[The impact of BMI on the course of the acute SARS-COV-2 infection and the risks that emerge during the first year after the hospital discharge. Subanalysis evidence of the AKTIV and AKTIV 2 registries].

BACKGROUND: There is enough evidence of the negative impact of excess weight on the formation and progression of res piratory pathology. Given the continuing SARS-CoV-2 pandemic, it is relevant to determine the relationship between body mass index (BMI) and the clinical features of the novel coronavirus infection (NCI). AIM: To study the effect of BMI on the course of the acute SARS-COV-2 infection and the post-covid period. MATERIALS AND METHODS: AKTIV and AKTIV 2 are multicenter non-interventional real-world registers. The АКТИВ registry (n=6396) includes non-overlapping outpatient and inpatient arms with 6 visits in each. The АКТИВ 2 registry (n=2968) collected  the  data  of  hospitalized  patients  and  included  3  visits.  All  subjects  were  divided  into  3  groups:  not  overweight  (n=2139), overweight (n=2931) and obese (n=2666). RESULTS: A higher BMI was significantly associated with a more severe course of the infection in the form of acute kidney injury (p=0.018), cytokine storm (p<0.001), serum C-reactive protein over 100 mg/l (p<0.001), and the need for targeted therapy (p<0.001) in the hospitalized patients. Obesity increased the odds of myocarditis by 1,84 times (95% confidence interval [CI]: 1,13-3,00) and the need for anticytokine therapy by 1,7 times (95% CI: 1,30-2,30).The  patients  with  the  1st  and  2nd  degree  obesity,  undergoing  the  inpatient  treatment,  tended  to  have  a  higher  probability  of  a  mortality  rate.  While  in  case  of  morbid  obesity  patients  this  tendency  is  the  most  significant  (odds  ratio  -  1,78; 95% CI: 1,13-2,70). At the same time, the patients whose chronical diseases first appeared after the convalescence period, and those who had certain complaints missing before SARS-CoV-2 infection, more often had BMI of more than 30 kg/m2 (p<0,001).Additionally, the odds of death increased by 2,23 times (95% CI: 1,05-4,72) within 3 months after recovery in obese people over the age of 60 yearsCONCLUSION.  Overweight  and/or  obesity  is  a  significant  risk  factor  for severe  course  of  the  new  coronavirus  infection  and  the associated cardiovascular and kidney damage Overweight people and patients with the 1st and 2nd degree obesity tend to have a high risk of death of SARS-CoV-2 infection in both acute and post-covid periods. On top of that, in case of morbid obesity patients this tendency is statistically significant. Normalization of body weight is a strategic objective of modern medicine and can contribute to prevention of respiratory conditions, severe course and complications of the new coronavirus infection.

[ACTIV SARS-CoV-2 registry (Analysis of Chronic Non-infectious Diseases Dynamics After COVID-19 Infection in Adult Patients). Assessment of impact of combined original comorbid diseases in patients with COVID-19 on the prognosis].

AIM: Study the impact of various combinations of comorbid original diseases in patients infected with COVID-19 later on the disease progression and outcomes of the new coronavirus infection. MATERIALS AND METHODS: The ACTIV registry was created on the Eurasian Association of Therapists initiative. 5,808 patients have been included in the registry: men and women with COVID-19 treated at hospital or at home. CLINICALTRIALS: gov ID NCT04492384. RESULTS: Most patients with COVID-19 have original comorbid diseases (oCDs). Polymorbidity assessed by way of simple counting of oCDs is an independent factor in negative outcomes of COVID-19. Search for most frequent combinations of 2, 3 and 4 oCDs has revealed absolute domination of cardiovascular diseases (all possible variants). The most unfavorable combination of 2 oCDs includes atrial hypertension (AH) and chronic heart failure (CHF). The most unfavorable combination of 3 oCDs includes AH, coronary heart disease (CHD) and CHF; the worst combination of 4 oCDs includes AH, CHD, CHF and diabetes mellitus. Such combinations increased the risk of lethal outcomes 3.963, 4.082 and 4.215 times respectively. CONCLUSION: Polymorbidity determined by way of simple counting of diseases may be estimated as a factor in the lethal outcome risk in the acute phase of COVID-19 in real practice. Most frequent combinations of 2, 3 and 4 diseases in patients with COVID-19 primarily include cardiovascular diseases (AH, CHD and CHF), diabetes mellitus and obesity. Combinations of such diseases increase the COVID-19 lethal outcome risk.

COVID-19 Pandemic and Cardiovascular Diseases: Lessons and Prospects.

This article is focused on the topicality of assessing complications and mortality from diseases of the circulatory system during the COVID-19 pandemic. The main variants of damage to the cardiovascular system, the mechanisms of their development, and risk factors are given. The long-term consequences of the new coronavirus infection for the heart and blood vessels are considered. In addition, the necessary measures to reduce the burden of disease after the pandemic are discussed.

Analysis of influence of background therapy for comorbidities in the period before infection on the risk of the lethal COVID outcome. Data from the international ACTIV SARS-CoV-2 registry («Analysis of chronic non-infectious diseases dynamics after COVID-19 infection in adult patients SARS-CoV-2¼).

Aim      To study the effect of regular drug therapy for cardiovascular and other diseases preceding the COVID-19 infection on severity and outcome of COVID-19 based on data of the ACTIVE (Analysis of dynamics of Comorbidities in paTIents who surVived SARS-CoV-2 infEction) registry.Material and methods  The ACTIVE registry was created at the initiative of the Eurasian Association of Therapists. The registry includes 5 808 male and female patients diagnosed with COVID-19 treated in a hospital or at home with a due protection of patients' privacy (data of nasal and throat smears; antibody titer; typical CT imaging features). The register territory included 7 countries: the Russian Federation, the Republic of Armenia, the Republic of Belarus, the Republic of Kazakhstan, the Kyrgyz Republic, the Republic of Moldova, and the Republic of Uzbekistan. The registry design: a closed, multicenter registry with two nonoverlapping arms (outpatient arm and in-patient arm). The registry scheduled 6 visits, 3 in-person visits during the acute period and 3 virtual visits (telephone calls) at 3, 6, and 12 mos. Patient enrollment started on June 29, 2020 and was completed on October 29, 2020. The registry completion is scheduled for October 29, 2022. The registry ID: ClinicalTrials.gov: NCT04492384. In this fragment of the study of registry data, the work group analyzed the effect of therapy for comorbidities at baseline on severity and outcomes of the novel coronavirus infection. The study population included only the patients who took their medicines on a regular basis while the comparison population consisted of noncompliant patients (irregular drug intake or not taking drugs at all despite indications for the treatment).Results The analysis of the ACTIVE registry database included 5808 patients. The vast majority of patients with COVID-19 had comorbidities with prevalence of cardiovascular diseases. Medicines used for the treatment of COVID-19 comorbidities influenced the course of the infectious disease in different ways. A lower risk of fatal outcome was associated with the statin treatment in patients with ischemic heart disease (IHD); with angiotensin-converting enzyme inhibitors (ACEI)/angiotensin receptor antagonists and with beta-blockers in patients with IHD, arterial hypertension, chronic heart failure (CHF), and atrial fibrillation; with oral anticoagulants (OAC), primarily direct OAC, clopidogrel/prasugrel/ticagrelor in patients with IHD; with oral antihyperglycemic therapy in patients with type 2 diabetes mellitus (DM); and with long-acting insulins in patients with type 1 DM. A higher risk of fatal outcome was associated with the spironolactone treatment in patients with CHF and with inhaled corticosteroids (iCS) in patients with chronic obstructive pulmonary disease (COPD).Conclusion      In the epoch of COVID-19 pandemic, a lower risk of severe course of the coronavirus infection was observed for patients with chronic noninfectious comorbidities highly compliant with the base treatment of the comorbidity.

[Blood pressure telemonitoring and remote counseling in uncontrolled hypertension].

Telehealth is a useful adjunct in hypertension (HTN) management. Despite obvious short-term clinical benefit, long-term social impact and cost-effectiveness have not been fully investigated. AIM: Predictive modeling of long-term clinical and social outcomes and the cost-effectiveness analysis of blood pressure (BP) telemonitoring and remote counseling (BPTM) in patients with HTN. MATERIALS AND METHODS: A Markov cohort-based (1000 patients in each study arm) model was developed and adopted a 10-year time horizon with 12-month time cycles. Cost and outcome data collected from the three-month study of 240 patients (160 in BPTM group and 80 controls, 48 y.o.). All patients started at a non-complicated HTN well state with a certain possibility of disease progression in a number of health states over a discrete time period. BPTM was compared with usual care in terms of 10-year healthcare costs, quality adjusted life years (QALY) using a Ministry of Health of Russian Federation perspective. RESULTS: In the long-term run when compared with usual care BPTM was more effective in terms mortality (67 versus 91 patients lost and 9.6 versus 9.71 life years gained) and costs (cost of illness 102 508 000 RUR versus 145 237 700 RUR). Taking quality of life measures into account, the effect of BPTM was also more pronounced (8.31 versus 7.82 QALYs gained). The resultant incremental cost-utility ratio for BPTM was 275 178.98 RUR/1 QALY gained/1 patient (134 837.70 RUR/0.49 QALY/1 patient). CONCLUSION: According to the results of predictive modeling, implementation of BPTM into clinical practice is likely lead to reduced cardiovascular morbidity and mortality in a cost-effective way.

[International register "Analysis of Chronic Non-infectious Diseases Dynamics After COVID-19 Infection in Adult Patients (ACTIV SARS-CoV-2)"].

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[Features of antihypertensive therapy and real-world prescription of selective imidazoline receptor agonists in Russia vs other countries: STRAIGHT study data analysis].

Analysis of routine clinical practice of hypertensive patient management represents one of the important tools in the search for further ways to minimize hypertension-associated cardiovascular and renal adverse outcomes. AIM: To compare the strategies for hypertension management and features of clinical use of I1-imidazoline receptor (I1-IR) agonists in the Russian Federation and other countries where the STRAIGHT (Selective imidazoline receptor agonists Treatment Recommendation and Action In Global management of HyperTension) study was conducted. MATERIALS AND METHODS: It was a cross-sectional online study involving physicians of various specializations. The study was conducted from January 18 to July 1, 2019, in seven countries with a high rate of I1-IR agonist prescription, including Russia. RESULTS: A total of 125 (4.5%) responders filled out the survey in the Russian Federation, which was somewhat lower than in other countries (6.8%). The participants were mostly general practitioners (54.0%) and cardiologists (42.0%), while in other countries greater diversity was seen. Most Russian physicians (83.0%) seemed to rely on national clinical guidelines in their routine practice, while in other countries the US guidelines were more popular (66.0%). The majority of responders stated that they took into account the traditional risk factors of hypertension when initiating the therapy; every second responder noted if sleep apnea was present. Awareness of I1-IR agonists, their prescription rate and their preference were higher in Russia. The main reported benefits of I1-IR agonists were their efficacy, including in resistant hypertension, and their metabolic effects (in Russia). Most participants preferred I1-IR agonists as third-line therapy (65.0% in Russia vs 60.0% in other countries) and in combination with an angiotensin-converting enzyme inhibitor (ACEi) or angiotensin II receptor blockers (ARB) (55.0% in Russia vs 54.0% in other countries). Compared to responders from other countries, Russian physicians prescribe I1-IR agonists as first-line (15.0% vs 5.0%) and second-line (48.0% vs 21.0%) therapy more often. CONCLUSION: Russian physicians were the most aware of I1-IR agonists and tended to prescribe drugs of this class for hypertension management more often, and I1-IR agonist combination with ACEi was preferable compared to physician responders from other countries. Antihypertensive efficacy and metabolic effects were reported as the major benefits of I1-IR agonist therapy.

[Use of Statins, Anticoagulants, Antiaggregants and Antiarrhythmic Drugs in Patients With COVID-19. The Agreed Experts' Position of Russian Society of Cardiology, Eurasian Association of Therapists, National Society on Atherothrombosis, Societies of Experts in Urgent Cardiology, Eurasian Arrhythmology Association].

This article discusses relevant aspects in the treatment of patients with COVID-19. Up-to-date information about principles for administration of statins, antithrombotics, and antiarrhythmics is presented. The authors addressed in detail specific features of reversing heart rhythm disorders in patients with coronavirus infection and the interaction of antiarrhythmic and antiviral drugs. Recommendations are provided for outpatient and inpatient antithrombotic therapy for patients with COVID-19. Issues of antithrombotic and antiviral drug interaction are discussed.

[Assessment of the clinical efficacy of telemonitoring and distant counseling in patients with uncontrolled hypertension].

The aim of the study was to investigate the mathematical correlation of the clinical efficacy of blood pressure telemonitoring and distant counseling (BPTM) in patients in uncontrolled hypertension (HTN). Telehealth tools are widely used in HTN management. However clinical efficacy of such interventions assessed mainly in groups investigated without its populational and attributable impact. Materials and methods. The total of 240 patients were included, then randomized in 2:1 manner to BPTM group (n=160, median age 47 y.o.) and control group (n=80, median age 49 y.o). The user - friendly and secure telehealth software was provided with mobile application (patients) and desktop (doctors) platforms which allowed storage and analysis of self-BP monitoring data and remote consultations. A three - month surveillance was designed with mandatory baseline and final face - to - face visits with the assessment of office systolic BP (oSBP). Mathematical evaluation was based on target SBP rates achieved in comparator groups and included the absolute efficacies (AE), the attributable efficacy (AtE), the relative efficacy (RE) and the population attributable efficacy (PAtE). Results. BPTM group characterized by larger decrease in SBP level compared with controls (-16.8±2.9 mm Hg versus -7.9±3.9 mm Hg; p.

[Multifunctional Monitoring: is it Possible to Simultaneously Evaluate Blood Pressure and Sleep-Disordered Breathing?]

Objective Carry out a comparative assessment of respiratory performance, based on multifunctional monitoring (MFM) and the recommended practice for complete polysomnography (PSG), and evaluate the effect of the blood pressure (BP) measurements in MFM on the quality of sleep.Materials and Methods At the first stage, 22 healthy volunteers (control group) underwent concomitant PSG and MFM, and 14 patients with suspected sleep-disordered breathing (SDB) underwent only PSG. At the second stage, concomitant PSG and MFM were performed in patients with confirmed SDB.Results In the control group, MFM detected a lower level of SpO2, a lower desaturation index (DI), and a higher apnea index (AI) than in the PSG group. However, the apnea-hypopnea index (AHI) was comparable in both groups. During concomitant PSG-MFM, the measurements of BP increased the number of micro-arousals only in the SDB group.Conclusion Results of the assessment of respiratory performance in MFM are comparable in both groups. The detected features of MFM indicators in the evaluation of the chest movements using rheopneumography, criteria different from that generally used for desaturation and hypoxemia, can lead to underestimation of desaturation and DI and underestimation of AI in the control group. The measurements of BP during sleep induced micro-arousals in the SDB group.

[Sleep disorders and stroke: data of the esse-rf study]. / Narusheniia sna i insul't: dannye issledovaniia ÉSSE-RF.

AIM: To assess the association between stroke and self-reported sleep disorders in the epidemiological studies of cardiovascular diseases in various regions of Russia (ESSE-RF). MATERIAL AND METHODS: A questionnaire survey included unorganized male and female population, aged 25 to 64 years, from 13 regions of the Russian Federation. In the analysis, answers to the question related to history of stroke: 'Did the doctor ever tell you that you had / had the following diseases?' (the 'Diseases' module) were included. The authors also evaluated answers about sleep duration, insomnia complaints, and sleepiness (the 'Sleep assessment' module). RESULTS AND CONCLUSION: Of 20 357 respondents, 422 (2%) confirmed the history of stroke. Both short and long sleep duration were not associated with stroke. Complaints of sleep disorders (snoring, sleep apnea, difficulty falling and maintaining sleep, as well as their combinations) were more frequently correlated with stroke. After adjustment for gender, age, body mass index, office blood pressure, the regression analysis showed that odds ratio was not significant for all complaints, except the combination of sleep apnea with frequent daytime sleepiness (1.7 (95% CI 1.04-2.8) (p=0.034). Therefore, symptoms of sleep-disordered breathing and insomnia are more common in respondents with the history of stroke. The combination of sleep apnea and frequent sleepiness complaints may indicate more severe sleep disorders in post-stroke patients.

Vascular Age Concept: Which Approach Is Preferable in Clinical Practice?

AIM: to compare various approaches to estimation of vascular age in patients from sample of citizens of Saint-Petersburg (SPB) with arterial pressure (AP) above 130 / 80 mm Hg without history of cardiovascular events. MATERIALS AND METHODS: Examination of a population sample of SPB citizens (n=1600) was carried out within framework of the observational epidemiological study ESSE-RF (ЭССЕ-РФ) in 2012-2013. We selected from this sample 477 women and man aged 40-65 years without history of cardiovascular events, diabetes, or chronic kidney disease, and AP >130 / 80 mm Hg. Examination included anthropometry, sampling of fasting blood for measurement of lipids, glucose, creatinine levels, urine sampling for determination of albumin excretion, and AP measurement in ac-cordance with standard methods. The SCORE scale was used of evaluation of 10-year risk of fatal stroke and fatal myocardial infarction. Volume sphygmography (VaSera device) was applied for determination of cardio-ankle vascular index (CAVI) with calculation of vascular age, and ankle-brachial index. ASCORE scale was used for determination of сalculated vascular age was determined with help of the ASCORE scale. RESULTS: Mean age of participants (182 men [38.2 %], 295 women [61.8 %]) was 52.5±6.2 years. Calculated and instrumental methods of determination of vascular age and early vascular aging had low concordance (κ = 0.099). With elevation of cardiovascular risk early vascular aging was more frequently detected by method of its calculation ASCORE than with instrumental method (VaSera). In the absence of achievement of target AP level signs of early vascular aging were significantly more often detected by the method of vascular age calculation than by the instrumental method VaSera. CONCLUSION: Application of the concept of vascular age and early vascular aging syndrome might be an effective tool for stratification of cardiovascular risk by a physician and improvement of adherence of a patient. This is especially actual for young patients with burdened heredity. One can assume that estimation of virtual risk factor load on blood vessels by the ASCORE method of calculation is more sensitive to detection of premature vascular aging, while requiring less financial and organizational efforts.

Large artery stiffness according to different assessment methods in adult population of St.Petersburg.

OBJECTIVE: The aim of the present study was to assess the prevalence of increased arterial stiffness by different diagnostic methods and its association with cardiovascular risk in Russian population-based cohort. DESIGN AND METHODS: In terms of Russian epidemiological study ESSE-RF a random selection of 452 apparently healthy Saint-Petersburg inhabitants aged 25-65 years was performed. Fasting lipids, glucose and blood pressure measurements were performed. We used 3 diagnostic methods of arterial stiffness assessment: pulse wave velocity by applanation tonometry (SphygmoCor - PWV-S) and pulse wave velocity by volumetric sphygmography (VaSera - PWV-V), and cardio-ankle vascular index (CAVI) by VaSera. RESULTS: 341 (75,4%) had normal parameters of arterial stiffness assessed by all methods. Spearmen's coefficient of correlation and "kappa" coefficient for PWV-S and CAVI were 0,74 and 0,04, for PWV-S and PWV-V - 0,10 and 0,06, for CAVI and PWV-V - 0,28 and 0,03, respectively. There was a significant correlation between cardiovascular risk (defined by SCORE) and PWV-S (r = 0,38, p < 0,001) and a non-significant trend of increasing CAVI along with cardiovascular risk (r = 0,35, p = 0,14). CONCLUSIONS: Different methods of arterial stiffness assessment showed a weak correlation with each other. Carotid-femoral pulse wave velocity detected by applanation tonometry is associated with high cardiovascular risk score and might be considered as better additional risk marker for cardiovascular risk stratification.

[Social-demographic aspects of insomnia in the Russian population according to ESSE-RF study]. / Sotsial'no-demograficheskie aspekty insomnii v rossiiskoi populiatsii po dannym issledovaniia ÉSSE-RF.

AIM: To estimate the prevalence of insomnia symptoms and their association with socio-demographic characteristics in the regions participated in the study. MATERIAL AND METHODS: Data from participants of the cohort study Epidemiology of cardiovascular disease in various regions of the Russian Federation (ESSE-RF), aged 25-64 years, from 13 regions of the Russian Federation were analyzed. They were interviewed about sleep complaints: difficulties falling asleep, maintaining sleep, sleepiness and sleeping pill intake (response variants: never, less than once a week, 1-2 times a week, three and more times a week). Responses with complaints occurring at least three times a week were considered as insomnia symptoms. Social and demographics characteristics from survey included: age, gender, education, marital status, job/employment, type of housing. The final analysis included 20 359 respondents. RESULTS: Clinically significant frequent (≥3 times a week) difficulties of falling asleep were reported by 17.2% respondents, difficulties in maintaining sleep by 13.6%; drowsiness by 6.3%, taking sleeping pills by 2.9% respondents. Women reported sleep complaints twice more after comared to men. The occurrence of frequent difficulties to falling asleep and nocturnal awakenings increased with age - from 11.4% and 5.9% to 24.2% and 20.7%. The highest occurrence of insomnia symptoms to such as difficulties in falling asleep and nocturnal awakenings was found in women, older age groups, divorced subjects or living separately, those with primary education, retired or disabled and living in a communal apartment or 'other' type of housing. CONCLUSION: Symptoms of insomnia are widespread among participants of the ESSE-RF study and associated with socio-demographic characteristics. Groups with high risk of insomnia include women, older age groups, divorced or living separately, those with primary education, unemployed pensioners and people with disabilities living in a communal apartment or 'other' type of housing.

[Stress levels and coping behavior in patients with chronic insomnia]. / Uroven' stressa i stress-preodolevaiushchee povedenie u patsientov s khronicheskoi insomniei.

AIM: To assess stress level and coping strategies in chronic insomnia as its potential psychological factors. MATERIAL AND METHODS: The study group included 29 patients (19 women), aged 18-55 years old (mean age 33.1±2.1 years), with chronic insomnia diagnosed in accordance with the International Classification of Sleep Disorders III. The control group was formed by 32 subjects (11 men), aged 18-55 years old (mean age 31.5±2.0 years), without sleep disorders. Insomnia Severity Index and polysomnography were used to evaluate sleep quality. Stress level and coping strategies were assessed via an interview (stressfull life events during last year, their duration, their controllability, unexpectedness, and outcome), and by 'Level of subjective control' and 'Ways of coping questionnaires'. RESULTS: Both groups were comparable by the mean number of significant events during last year (4.97±0.34 vs 4.72±0.23, p=0.54). Patients with insomnia more often reported the loss of a relative (p=0.04), while controls more frequently reported positive events, such as pregnancy (p=0.007) or wedding (p=0.02) among close ones. Insomniacs more often described the stressful events as uncontrolled (p<0.001) and prolonged (p<0.001). They demonstrated lower indices of all the scales of the 'Level of subjective control', questionnaire except the scale of interpersonal attitudes. They rarely implemented confrontive coping (p=0.001), seeking social support (p<0.001), accepting responsibility (p<0.001) and positive reappraisal (p<0.001). CONCLUSIONS: The interpretation of stressful events and personal response in insomnia patients might be considered as psychological risk factors for insomnia development.

The prevalence of abdominal obesity and the association with socioeconomic status in Regions of the Russian Federation, the results of the epidemiological study - ESSE-RF.

AIM: The aim of the study is to determine the prevalence of AO in the population and to assess the association with socioeconomic factors according to the data of the ESSE-RF study (Epidemiology of Cardiovascular diseases in the Regions of the Russian Federation). MATERIALS AND METHODS: The object of the study is a random population sample of men and women aged 25-64 years from 13 regions of the Russian Federation (n=21 817). Abdominal obesity in men was defined as waist circumference (WC) >94 cm, and in women - WC >80 cm. Body mass index (BMI) >30.0 kg/m2 was adopted as the criterion of common obesity. RESULTS: The prevalence of AO in Russia was 55% (61.8% in women and 44% in men), while the percent of people with obesity, defined by BMI was significantly lower (33.4%). The number of examined patients with AO increased with age among both men and women (p<0.0001). A person with AO more often were people with low and very low income and low education levels (p<0.0001). Direct association between employment status and family status and AO in present study did not find, but WC was statistically significantly important criterion among male workers in comparison with those who never worked (p<0.0001), young men and women married, as well as married men of older age groups (p<0.0001).

[The role of subjective methods for the evaluation of sleep quality]. / Opredelenie roli sub''ektivnykh metodov obsledovaniia v otsenke kachestvennykh kharakteristik sna.

AIM: To assess the accuracy of questions evaluating the quality and duration of sleep. MATERIAL AND METHODS: Target population included residents of St. Petersburg, who participated in the epidemiological study ESSE-RF. Out of 1417 participants, 136 individuals agreed to undergo additional sleep evaluation, and 49 subjects underwent polysomnography study for objective sleep evaluation. All participants were interviewed for subjective sleep assessment (standard questionnaires and Pittsburgh sleep quality index questionnaire). RESULTS: One third of the participants evaluated sleep quality in the lab worse than at home. Their sleep duration was 1,5h shorter than in those who reported sleep quality to be as good as at home. However, the majority of participants slept in the sleep lab more than at home for the previous month. Moreover, 59% subjects reported sleep disturbances. Sleep duration during night in the lab was 6.6 [3; 9] - vs. 7 [3; 10] hours as assessed by PSG and by subjective report, respectively (p=0,06). At the same time, usual average sleep duration was 8 [5; 10] hours (p=0.005), and average sleep duration during last month - 7 [5; 9] hours. CONCLUSION: One third of subjects report worse sleep in the laboratory compared to the usual nights and it is associated with their subjective shorter sleep duration. Subjective assessment of sleep duration and sleep onset time is appropriate for sleep evaluation during the last night, unlike subjective assessment of awakenings after sleep onset. Average self-reported sleep duration depends on the question formulation.

[Optimization of BP Control and Arterial Elasticity With Fixed Combination Therapy Perindopril and Amlodipine In Patients With Arterial Hypertension and Increased Pulse Wave Velocity].

The aim of the study was to assess the possibility of fixed combination perindopril+amlodipine to improve arterial elesticity in patients with hypertension and high pulse wave velocity, despite previous combination antihypertensive therapy. In an open, multicenter, observational study duration of 24 weeks 80 patients were included, divided into 4 equal-sized groups, depending on initial antihypertensive therapy: Group 1 - the combination of ACE inhibitor and diuretic, Group 2 - the combination of ACE inhibitor and calcium channel blocker, Group 3 - the combination of diuretic and angiotensin receptor blocker, Group 4 - the combination of angiotensin receptor blocker and calcium antagonist. All patients underwent ambulatory BP monitoring, applanation tonometry (assessment of augmentation index and central blood pressure), pulse wave velocity measurement. According to the office BP measurements fixed combination perindopril+amlodipine provided the SBP reduction by 17.5%, 15.6%, 15, 6%, 15.5% and 17.7%, DBP reduction by 14.6%, 12.9%, 13.8%, respectively, in groups ACEI+D initial combination therapy, ACEI+AC initial combination therapy, ARB+D initial combination therapy, ARB+AC initial combination therapy. According ABPM data SBP has been decreased by 12.2%, 12.4%, 11.3%, 12.6% and DBP by 14.3%, 11.1%, 8.9%, 12.6%. The fixed combination perindopril+amlodipine reduced PWV by 25.2%, 21.6%, 23.1%, 23.0%, augmentation index by 43.4%, 48.9%, 41.5%, 38.3%, central SBP by 16.1%, 15.5%, 14.4%, 15.2%, the central DBP by 15.1%, 13.8%, 13.8%, 18.0% (p<0.01 vs. baseline). CONCLUSIONS: Fixed combination perindopril+amlodipine provides goal blood pressure control, improves arterial elasticity indexes (augmentation index, PWV, central blood pressure). Additional properties include reduction of BMI and lipid metabolism improving in patients initially treated with a combination antihypertensive therapy.

[Elevated Level of the Natriuretic Peptide Among Adult Population in Regions Participating in the ESSE-RF Study and Its Association With Cardiovascular Diseases and Risk Factors].

AIM: to study associations between elevated blood plasma concentration of N-terminal pro-brain natriuretic peptide (NT-proBNP), risk factors and cardiovascular diseases (CVD) in samples of adult population of Russian Federation (RF) aged 25-64 years. MATERIALS AND METHODS: We analyzed data of examination of representative samples of population of 5 regions of RF obtained within the framework of the multicenter ESSE-RF study (2012-2013). Number of examined subjects was 8 077 (3 176 men). Methods included use of standard questionnaire, measurements of height, body mass, blood pressure (BP), and plasma NT-proBNP level. The following CVD were included into analysis: arterial hypertension (AH), ischemic heart disease (IHD), atrial fibrillation (AF), and stroke. RESULTS: Women compared to men had higher NT-proBNT concentration was higher in women compared to men, in both genders it rose with age. Overall 17.9 % of examinees had elevated NT-proBNT levels (14.2 and 20.3 % among men and women, respectively). Elevated NTproBNP level was associated in men with age, myocardial infarction, angina pectoris, ischemic ECG changes, left ventricular hypertrophy, AF, bradycardia, smoking, in women with age, IHD, ischemic ECG changes, AF, bradycardia, heart rate ≥80 bpm, BP ≥160/95 mm Hg. CONCLUSION: In studied RF population elevated NT-proBNP level was significantly associated with gender, age, smoking, and CVD.

[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.