Expression of Genes Encoding Nuclear Factors PPARγ, LXRß, and RORα in Epicardial and Subcutaneous Adipose Tissues in Patients with Coronary Heart Disease.

The nuclear factors PPARγ, RORα, and LXRß are involved in transcriptional control of adipogenesis and implicated in glucose and lipid metabolism. In adipose tissues, they regulate inflammation. This study focuses on expression of the PPARG, RORA, and LXRß (NR1H2) genes in epicardial and subcutaneous adipose tissues in patients with coronary heart disease as well as with concomitant abdominal obesity. In patients with coronary heart disease and abdominal obesity, PPARG mRNA level in subcutaneous adipose tissue was reduced in comparison with control group. In patients with total coronary occlusions, LXRß mRNA level in epicardial adipose tissue was reduced, and it positively correlated with plasma HDL cholesterol. Thus, in cases of concomitant abdominal obesity and chronic total coronary occlusions, coronary heart disease is characterized by down-regulated expression of the genes of various transcriptional adipogenesis-regulating factors in adipose tissue.

[The Expression of Genes Encoding ABCA1 and ABCG1 Transporters and PPARγ, LXRß, and RORα Transcriptional Factors in Subcutaneous and Visceral Adipose Tissue in Women with Metabolic Syndrome].

The study aimed to investigate tissue-specific gene expression of ABCA1 and ABCG1, encoding cholesterol transporters, as well as PPARG, LXRß (NR1H2), and RORA, encoding the most important transcriptional regulators of lipid metabolism, in subcutaneous and visceral adipose tissue (SAT and VAT) in women with metabolic syndrome. It was shown that the ABCG1 mRNA SAT/VAT ratio decreases with age and correlates with the development of metabolic syndrome. After age adjustment, women have reduced chances of metabolic syndrome development when ABCG1 gene expression in SAT is higher relative to VAT than women with VAT ABCG1 gene expression higher or comparable to SAT: OR = 0.15 (95% CI 0.03-0.76), p = 0.023. The ABCA1 mRNA SAT/VAT ratio positively correlated with HDL cholesterol levels (after age adjustment ß = 0.350, p = 0.046), therefore individuals with higher ABCA1 mRNA level in SAT relative to VAT had elevated HDL levels. The ABCA1 mRNA level in SAT was decreased in smokers (p = 0.001). There was a negative correlation between the PPARG mRNA level in SAT with body mass index and waist circumference in the general sample (ß = -0.602, p = 0.003 and ß = -0.642, p = 0.001, respectively, after age adjustment). A decrease of the PPARG mRNA SAT/VAT ratio was associated with elevated plasma insulin level and the insulin resistance index HOMA-IR ß = -0.819, p = 0.004 and ß = -1.053, p = 0.008, respectively, after age adjustment). Thus, the study has shown that the ratio of ABCA1, ABCG1, and PPARG genes expression in different types of adipose tissue (SAT/VAT) could be a significant factor that predicts the development of atherogenic dyslipidemia, metabolic syndrome, and insulin resistance in obesity.

Association of myocardial and serum miRNA expression patterns with the presence and extent of coronary artery disease: A cross-sectional study.

BACKGROUND: MicroRNA (miRNAs) participate in the pathogenesis of coronary artery disease (CAD). OBJECTIVE: To evaluate the expressions of myocardial and serum miRNA-27а, miRNA-133а, and miRNA-203 in CAD patients. METHOD: This cross-sectional observational study comprised 100 subjects (60.9 ± 1.0 years; 67% men). The right atrial and serum expressions of miRNA-27a, miRNA -133a, and miRNA-203 in 80 patients referred for elective coronary artery bypass graft surgery (CABG) and 20 control patients scheduled for heart valve surgery were analyzed using real-time polymerase chain reaction. RESULTS: There was a positive correlation between the SYNTAX score I index and serum miRNA-203 expression level (r = 0.693; p < .001). Patients with ≥3 coronary artery lesions had significantly higher myocardial expressions of miRNA-27a, miRNA-133а, and miRNA-203 than patients with 1-2 vessel disease in the atrial myocardium (miRNA-27a: 234.62 ± 29.51 vs. 182.39 ± 19.62 relative expression unit (REU); miRNA-133а: 127.53 ± 13.41 vs. 111.35 ± 12.31 REU; and miRNA-203: 5.25 ± 0.96 vs. 4.71 ± 0.67 REU; р < 0.05); the same association was found for serum miRNA expressions (miRNA-27a: 11.41 ± 3.85 vs. 4.82 ± 1.82 REU; miRNA-133а: 8.42 ± 2.43 vs. 4.35 ± 1.23 REU; and miRNA-203: 145.71 ± 15.73 vs. 43.70 ± 9.67 REU; р < 0.05). The decision tree method established that the risk of multivessel lesions was increased five-fold if the miRNA-203 serum expression was >101.00 REU (OR, 5.90; 95% CI, 2.34-9.46; p < .001). CONCLUSIONS: Both myocardial and serum miRNA-27а, miRNA-133а, and miRNA-203 expressions are higher in CABG patients than in non-CAD subjects. The serum miRNA-203 expression level corresponds to myocardial expression and is strongly correlated with the extent of coronary atherosclerosis.

[Epicardial and subcutenious adipose tissue adiponectin gene expression in coronary artery disease patients].

Aim To determine the expression of adiponectin gene (ADIPOQ) and the content of high-molecular-weight adiponectin (HMWA) in epicardial (EAT) and subcutaneous adipose tissue (SCAT) in patients with ischemic heart disease (IHD).Material and methods Paired samples of EAT and SCAT and blood serum were withdrawn from patients with IHD after bypass surgery and 16 subjects without IHD (comparison group). Matrix RNA (mRNA) level was measured using real-time polymerase chain reaction. HMWA levels in EAT and SCAT were evaluated by Western blotting. Serum adiponectin concentration was measured immunoenzymatically. For all patients, echocardiography was performed to measure the EAT thickness; coronarography was performed to determine severity of coronary atherosclerosis.Results Serum adiponectin concentration was lower in IHD patients than in the comparison group (p<0.001). Levels of ADIPOO gene mRNA and HMWA in SCAT were lower in IHD patients than in the comparison group (р=0.020 and p=0.003, respectively). The HMWA level in EAT was lower with the EAT thickness of 8 mm compared to the HMWA level in IHD patients with EAT ≤8 mm (p=0.034).Conclusion The decreased serum concentration of antiatherogenic adiponectin and the reduced expression of ADIPOQ gene in SCAT (mRNA, HMWA) are associated with IHD.

[Prognostic value of epicardial fat thickness in coronary heart disease patients after myocardial revascularization].

Objective To study the role of epicardial adipose tissue (EAT) in determination of risk for adverse course of ischemic heart disease (IHD) in patients after myocardial revascularization.Materials and Methods This study included 217 subjects, 182 IHD patients and 35 evaluated individuals without IHD. Percutaneous coronary intervention (PCI) was performed for 104 patients and coronary bypass (CB) was performed for 78 patients. Also echocardiography (EchoCG) and cardiac computed tomography were performed.Results In IHD patients, EAT volume and thickness were greater than in evaluated subjects without IHD. The composite endpoint (CEP) was observed after PCI more frequently than after CB. In IHD patients with an EAT thickness of 8.5 to 10.2 mm measured with EchoCG in the atrioventricular groove, the risk of CEP was 4.3 times higher after myocardial revascularization than with thicker or thinner EAT regardless of the revascularization method.Conclusion An EAT thickness of 8.5 to 10.2 mm in the atrioventricular groove as measured with EchoCG was associated with a risk of adverse IHD course in patients who have underwent myocardial revascularization.

[Epidemiology of Arterial Hypertension in Russian Federation - Importance of Choice of Criteria of Diagnosis].

PURPOSE: Assessment of prevalence of arterial hypertension (AH), need for prescription of antihypertensive therapy (AHT), and efficacy of AHT in Russian population in accordance with novel guideline of the American College of Cardiology/American Heart Association ("American recommendations") on diagnosis and treatment of AH (2017). MATERIALS AND METHODS: Epidemiological study ESSE-RF (ЭССЕ-РФ) was carried out in 12 regions of Russian Federation (RF) with different climatic-geographic characteristics. Number of examined residents of RF aged 25-65 years was 20 652. The sample was stratified by  gender and age. Examination included anthropometry, laboratory tests, blood pressure (BP) measurement with the OMRON tonometer. The SCORE scale was used for evaluation of risk of development of cardiovascular diseases (CVD). In  American recommendations AH was defined as  follows: 1-st degree  - systolic BP (SBP) 130-139  and/or diastolic BP (DBP) 80-89 mm Hg, 2-nd degree - BP ≥140/90 mm Hg and/or presence of AHT. In recommendations of the European Society of Cardiology (2013, 2018) ("European recommendations") AH was defined as BP ≥140/90 mm Hg and/or presence of AHT. RESULTS: We analyzed data of examination of  20 607  participants - 7806 men (37.9%) and 12 801  women (62.1%). According to  European recommendations AH was diagnosed in 10 347  persons (50.2%)  - 3987 men (51.1%) men and 6 360 women (49.7%). According to American recommendations AH was registered in 14 853 persons (72.1%) - 6 059 men (77.6%) and 8 794 women (68.7%). AHT received 6324 persons (61.1% of those with AH); according to American recommendations, the onset of AHT was indicated to additional 620 persons with 1-st degree AH because of high CVD risk. Among all participants with AH (on and without AHT) strengthening of AHT for achievement of target BP level was required in 77.8 and 92.6% of patients according to European and American recommendations, respectively. CONCLUSION: Application of novel criteria of AH diagnosis from 2017 ACC/AHA guideline to Russian population would increase prevalence of AH up to 72.1%. Onset of AHT would be indicated in 13.8% of patients with 1-st degree AH, while in 93% of patients receiving AHT its strengthening would be required.

[Common Carotid Intima-Media Thickness, Levels of Total and High-Molecular Weight Adiponectin in Women With Abdominal Obesity].

OBJECTIVE: to investigate influence of different forms of adiponectin on carotid intima-media thickness (CIMT) in women with abdominal obesity (AO) in St.­Petersburg. It has been recognized before that AO is associated with cardiovascular diseases, including atherosclerosis, but mechanism of this association remains unclear. AO leads to imbalance of adipokines, in particularly decrease of adiponectin, which may lead to atherosclerotic lesion of carotid arteries. MATERIALS AND METHODS: We investigated 81 women with AO (IDF criteria, 2005) and 21 women with normal waist circumference. СIMT was evaluated by an ultrasound scanner. RESULTS: Among patients with AO 54.9 % had CIMT >0.9 mm and 38.5 % had atherosclerotic plaques in common carotid arteries. The total adiponectin level (TA) was lower in women with CIMT> 0.9 mm, than in women with normal CIMT (23.20 [2.55; 40.65] and 18.09 [1.60; 38.92] µg/ml, respectively; р0.9 mm, than in women with normal CIMT (2.21 [0.50; 6.85] and 2.88 [1.29; 15.45] µg/ml, respectively; р0.9 mm, than in women with CIMT >0.9 mm and atherosclerotic plaques in carotid arteries (3.09 [1.34; 6.85] and1.82 [0.50; 2.94] mcg/ml, respectively; р0.9 mm depended on waist circumference, diastolic blood pressure and level of C-reactive protein (CRP), while presence of atherosclerotic plaques was associated with levels of HMWA and CRP. CONCLUSIONS: Factors that make the greatest contribution at early stages of atherosclerosis development in carotid arteries in women with AO can be increased waist circumference, high diastolic blood pressure, and high level of CRP. At later stages of atherosclerosis development lowered HMWA level can contribute to the formation of atherosclerotic plaques.

[Genetic Risk Factors of Macrovascular Complications in Patients With Type 2 Diabetes].

High risk of macrovascular complications in patients with type 2 diabetes mellitus (T2DM) is caused by insulin resistance and atherogenic dyslipidemia that may be genetically determined. The aim of this study was to assess the association of polymorphic genetic variants APOA5 (S19W/rs3135506), CETP (Taq1B/rs708272), PON1 (Q192R /rs662) and PPARG (Pro12Ala /rs1801282) with T2DM and macrovascular complications in patients with T2DM resident in Northwestern Russia. We examined 386 patients with T2DM and 199 healthy controls. Genotyping was performed by polymerase chain reaction followed by restriction analysis. The study revealed the protective role of allele 12Ala of PPARG gene against T2DM development (odds ratio [OR]=0.58; 95% confidence interval [CI] 0.39-0.85). B1B1 genotype of CETP was associated with increased risk of stroke in T2DM patients (OR=1.85; 95%CI1.07-3.21). RR genotype of PON1 was associated with increased risk of T2DM with stroke (OR=2.98; 95%CI1.01-8.84). According to study results Pro12Ala (rs1801282) variant of PPARG affected the risk of T2DM; polymorphic variants of CETP (Taq1B/rs708272) and PON1 (Q192R/rs662) contributed to the risk of macrovascular complications of T2DM.

ITLN1, PPARg AND TNFa GENE EXPRESSION IN VISCERAL ADIPOSE TISSUE.

The adipose tissue is considered today as an endocrine organ in which tissue-specific regulation of gene expression plays a key role in the processes of development of obesity and comorbidities, such as diabetes and cardiovascular disease. The present study is focused on ITLN1, PPARã and TNFá gene expression in intra-abdominal adipose tissue and its effect on the serum levels of omentin 1 and TNFa in individuals with different body mass. It has been shown that serum TNFa level is significantly higher in the subgroup of patients with overweight and obesity (BMI ≥ 25 kg/m2) as compared to individuals with normal body weight (BMI < 25 kg/m2)( p < 0.03). We have demonstrated that the expression level of the PPARã gene is positively correlated with the ITLN1 gene expression level in the intra-abdominal adipose tissue (r = 0.516, p = 0.020). Serum level of omentin 1 positively correlates with PPARã mRNA and protein levels in intra-abdominal adipose tissue (r = 0.550, p < 0.05 and r = 0.581, p < 0.03, respectively). For the subgroup of patients with overweight and obesity, we have shown negative correlation of the level of TNFá mRNA with PPARã and ITLN1 mRNA levels was shown (r = ­0.549, p < 0.05 and r = ­0.475, p < 0.05, respectively). This study is the first to show a correlation relationship between PPARã gene expression level in the intra-abdominal adipose tissue and the expression and secretion levels of omentin 1.

[Regulation of ABCA1 and ABCG1 gene expression in the intraabdominal adipose tissue]. / Reguliatsiia ékspressii genov transporterov ABCA1 i ABCG1 v intraabdominal'noi zhirovoi tkani.

Tissue specific expression of genes encoding cholesterol transporters ABCA1 and ABCG1 as well as genes encoding the most important transcriptional regulators of adipogenesis - LXRa, LXRb, PPARg and RORa has been investigated in intraabdominal adipose tissue (IAT) samples.A direct correlation between the content of ABCA1 and ABCG1 proteins with RORa protein level (r=0.480, p<0.05; r=0.435, p<0.05, respectively) suggests the role of the transcription factor RORa in the regulation of IAT ABCA1 and ABCG1 protein levels. ABCA1 and ABCG1 gene expression positively correlated with obesity indicators such as body mass index (BMI) (r=0.522, p=0.004; r=0.594, p=0.001, respectively) and waist circumference (r=0.403, p=0.033; r=0.474, p=0.013, respectively). The development of obesity is associated with decreased IAT levels of RORa and LXRb mRNA (p=0.016 and p=0.002, respectively). These data suggest that the nuclear factor RORa can play a significant role in the regulation of cholesterol metabolism and control IAT expression of ABCA1 and ABCG1, while the level of IAT LXRb gene expression may be an important factor associated with the development of obesity.

[Galectin-3 in Patients With Paroxysmal and Persistent Atrial Fibrillation and Metabolic Syndrome].

OBJECTIVE: To evaluate serum galectin 3 and to determine the potential clinical value of this parameter in patients with atrial fibrillation - AF (paroxysmal and persistent) and metabolic syndrome (MS). DESIGN AND METHODS: We examined 100 patients with MS (50 with paroxysmal or persistent AF and 50 without arrhythmia) and 50 healthy persons. Serum galectin 3 measured by ELISA method, ECHO cardiography was performed to all examined persons. RESULTS: Galectin 3 in patients with MS and AF was higher, than in patients with MS without arrhythmia and much more higher than galectin 3 in healthy persons 0,72 (0,44;1,36), 0,44 (0,42;1,22) and 0,32 (0,28;0,42) ng/ml (<0,01). In patients with persistent AF levels of galectin 3 is higher than in patients with paroxysmal AF. Positive correlation between the levels of galectin 3 and duration arrhythmia was revealed (r=0,301; p<0,01). Higher level of galectin 3 was revealed in patients with frequent paroxysms of AF and ineffective antiarrhythmic therapy. CONCLUSION: Marker of myocardial fibrosis serum galectin 3 in patients with atrial fibrillation and metabolic syndrome is higher than in patients with the metabolic syndrome, without this arrhythmia and higher than in healthy controls. In patients with persistent AF level of galectin 3 was higher than in patients with paroxysmal AF.

[Adipokines Level in Metabolically Healthy Obese Saint-Petersburg Inhabitants (ESSE-RF)].

AIM: to elucidate prevalence of phenotypes of metabolically heathy obesity (MHO) among inhabitants of Saint-Petersburg using various criteria and assess dependence levels of adipokines on obesity phenotype. MATERIAL AND METHODS: Within a framework of epidemiologic study ESSE-RF we formed a random sample of 1600 Saint-Petersburg inhabitants stratified according to gender and age. Examination of participants included anthropometry with measurement of waist circumference CRP and estimation of body mass index (BMI), measurement of arterial pressure, determination of fasting blood glucose, insulin (with calculation of index of insulin resistance -IIR), lipid spectrum, C-reactive protein (CRP), adiponectin, leptin. In subjects with obesity (BMI more or equal 30 kg/m) we used Meigs and Wildman MHO criteria. To Wildman criteria we applied 3 variants of definition of elevated CRP and IIR: 90th percentile among subjects with BMI <25 kg/m (variant 1) or among all participants (variant 2), and (variant 3) definition from publication by E.Oliveros et al. (2014). RESULTS: Obesity (BMI more or equal 30 kg/m) was found in 430 participants. Numbers/rates of MHO according to the Wildman criteria were the following: variant 1 - 49/12% (among them 13/10% men and 36/14% women, =0.15); variant 2 - 85/22% (24/18% men, 61/23% women, =0.13); variant 3 - 59/15% (13/10% men, 46/18% women, =0.02). Portion of MHO according to Meigs criteria was 138/35% (among them 48/36% men, 90/35% women, =0.4). Significant differences in adipokines levels between subjects with MHO and metabolically unhealthy obesity (MUHO) were revealed only among women. There was no difference in leptin level between subjects with MHO and MUHO irrespective of gender. CONCLUSION: Rate of MHO phenotype in a sample of inhabitants of Saint-Petersburg varied from 12 to 35% depending on criteria used. Gender differences in MHO rates were minimal and depended on selected criteria. Elevated adiponectin level among obese women could be presumably related to more favorable metabolic profile.

[Safety and Efficacy of Amlodipine, Lisinopril and Rosuvastatin Therapy in Patients With Metabolic Syndrome and Nonalcoholic Fatty Liver Disease].

AIM: To evaluate the efficacy and safety of amlodipin, lisinopril and rosuvastatin therapy in metabolic syndrome and high cardiovascular risk patients with nonalcoholic fatty liver disease (NAFLD). PATIENTS AND METHODS: 6 months randomized study of fixed combination of amlodipin and lisinopril with or without rosuvastatin of 20 patients with 2 grade of arterial hypertension, dyslipidemia with metabolic syndrome and nonalcoholic fatty liver disease (NAFLD). Efficacy and safety was revealed: office BP, ABPM, NAFLD Fibrosis scale, insulin resistance index (HOMA-IR), serum lipids were measured basically and after 6 months of therapy. RESULTS: 6 months amlodipin and lisinopril therapy results: office BP decreased from 153,4+/-2,9/83,3+/-2,5 to 131,0+/-2,4/79,9+/-4,5 mm Hg (=0,001, for systolic BP).159/91 to 132/77 mm Hg. 24-hours BP decreased from 153,6+/-3,6/89,5+/-3,2 to 127,1+/-3,0/73,5+/-2,9 (=0,002); in 85% of patients BP normalized. Low density lipoprotein cholesterol (LDL-C) decreased lower 2.5 mmol/l in all patients and lower 1.8 mmol/l in 45% patients on rosuvastatin therapy. Before therapy 3 patients had elevated ALT levels, after 6 months therapy all patients had normal levels of ALT and AST. ALT decreased from 33,7+/-4,3 to 23,2+/-3,5 U/l (=0,01). Alkaline phosphatase decreased from 65,4+/-4,1 to 51,1+/-6,9 U/l (=0,02), gamma glutamyl transpeptidase level was stable. NAFLD Fibrosis index revealed fibrosis and was stable -0,9+/-0,2 and -0,9+/-0,2 (>0,05). HOMA-IR decreased from 4.2+/-0,4 to 2,9+/-0,4 (=0,02). DISCUSSION: Some antihypertensive drugs and statins can be hepatotoxic especially in patients with metabolic syndrome and NAFLD. Antihypertensive drugs and statins with minimal liver metabolism can be preferable in NAFLD patients. CONCLUSION: Amlodipin, lisinopril and rosuvastatin therapy is effective and safe in patients with metabolic syndrome of high cardiovascular risk and liver steatosis.

[Leptin and metabolic syndrome].

Obesity is characterized by increased concentration of leptin and disturbance of the feedback between hyperleptinaemia and enhanced appetite. The hyperleptinaemia is often combined with hyperglycaemia and arterial hypertension and seems to be a predictor of acute cardiovascular events. Leptin inhibitors might be used in the future for therapy in case of the metabolic syndrome.

[Antihypertensive treatment compliance and obstacles to its improvement. Results of Russian program ARGUS-2].

AIM: To study barriers made by the patients for adequate treatment of arterial hypertension. MATERIAL AND METHODS: The ARGUS-2 trial was made in 15 centers of 13 cities of Russia. Anonymous questionnaire survey covered 1298 patients (796 outpatients and 502 inpatients). The patients answered the following questions: 1) what are basic problems of life with hypertension; 2) compliance with intake of antihypertensive drugs; 3) causes of missed intakes of the drugs; 4) opposition to intake of drugs by the patients. Questioning procedure was preset by the trial protocol. RESULTS: Only 37.4% (38.9% outpatients, 34.6% inpatients) were the treatment adopters. Drug intake was missed most frequently because offorgetting. The problems of life with hypertension were differently interpreted by patients and physicians: for the latter main problems were financial and routine while AH complications were on the 6-7 place. The latter were of primary importance for the patients while financial problems took place 4-6 Barriers to regular intake for the patients were poor self-control and unawareness about side effects of the drugs. CONCLUSION: Complience of the patient can be improved only by complex approach: improvement of education, higher motivation, active involvement of patients into the treatment process, better contacts between the physician and the patient.

[Problems of a physician-patient interaction and control of arterial hypertension in Russia. Main results of scientific-practical program ARGUS-2].

OBJECTIVE: To study the problems of physician-patient cooperation, patient- and physician related barrieres to target blood pressure (BP) achievement and to demonstrate improvement of BP control with indapamide SR 1.5 mg, when given to patients remaining uncontrolled while receiving antihypertensive therapy without thiazide diuretics (TD). METHODS: The trial Improvement of Arterial Hypertension Control in High-Risk Hypertensive Patients (ARGUS-2) run in 15 Russian centres during the year 2006. Retrospective analysis of medical notes of 684 outpatients and 575 inpatients with arterial hypertension. Validated questionnaires were used for interview of 373 physicians and 1298 patients. The study of Arifon retard efficacy was carried out in 1438 outpatients with difficult-to-control hypertension. RESULTS: BP was above the goal level in 97.1% pts at the first analyzed visit to an outpatient department. Antihypertensive therapy was unchanged in 20.5% cases, the drug dose was increased in 46,6%, additional medication was administered in 36,8%. In 30.8% pts antihypertensive agent was substituted by another class drug. At the last analyzed visit target BP was found in 24.4% pts. BP control was poorer in pts with BP goal <130/80 mmHg (20.1%) than in those with higher target BP (25.9%). Achievement of BP goal was associated with combination therapy, higher rate of TD administration and with more frequent visits to physician. During hospitalization target BP <140/<90 mmHg was achieved in 87.1%,<130/<80 mmHg in. 76.2%. Arifon retard administration resulted in target BO achievement in 84.5% patients. Physicians percept low adherence to antihypertensive treatment, lack of patients knowledge about risk related to arterial hypertension, economical problems as main barriers to improvement of arterial hypertension management. Patients considered economical problems related to antihypertensive treatment more much less important than physicians did. CONCLUSION: The study results suggest the importance of therapeutic inertia overcome to improve arterial hypertension management in Russia. Low rate of multiple combination therapy and TD prescription are important features of therapeutic inertia. Polar perception of problems related to arterial hypertension by physicians and patients should be considered as influencing factors for educational programs development.

[The comparative efficacy and prognosis of the long-term treatment with korinfar of men and women suffering from hypertension]. / Sravnitel'naia éffektivnost' i prognoz dlitel'nogo lecheniia korinfarom muzhchin i zhenshchin, stradaiushchikh gipertonicheskoi bolezn'iu.

The paper is concerned with the results of the corinfar treatment for a year of men and women suffering from stage II stable essential hypertension. The treatment efficacy, the influence on central hemodynamics were estimated as was the prognostic significance of different variants of acute pharmacological tests (sublingual, oral, oral with the use of static loading) compared with the treatment results. The long-term monotherapy with corinfar was shown to be effective in the majority of patients suffering from stage II stable essential hypertension. However, in women with essential hypertension, the hypotensive effect was more stable, the effective doses were lower, and tolerance was better than in men. To predict the efficacy of the long-term monotherapy a method of acute pharmacological test with the use of static leading devised by the authors is suggested. The method has a high prognostic significance.