Designed by experts of the Russian Medical Society on Arterial Hypertension Approved at the meeting of the Russian Medical Society on Arterial Hypertension December 11, 2015 and the profile commission of Cardiology November 25, 2015 Moscow, 2015

The prevalence of hypertension in the female population, depending on the presence of gestational hypertension history, set the sensitivity, specificity, and predictive value of gestational hypertension as a predictor of hypertension. The observation was carried out during the mandatory preventive examinations, the volume of which amounted to 643 women. The questionnaire for the study of obstetric history included a chronological description of all the pregnancies of more than 22 completed weeks of gestation. Inclusion in the object of study only workers of the railway system made it possible to clarify and supplement the personal information about gestational hypertension according to the history of the birth, which are stored in the archives of the railway hospital. Women aged 49-54 years with gestational hypertension often observed significant increase in blood pressure. Probability of high blood pressure in women aged 4953 years, significantly increases depending on the number of pregnancies associated with gestational hypertension. Gestational hypertension is a highly sensitive (> 56,5%) and specific (>46,0%) predictor of hypertension aged 49-53 years, the predictive value which is greater than 42.9%.

Current study was designed to investigate the frequency of the incidence of type A personality and high levels of neuroticism in groups of healthy young men and women with a family history of coronary artery disease (CAD) and diabetes mellitus (DM). The study was performed using psychological questionnaires of Jenkins and Aizenk. The high frequency of type A behavior, high levels of neuroticism, as well as the combination of the two, was established in the groups of healthy men with family history of CAD and DM. Women's groups were characterized by a lower frequency of type A personality and also lower incidence of the combination of type A personality with high levels of neuroticism. Thus, among the groups of healthy young men with a family history of CAD and DM, a sufficient number of individuals with a high risk of CAD, who need preventive measures with involvement of professional psychologists was found.

Pulmonary endarterectomy (PEA) is the method of choice in treatment of chronic thromboembolic pulmonary hypertension (CTEPH). There are a lot of factors still restricting the widespread use of these operations. Among them are the difficulties of diagnosing and patient selection, the peculiarities of operation and postoperative treatment, the unawareness of cardiological community about surgical outcomes. We discuss the preparation of the patient to PEA, standards of the surgery and postoperative treatment. The results of preoperative diagnostics and PEA-operations at our center are presented. The possible causes of postopreative mortality and adverse outcomes are also discussed.

Objective. To evaluate the dynamics of clinical and functional status, the parameters of central hemodynamics and tolerability of bosentan therapy lasting more than 12 months in patients with idiopathic pulmonary hypertension (IPAH). Materials and methods. In the study we included 20 IPAH non-responders with functional class II-III (WHO). All patients were assigned to treatment with bosentan in the initial dose of 125 mg/ day, which was increased to 250 mg/day after 4 wks. The mean FU duration was 15±3 months. Conducted 5 visits: at baseline and visit 5, all patients underwent a comprehensive examination, including right heart catheterization (RHC). Transthoracic echocardiography was performed additionally at visit 3. 6-minute walking (6MW) test was assessed every 3 months. For safety reasons hepatic transaminases were analyzed monthly. Results. Bosentan therapy resulted to significant improvement of functional class (FC (I/II/III) with 0%/45%/55% to 30%/45%/25%, p<0.05) to 15±3 month. Mean 6MW distance increases by 54 m. In 9 pts during extension period the achieved clinical and functional status remained stable to 54±6 months. We showed the significant decrease of right ventricle and atrium sizes. At 15±3 months RHC revealed a significant decrease in SPAP, PVR, increase of cardiac output / cardiac index, oxygen saturation of mixed venous and arterial blood. During follow-up period we found the maximal increase of liver enzymes of 1.5 ULN. Adverse events (headache and flushing) were reported in 1 pt. without requirement of treatment discontinuation. Conclusion. Bosentan therapy was highly effective in IPAH patients with FC II-III for 15±3 months. Stable functional and hemodynamic status of patients was maintained to 54±6 months with good tolerability of the treatment.

Aim: To evaluate features of the functional state of microvascular bed of the skin in patients with idiopathic pulmonary arterial hypertension (IPAH) depending to acute vasoreactivity testing on inhaled nitric oxide. Methods: in study included 28 patients with IPAH (mean age 39,8±13,2 years) and 25 healthy volunteers (39,3±10,1 years). All the patients underwent 6-minuts walking test (6-MWT), transthoracic echocardiography, thorax organs radiography, right heart catheterization (RHC) with acute pharmacological test (APT), laser Doppler flowmetry (LDF) with functional tests. Patients were divided into 2 groups by results of APT. Results: according to the LDF the APT+ patients didn't differ from control group on any of the parameters. The APT-patients according to the basal perfusion also were comparable with control group, but had significantly higher constrictory reactions for all types vasoconstrictor stimulations (at activation of sympathetic nervous system in respiratory and cold tests, and in the development venule-arteriolar constrictory response on venous occlusion) and elongation of time development post-occlusive reactive hyperemia. We identified significant correlation of the amplitude of respiratory section of blood flow modulation, which reflected degree of venule plethora, with the RHC parameters and functional status of patients. Conclusion: In the APT-patients on against a background the of uncharged basal perfusion parameters noticed increased constrictory activity smooth muscle cells of resistive microvessels for all type vasoconstrictor stimulations, but expression of constrictory reactions correlated with indications of patients functional status.

Phylogenetically late intima of elastic arteries has no proteins for transportation of non-ligand oxidized low density lipoproteins (LDL) adsorbed on the matrix to resident macrophages. Phylogenetically early cells realize the reaction of extracellular digestion by secreting the proteolytic enzymes metalloproteases in the matrix. They hydrolyze matrix proteoglycans, adsorbed and non-ligand LDL, absorb detritis, and terminate hydrolysis of the most hydrophobic polyenic cholesterol esters (poly-CE) in lysosomes. Smooth muscle cells migrate from arterial media, change their phenotype from contractile to synthetic and produce in situ de novo matrix proteoglycans. Elastic arterial wall consists of three layers: a) endothelial monolayer, b) intima + media (smooth muscle cells) and b) adventitia. It seems reasonable to define functional differences between phylogenetically early resident macrophages and phylogenetically late monocytes-macrophages. They may be associated with scavenger receptors, CD36 translocase activity, production of acid hydrolases for poly-CE or realization of the biological reaction of extracellular digestion. We suppose that atheromatous masses are formed in the matrix of arterial intima but not in lysosomes when the ability of monocytes-macrophages to provide endocytosis of non-ligand LDL from the matrix is limited. If atheromatosis is a syndrome caused by intracellular deficiency of essential polyenic fatty acids (PFA), intimal atheromatosis is associated with partial utilization of excess PFA in the matrix of elastic arteria. At late stages of phylogenesis the intima formed from smooth muscle cells of the media.