The prevalence of hyperuricemia is due to the epidemic of obesity, changes in eating behavior in the population with the rise of purines, alcohol and fructose consumption, as well as the increased use of diuretics. It’s important to mention that over the past 20 years there has been an increase in the prevalence of such concomitant diseases and conditions as arterial hypertension (+15%), diabetes mellitus (+19%), decreased kidney function (+17%), hyperlipidemia (+40%) and obesity (+19%). Hyperuricemia (and/or gout) can be both a cause and a consequence of various comorbid conditions. That is why their treatment is closely connected with the treatments of hyperuricemia, especially of asymptomatic one.
It’s important to determine not only the upper limit of the uric acid in patients, when the therapy is being initiated, but to assess the target levels of uric acid, that must be achieved in patients receiving optimal treatment.
In this review article the main principles of both non-pharmacological and pharmacological treatment in patients with cardiovascular diseases are described. The need for medical treatment, target serum urate levels in patients with cardiovascular risk factors are discussed, as well as further perspectives in the field of research in patients with hyperuricemia and cardiovascular diseases.
Allopurinol is currently the key drug prescribed to patients with hyperuricemia and cardiovascular risk factors. The most important advantage is its safety profile. Patients receiving renal replacement therapy can also safely receive the drug.
The need to reduce the level of uric acid in patients with cardiovascular disease is currently beyond doubt. In the group of patients with additional risk factors, such as diabetes mellitus, metabolic syndrome and CKD, lifestyle modification in combination with urate-lowering therapy improves both the quality of life and prognosis. Currently, allopurinol is the drug of choice for the treatment of AH in combination with AH, taking into account both the efficacy and safety of its administration to this group of patients. However, it is obvious that further studies with clearer inclusion criteria are needed to analyze the effect of therapy on cardiovascular events, as well as combined endpoints.

This publication discusses the relevance of the problem of blood pressure control in patients with resistance to drug therapy in real clinical practice. Data on the prevalence of true resistant arterial hypertension and clinical features of patients are presented. At the same time, taking into account the wider prevalence of patients with pseudo resistant arterial hypertension, special attention is paid to diagnostic algorithms in the publication, and the criteria for excluding pseudo resistant arterial hypertension are analyzed in detail. Presented are modern ideas about the most common secondary causes of arterial hypertension, such as obstructive sleep apnea syndrome, the possibility of correcting this condition and the choice of drug therapy. For this publication, modern recommendations were used in the strategy for choosing the optimal antihypertensive therapy, taking into account the pharmacokinetic properties and the possibility of personalized choice in various clinical situations. We analyzed data on the benefits of antihypertensive therapy using fixed combinations to increase adherence to therapy with a blood pressure control strategy and reduce the risk of cardiovascular risks. Various search engines were used to search for data and material: PubMed, Google Academy, Elsevier, information resources of the Russian Society of Cardiology and the European Society of Cardiology.

The steady growth and prevalence of chronic heart failure (CHF) leads to an increase in mortality, repeated hospitalizations and disability of the population. More than half of rehospitalizations are due to poor adherence to therapy, the impossibility of timely observation by a doctor, and inadequate patient education in the basics of self-control and self-help during and after discharge. In order to improve the quality of life of patients with CHF, reduce the frequency of readmissions and mortality, it is necessary to create programs to optimize outpatient care with the possibility of monitoring clinical indicators and timely correction of therapy, which can be done using digital technologies — mHealth. The ubiquity of mobile phones and portable gadgets is thought to make the introduction of remote monitoring software more affordable and cost effective. Thus, the purpose of the review is to collect and analyze the available literature data on the use of mobile technology programs for non-invasive remote monitoring of patients with CHF. Thus, studies investigating the impact of remote monitoring on the course of CHF have included widely varying patient cohorts using dissimilar devices with different support packages. Of course, the heterogeneity of both the sample and the methods used led to the inconsistency of the data obtained, the inability to compare and evaluate the results in full. Along with this, the inability to directly compare different methods of remote monitoring of patients with CHF determines the impossibility of choosing the most effective of them, which, in turn, dictates the need for standardization of methods according to, including the healthcare system in each individual country. Overall, mHealth applications offer a potentially cost-effective solution with continued access to symptom monitoring, encouraging patient engagement in self-care and self-monitoring, and improved outcomes over standard practice. While there is considerable evidence for the effectiveness of remote monitoring programs, many areas of uncertainty remain, and mobile phone interventions require further careful evaluation. Although the available data is insufficient to confirm the impact of mobile phone monitoring, it is clear that the potential is enormous.

In December, 2021 at the IXth All-Russian Congress «Pulmonary Hypertension – 2021» the first Eurasian guidelines for the diagnosis and treatment of pulmonary hypertension associated with congenital heart disease (CHD) in adults were approved. In this review, the expert group presents the basic principles of calculating hemodynamics according to Fick for the systemic and pulmonary circulation. The method is indispensable for congenital heart defects. Theoretical and practical aspects of calculating hemodynamics with arteriovenous, venoarterial and bidirectional shunting are considered. The calculation of the cardiac index of each of the circles of blood circulation is performed on the basis of oxygen consumption, the oxygen capacity of the blood and the oxygen arteriovenous difference of each of the circles of blood circulation. Formulas are given for calculating the cardiac index of the systemic and pulmonary circulation, the cardiac index of effective blood flow, arteriovenous and venoarterial shunt, pulmonary and peripheral vascular resistance, as well as the classical table and the LaFarge and Miettinen formula for the calculated oxygen consumption depending on gender, age and heart rate. The review is illustrated with three clinical examples. Calculation of hemodynamics according to Fick should be started after getting acquainted with the anatomy and clinic of congenital heart disease: diagnosis, typical hemodynamic disorders, number and possible direction of shunts, saturation by pulse oximeter on the arms and legs; a purely mechanistic approach that does not take into account the clinical picture can reduce the information content and reliability of the method. The Fick method is somewhat limited by the impossibility of catheterization of the left atrium with an intact interatrial septum. Inaccuracies that are possible when assessing absolute indicators by the indirect Fick method are leveled when calculating their relative values, and the values are identical in reliability to the direct method. The Fick method, due to the obviously high error, is not advisable to use if there is another source of pulmonary blood flow besides the pulmonary artery system, as well as with a low arteriovenous difference in circulatory circles.

The aim of the study:to analyze ABPM readings in patients with stage II HTN receiving antihypertensive therapy in order to plan a personalized algorithm for managing HTN patients at the stage of the outpatient care. Materials and methods. 60 patients with stage II HTN were examined. ABPM readings were assessed on the background of planned antihypertensive therapy (ARBs and diuretics) and after the adjustment of the therapy (perindopril and amlodipine).
Results. The use of long period monitoring provides comprehensive information about the patterns of blood pressure changesthroughout the day. Patients with stage II HTN receiving planned antihypertensive therapy with ARBs and diuretics did not have targeted BP during the day and had a systolic HTN of stage I, while there was a statistically significant increase in BP variability during the day and in the readings indicating a hypertensive load of target organs in comparison with a group of patients receiving a combination of perindopril and amlodipine for 3 months. In addition, there was a statistically significant (ANOVA, p<0.05) difference in the rate of morning BP rise, which can serve as a precursor for the development of cardiovascular events in the morning compared to the group of patients with theadjusted therapy. Among hypertensive patients receiving ARBs and diuretics a disturbed circadian rhythm predominated in the structure of the diurnal BP profilecompared with the patients who received combined therapy with perindopril and amlodipine. In addition, the proportion of night-peakers among patients taking ARBs and diuretics was 2 times higher than among patients whose therapywas adjusted 3 months ago.
Conclusion. Thus, in the group of patients whose antihypertensive therapy was timely adjusted, there was an improvement in hemodynamics: due to the achievement of targeteddiurnal blood pressurereadings, a significant decrease in BP variability during the day and the rate of the morning rise in blood pressure, as well as the proportion of patients with a normal diurnal blood pressure profileincreased.

The aim is to evaluate the results of long-term follow-up of patients with various clinical forms of NCCM, associated clinical outcomes, as well as 3-year survival.
Materials and methods. 211 patients with NCCM (median age 39 [18; 72] years) were examined, of which: 94 (44.5 %) were diagnosed with an isolated phenotype and 117 (55.5 %) with a combination with other cardiomyopathies, including 103 (48.8 %) patients with a combination with DCM; 14 (6.6 %) with HCM, who, in addition to traditional clinical research methods, underwent CMR imaging with late gadolinium enhancement. The endpoints of the study included SCD, SCD with successful resuscitation and implantation of ICD and the implementation of OHT.
Results. During the follow–up period (median follow–up 36 [6-211] months), of 211 patients with NCCM, 24 (11.4 %) had adverse outcomes, including 1 (0.5 %) – SCD, 10 (4.7 %) – SCD with successful resuscitation and ICD implantation, 13 (6.2 %) had OHT. SCD occurred in 11 (5.2 %) patients with FC I-II NYHA, including 10 patients with successful ICD resuscitation and implantation after 23 (from 5 to 152) months after diagnosis. OHT was performed in 13 patients with FC III NYHA at 30 (from 8 to 113) months after diagnosis in a group of patients with a combination of NCCM and DCM. The average age at the time of SCD or OHT was 37±12 years.
The 3-year survival rate in the group of patients with the isolated form was 98.9 (96.7-100) %, and significantly differed with the group of patients with a combination of NCCM with DCM 86.5 (79.6-94) %, and with the group of patients with a combination of NCCM with HCM 72.9 (50.7-100) %, p=0.0012. Whereas the 3-year survival rate in the group with a combination of NCCM with DCM and NCCM with HCM did not significantly differ from each other. Conclusion. The prognosis of patients with an isolated form of NCCM is generally favorable and their 3-year survival rate was 98.9 (96.7-100) %. The presence of a combination of NCCM with other cardiomyopathies predicts the risk of adverse clinical outcomes and the 3-year survival rate of a combination of NCCM with DCM was 86.5 (79.6-94) %, and when combined with NCCM with HCM 72.9 (50.7-100) %, which may be useful when choosing a management strategy for patients with NCCM.

The article, using the example of two clinical cases, discusses the severity of the course of COVID-19 depending on the presence of cardiovascular diseases and the effectiveness of their treatment. Randomized clinical trials and meta-analyses of the coronavirus infection indicate a greater likelihood of developing severe forms of COVID-19 in patients with high and very high cardiovascular risk, in older age groups, with comorbid pathology, especially with arterial hypertension (AH), coronary heart disease (CHD), chronic heart failure (CHF), diabetes mellitus (DM). Considering effectiveness, safety and influence on the prognosis, an adequately selected therapy for concomitant diseases can reduce the number of adverse outcomes of the coronavirus infection. A key role in the development and progression of cardiovascular pathology is played by the renin-angiotensin-aldosterone system (RAAS), so RAAS blockers remain the first-line medicine in the treatment of cardiac patients. The experts of the European Society of Cardiology, the American College of Cardiology and the Russian Society of Cardiology confirm the importance of continuing therapy with this class of medicine in patients having already received RAAS blockers according to such indications as AH, CHD and CHF during COVID-19 and emphasize the danger of their cancellation in high-risk patients. Most patients need to take several groups of medicine which affect complementary pathogenetic mechanisms. It is shown that the reason for the lack of achieving blood pressure control in clinical practice is monotherapy or non-optimally combined therapy of free acceptable but not rational combinations of antihypertensive medicine. Optimization of the therapeutic regimen using fixed combinations of indapamide/perindopril and amlodipine/perindopril has made it possible to achieve an effective reduction in blood pressure according to routine measurement and ambulatory blood pressure monitoring, to reduce blood pressure variability, to increase patients’ adherence to the treatment. The use of such medicine is becoming the most relevant during the COVID-19 pandemic.

The development of heart failure in any patient causes a lot of concerns in view of the deterioration of quality of life of the latter. A clinical case of a patient with severe heart failure with a low left ventricular ejection fraction is described. The uniqueness of the demonstrated case consisted in the possibility of not only preserving the remaining resources of the heart muscle, but also in a significant restoration of systolic heart function due to adequate conservative therapy. The article presents a clinical case of successful restoration of contractile function of the heart in ischemic cardiomyopathy against the background of adequate conservative therapy. The diagnosis was not accompanied by difficulties. The patient underwent electrocardiography, echocardiography, coronary angiography, laboratory tests. According to the results patient was diagnosed with severe decompensated heart failure with reduced ejection fraction caused by coronary heart disease with NT-proBNP level of 286 ng/L. The results of coronary angiography did not reveal critical stenosis of the coronary arteries, and therefore the patient underwent drug treatment. Guideline-directed medical therapy treatment of chronic heart failure (angiotensin converting enzyme inhibitors, aldosterone antagonist, loop diuretics, beta-blockers, SGLT2 inhibitors) has allowed to achieve a good clinical result. Twelve months after beginning of the treatment left ventricular volume dimensions had changed significantly (LVEDV decreased from 220ml³ to 94ml³; LVESV from 162ml³ to 50 ml³), improvement of left ventricular ejection fraction from 17% to 42% (by Simson). The assessed 6-minute walk test showed functional class III according to the NYHA classification.

Venous thromboembolic complications (VTEC), including deep vein thrombosis (DVT) and pulmonary embolism (PE), are common pathologies of the cardiovascular system. Between 20% and 28% of patients experience recurrent VTE within 5 years of initial diagnosis. International clinical guidelines for the treatment of VTE prescribe oral anticoagulants to reduce the risk of recurrent VTE. Oral anticoagulants include direct oral anticoagulants (DOACs) and vitamin K antagonists (VKAs). DOACs have advantages over warfarin such as minimal interaction with other drugs, lower bleeding rate, fixed dosage, no need for regular laboratory monitoring. In connection with the above, DOACs are becoming the drugs of choice for anticoagulant therapy. In the absence of direct comparisons, data from observational studies are of interest. We present you the results of a large retrospective study evaluating the efficacy and safety of apixaban versus rivaroxaban in patients with VTEC (Dawwas, G. K. et al., 2021).