly published results obtained under light-dark conditions (CR-LD) were reanalyzed. Administration of 1.5 mg of exogenous melatonin modified the 24 h patterns of BT and SBP within short 3.5 h time window but did not influence DBP and HR. A short-term reduction of SBP and BT for 1.5-3.5 hours was observed. The values in the CR-LL+M group were significantly lower than in CR-LL at 2:00 h. Hence, exogenous melatonin did mimic the scotophase. Though this effect was gender-specific and found only in female YA. Results of this study prompt further research to qualify and quantify dosage-, duration- and time-dependent differences of melatonin effects, to discern between short-term (acute) and long-term (chronic) melatonin administration, and to clarify its underlying mechanisms.

Today, arterial hypertension (AH) is often associated with accelerated aging. In the structure of AH in persons over 65 years of age, the most common form is isolated systolic hypertension (ISAH), the mechanisms of development of which remain unexplained. Molecular regulation of remodeling of smooth muscle cells of vessels, changes in which, along with perivascular fibrosis and endothelial dysfunction, lead to increased sensitivity to procontractile mediators and calcification, forms the basis of mechanisms of vascular aging and rigidity. Clinically, this process is manifested in ISAH in individuals of an early period of old age and senile age. The search for new diagnostic molecular markers and the development of pharmacological correction of mechanisms of vascular wall aging in ISAH is an urgent and timely task. The review presents an analysis of current data from medical literature about the participation of fibulin-5 protein in the process of elastogenesis in the vascular wall, as well as in molecular pathological pathways of inflammation and aging of the vascular wall in ISAH. The role of multifunctional signal molecule fibulin-5 in the age-related loss of elasticity of the vascular wall is shown. Presented is the perspective of creating a drug from the group of senolitics based on fibulin-5 molecule, as well as modern application possibilities for preventing aging of the vascular wall of the drug Cytoflavin (active ingredients in 1 ml of solution: succinic acid, 100 mg; nicotinamide, 10 mg; riboxin, 20 mg riboflavin mononucleotide, 2 mg).

Background. The prevalence of arterial hypertension (HTN) increases with age, but the causes of HTN in elderly and young age are different. The contribution of the specific parameters of high blood pressure (BP) in the pathogenesis of organ damage in the elderly has not been studied enough. Objective. We assessed the effect of BP variability (BPV) on left ventricular (LV) remodeling and vascular stiffness in patients with HTN developed at age before and over 65 years. design and methods. Altogether 122 elderly patients were enrolled and divided into 3 groups: group 1–45 patients with newly diagnosed HTN 1–2 degree at the age over 65 years (21 males, 24 females, the average age — 71,7 ± 2,6 years), group 2–39 subjects with newly diagnosed HTN 1–2 degree under 65 years old (18 males, 21 females, the average age — 68,4 ± 2,4 years). The 3rd control group, comprised 38 elderly subjects without HTN (20 males, 18 females, the average age — 67,5 ± 2,0 years). At baseline, none of the patients achieved target BP. At admission to the hospital, two-component antihypertensive therapy was prescribed to all patients, it included a blocker of the renin-angiotensine-aldosterone system (RAAS) — an angiotensin-converting enzyme inhibitor or angiotensin receptor antagonist) and calcium channel blocker (amlodipine in all cases). Short-term BPV was assessed by ambulatory BP monitoring (ABPM), medium-term BPV — based on the BP monitoring for 7 days, and long-term BPV — based on the 3-month self-monitoring of BP. Central aortic pressure was also measured. LV myocardial mass index and LV relative wall thickness (2T/DD) were assessed by 2D-echocardiography, and early diastolic flow velocities E, A and the ratio E/A were evaluated by spectral Doppler. Pulse wave velocity, cardio-ankle vascular index (R-CAVI and L–CAVI), ankle-brachial index (ABI) and the biological arterial age were assessed by sphygmomanometry. Results. Increased BPV seems to be an indicator in elderly, as elderly patients without HTN show increased SBP and DBP short-term variability. However, the maximum rate of BPV increase was found in patients with the HTN development in the age over 65 years. In the same group, the correlation between BPV and LV and vascular remodeling was the most severe. The increase in visit-to-visit DBP variability had the greatest impact on the arterial wall stiffness, while visit-tovisit SBP variability affected LV remodeling. The increase in the mediumand long-term BPV was found to be a more powerful predictor of cardiovascular remodeling compared to the increase in short-term BPV assessed by ABPM. Thus, arterial stiffness may be an important factor leading to the increase in both short-term and longterm BPV. Conclusions. BPV measurement should be widely implemented for the assessment of cardiovascular risk and the overall effectiveness of antihypertensive therapy.

Aim. To study molecular effects of tiotriazoline in 30 patients with stable angina I-III functional class.Material and methods. Comparison of molecular effects of cardioprotection is done based on dynamics of exercise tolerance dynamics, and via proteomic methods of investigation, questionnaires assessment of life quality in patients with ischemic heart disease (IHD).Results. It was found, that tiotriazoline improves exercise tolerance, shows strong cardioprotective effect that includes antioxidant and cytoprotection effects in IHD patients.Conclusion. Tiotriazoline helps to reduce the mean number of angina attacks in IHD patients, as to improve mean functional class.

The purpose of this study was the development of personalized modes of therapy in elderly patients with isolated systolic hypertension (ISH).The study included 306 persons divided into two groups: Group 1 (Control) included 150 elderly persons without arterial hypertension (AH), and Group 2 included 256 elderly patients (early old- age pension, between 65 and 74 years) with ISH (ESH/ESC, 2013) according to the inclusion/exclusion criteria. All patients of Group 2 were divided into three subgroups depending on the combination of drugs at the beginning of the study. Group 2a (n=53) received amlodipine (5 mg/day) and indapamide- retard (1.5 mg/day), Group 2b (n=53) received valsartan (80 mg/day) and indapamide- retard (1.5 mg/day), and Group 2c (n=50) received amlodipine (5 mg/day) and valsartan (80 mg/day). The duration of therapy was 5.2 years.At the stage of data collection and screening, we applied standard methods for identification of ISH and secondary hypertension. Molecular phenotyping of blood serum was performed with methods of proteomics. We obtained the data of the molecular interactions and functional features of proteins from the STRING 10.0 database.Proteomic analysis contributes to the development of a personalized mode treatment in ISH patients, which is the safest and most efficient: 135 ISH patients switched to the administration of the amlodipine+valsartan combination.

The molecular pharmacological effects of cytoflavin in patients with hypertensive encephalopathy (HE) and isolated systolic arterial hypertension (ISAH) have been investigated using the following methods: assessment of complaints, 24-hour arterial pressure monitoring, ultrasound diagnostics including echocardiography, measurement of lipid profiles and coagulograms, and molecular phenotyping by MALDI-TOF/TOF-MS. A combination of cytoflavin administration with standard therapy of HE and ISAH led to the most expressed return development of clinical symptoms, restoration of the hemodynamic, structural, and geometrical parameters of cardiovascular system, and normalization of the indices of lipid profiles and coagulograms in comparison to patients with HE and ISAH, which accepted only standard therapy. Molecular mechanisms of cytoflavin action have been revealed, which include control of the activity of cellular signaling pathways by means of intermolecular interactions. The optimized therapy of HE and ISAH is recommended for clinical application, which assumes a combined use of standard therapy and cytoflavin and provides a geroprotective action upon the cardiovascular system.

The aim of the research was the search of the mechanism of Cytoflavin action in patients with isolated systolic arterial hypertension (ISAH) as the aging model. The following research methods were applied: the assessment of complaints, 24-hour arterial pressure monitoring, ultrasound diagnostic, volume sphygmography, lipid profiles and coagulogram, molecular phenotyping by MALDI-TOF-TOF-MS. The combination of Cytoflavin with standard therapy of ISAH led to the most expressed return development of clinical symptoms, the restoration of the haemodynamics, structural and geometrical parameters of cardiovascular system, indicators lipid profiles and coagulogram in the comparison with patients with ISAH, who accepted standard therapy and those of the control groups. Molecular mechanisms of Cytoflavin action, including regulation of the activity of cell signaling pathways through intermolecular interactions were found. We recommend using Cytoflavin together with the standard therapy in treatment of ISAH, which provides the action of geroprotectors for cardiovascular system.

The molecular pharmacological effects of cytoflavin in patients with hypertensive encephalopathy (HE) and isolated systolic arterial hypertension (ISAH) have been investigated using the following methods: assessment of complaints, 24-hour arterial pressure monitoring, ultrasound diagnostics including echocardiography, measurement of lipid profiles and coagulograms, and molecular phenotyping by MALDI-TOF/TOF-MS. A combination of cytoflavin administration with standard therapy of HE and ISAH led to the most expressed return development of clinical symptoms, restoration of the hemodynamic, structural, and geometrical parameters of cardiovascular system, and normalization of the indices of lipid profiles and coagulograms in comparison to patients with HE and ISAH, which accepted only standard therapy. Molecular mechanisms of cytoflavin action have been revealed, which include control of the activity of cellular signaling pathways by means of intermolecular interactions. The optimized therapy of HE and ISAH is recommended for clinical application, which assumes a combined use of standard therapy and cytoflavin and provides a geroprotective action upon the cardiovascular system.

The molecular effects of trimetazidine and mildronate were investigated in patients with stable effort angina, Functional Class (FC) I-III. The comparison criteria included blood activity and concentrations of the main products of free-radical oxidation and the components of Krebs cycle and anti-oxidant system. Proteomic methods were also used. Trimetazidine and mildronate could be recommended as cardio-protectors in primary and secondary prevention of FC I-III coronary heart disease.