[New Targets in Blood Pressure Control: Arguments Pro and Contra].

The review contains results of analysis of clinical studies on the problem of defining the target level of the blood pressure (BP). The rationale for selection the target systolic BP level below120 mmHg was obtained in the SPRINT study comparing the target levels <120 mmHg and <140 mmHg. A considerably lower number of cardiovascular complications and deaths was seen in the group of a stricter BP control. Nevertheless, this study had some limitations related to certain patient populations, and methods of BP measurement. More ambitious target of BP lowering was associated with elevated risk of iatrogenic hypotension and fainting. Moreover, the ACCORD study, exploring the same target levels failed to demonstrate similar risk reduction. Taking into account various literature data, the authors find it reasonable to use personalized approach to determining BP targets, and utilize assessment of central aortic pressure and state of vessels for more accurate risk stratification and selection of treatment.

[Effect of psychosocial stress on the level of anxiety, depression and behavioral risk factors of cardiovascular diseases in men].

AIM: To elucidate peculiarities of risk factors (RF) of cardiovascular diseases and frequency of arterial hypertension (AH) at place of work in men with various level of psychosocial stress. MATERIAL AND METHODS: We examined 224 men (and their assistants) aged 22-55 years. Examination included analysis of risk factors, assessment of psychoemotional status (self-assessment of psychosocial stress using Reeder Stress Inventory [RSI] and Hospital Anxiety and Depression Scale [HADS]), detection of AH at working place by "Mathematical calculation" stress test. Three groups were formed according to results of RSI: with high (16.1%), medium (44.6%), and low (39.3%) level of stress. RESULTS: High level of stress was associated with older age (p < 0.01), stressful occupation (locomotive drivers) (p < 0.001), threat of emergency situations (p = 0.0007), history of early cardiovascular diseases (p = 0.02), insufficient consumption of vegetables and fruits (p = 0.02), higher body mass (p = 0.02), insufficient sleep duration (p = 0.02), subclinical, clinical anxiety and depression, work place AH (p = 0.002).

[Professional stress and development of stress-induced hypertension].

AIM OF THE STUDY: to elucidate rates of development of arterial hypertension (AH) at working place (wp), risk factors of cardiovascular diseases (CVD), anxiety depressive disorders in persons with professional stress. We carried out monitoring of arterial pressure during working hours and hours of rest, assessed risk factors of CVD development, and evaluated severity of symptoms of anxiety and depression using the Hamilton scale in 138 men (mean age 40.0+/-1.2 years). Results of the study evidenced for high frequency (46.4%) of development of AHwp among representatives of stressful occupations. Patients with AHwp have risk factors of CVD development and total coronary risk comparable with those of patients with hypertensive disease. Patients with AH have more pronounced anxiety depressive disorders than healthy subjects.

[Physical rehabilitation in the complex hospital therapy of patients with chronic low cardiac output]. / Fizicheskaia reabilitatsiia v kompleksnom statsionarnom lechenii bol'nykh s khronicheskoi serdechnoi nedostatochnost'iu.

AIM: To study action of medication in combination with free-choice bicycle exercise on cerebral and peripheral hemodynamics in patients with chronic heart failure (CHF) of functional class II-III. MATERIAL AND METHODS: At admission to hospital and at discharge 100 patients with CHF of NYHA functional class (FC) II-III hospitalized for progression of CHF have undergone clinical examination, Doppler echocardiography and biomicroscopy of conjunctival vessels. The patients were randomized into two groups: group 1 of 60 patients received standard drugs and exercised on bicycle: group 2 of 40 patients received standard drugs only. RESULTS: The patients of group 2 achieved better hemodynamic effect, greater lowering of total peripheral vascular resistance. In patients with CHF FC II cardiac output increased due to improvement of left ventricular systolic function (end-systolic and end-diastolic volumes reduced by 20.3 and 38.7%, respectively, ejection fraction increased by 13.7%); in patients with FC III--due to improvement of diastolic function (end-diastolic volume reduced by 8.3%). Bicycle exercise in combined treatment of FC II CHF provides improvement in perivascular and intravascular components of microcirculation by 46.7 and 24.3%, respectively. In FC III CHF intravascular microcirculation improved by 24.3%. CONCLUSION: Bicycle exercise of patients with CHF of FC II and III used as an adjuvant to standard drugs has an additional positive effect on central hemodynamics and microcirculation.