[Comparative analysis of the European and Russian models of medical examination (overview)].

Screening or its synonym medical check-up is the result of a health indicator, representing results of a medical examination and an effective tool of disease prevention. The concept of the term screening in European countries implies active detection of a disease or a premorbidity in people who are considered or consider themselves healthy. Medical check-up is a set of measures that includes preventive medical examination and additional methods of examinations conducted in order to assess the state of health and carried out in relation to certain groups of the population. The study and analysis of the international screening model and experience of its implementation, its role in the system of primary health care, including rehabilitation, is very important in terms of shaping public health at the international level. The article discusses regional trends in screening (medical check-up) and issues related to the conceptual and methodological aspects of medical check-up organization in the context of public health and prevention of risk factors. The data were searched in Scopus Web of Science, MedLine, the Cochrane Library, PubMed.

[Acetylsalicylic acid in primary and secondary prevention of atherosclerotic cardiovascular disease]. / Primenenie atsetilsalitsilovoi kisloty pri pervichnoi i vtorichnoi profilaktike ateroskleroticheskikh serdechno-sosudistykh zabolevanii.

The article is devoted to an urgent problem - primary and secondary prevention of atherosclerotic cardiovascular diseases. Modern approaches to management tactics depending on age and the appointment of antiplatelet therapy with acetylsalicylic acid in low doses from 75 to 150 mg/day are presented. At the same time, the relatively high effectiveness of the use of ASA for primary prevention in men 40-69 years old without an increased risk of bleeding from the gastrointestinal tract is shown. Low doses of ASA provide little benefit in reducing the risk of CVD in people 40 years and older, when there is no history of CVD, but at the same time they are at increased risk of CVD.

[Use of Verapamil and Dilthiasem in treating patients at high cardiovascular risk (review of literature)].

The article deals with usage of nondihydropiridine calcium antagonists--verapamil and dilthiasem--in treating patients with arterial hypertension, cardiomyopathy and arrhythmia, for secondary prevention of IHD. Data also concern cardio-, angio--and nephroprotective activity of the medications, their ability to prevent left ventricle hypertrophy, possible usage in patients after myocardial infarction. The authors also discuss problems of tolerance and safety of calcium antagonists with prolonged action vs. those with short-term action.

Optimization of therapeutic teaching of patients with chronic cardiac failure.

The study was aimed to evaluate treatment efficiency of patients with chronic cardiac failure via therapeutic teaching. The study included 137 patients. Implementation of therapeutic teaching into treatment of chronic cardiac failure patients resulted in less number of patients with III-functional grade, better tolerance to physical exertion, more awareness, greater number of patients with self-control skills and adherence to recommended treatment, better life quality of the patients. Medical and social significance manifested in less frequent hospitalizations and calls for emergency medical care.

Functional state of sportsmen with mitral valve prolapse.

The study covered functional peculiarities in 541 professional sportsmen. Mitral valve prolapse (in 132 examinees) appeared to be associated with reliably lower levels of reticulocytes, leucocytes, lymphocytes CD4+, immunoglobulines G, magnesium, and higher cortisol level, in comparison with the sportsmen having no mitral valve prolapse. The athletes with mitral valve prolapse demonstrated more frequent changes in ECG, reliably lower performance in treadmill test, slower recovery of heart rate after exertion is over.

[Immune state in athletes with mitral valve prolapse].

The authors evaluated immune state in 541 professional athletes. The athletes with vitral valve prolapse (132 subjects) appeared to have immune changes - lower immunoglobulines levels, general leucocytes count, if compared to the athletes without mitral valve prolapse.

[High technology examination methods in athletes with tricuspidal insufficiency].

The article exemplifies solving problem of permit for coaching and contest in athletes with marked tricuspidal regurgitation. Invasive study analysis of intracardiac hemodynamic parameters at rest and during electrostimulation-induced tachycardia helps to differentiate primary and functional tricuspidal insufficiency, to reveal latent cardiac insufficiency and unfavorable disorders of cardiac rhythm and conductivity. This investigation method has to be used in cases when other modalities are unable to assess the risk of fatal events at the highest submaximal heart rate.

[Evaluation of vascular modification in hypertensive patients].

Assessment of arterial stiffness for revealing vascular modification in hypertensive patients seems to be an actual problem in clinical practice. 377 patients with arterial hypertension and 232 nonhypertensive subjects were included in the research. The noninvasive technique of investigation of pulse wave velocity (PWV) was used. The reference values of carotid-femoral and carotid-radial PWV in relation of age and gender in nonhypertensive subjects and hypertensive population are described. Dependence of PWV on different clinical markers are shown. Correlations between PWV and left ventricular hypertrophy, PWV and carotid artery intima-media thickness are introduced. Therefore noninvasive technique of assessment of large and medium arterial stiffness can be used for separating patients with vascular modification from general population.

[Effects of hypotensive treatment on structural-functional properties of the vascular wall in hypertensive patients].

AIM: To study structural-functional properties of the walls of large and middle-size arteries and changes of these properties in the course of hypotensive therapy in hypertensive patients. MATERIAL AND METHODS: Of 609 participants of the trial (233 males and 376 females), 377 patients with essential hypertension stage I-II (mean age 46.9 +/- 7.2 years) entered the study group, 232 healthy subjects (mean age 45.7 +/- 6.9 years)--the control group. Pulse wave velocity (PWV) for vessels of elastic and muscular type was measured in all the examinees. Circadian blood pressure monitoring, echocardiography, duplex scanning of the common carotid artery were performed in hypertensive patients. 76 hypertensive patients were reexamined 6 months after treatment with amlodipin (n = 32) or fixed combination perindopril+indapamide (n = 44). RESULTS: Mean PWV appeared to be higher in hypertensive patients in whom PWV correlated with left ventricular (LV) remodeling and thickness of intima-media complex (IMC). After 6 months of hypotensive therapy PWV significantly lowered for both types of vessels studied. IMC thickness reduced by 10.1%, on the average, LV myocardial mass index--by 6.3%. CONCLUSION: The link between PWV, LV hypertrophy and IMC allows PWV use as a method of detection of cardiovascular remodeling in hypertension and for follow-up of antihypertensive treatment effect on this remodeling in outpatient treatment of hypertension.

[Outpatient follow-up and management of pregnant women with hypertension].

AIM: To study variants of the course of chronic hypertension in pregnant women and determination of factors predisposing to a persistent rise of arterial pressure (AP) in pregnancy. MATERIAL AND METHODS: A total of 50 pregnant women were examined (heart rhythm variability and psychological testing) who had AP 140/90 mm Hg and higher as shown by measurements at three outpatient check-ups. After delivery the patients were retrospectively devided into two groups. Twenty-seven group 1 women had frequent rises of AP to 140/90 and higher throughout pregnancy; twenty-three women of group 2 had high AP only at early terms of pregnancy, later they became normotensive without use of hypotensive drugs. 24-h AP monitoring was made in 29 patients. By its results, two subgroups were identified: 11 patients with essential hypertension and 18 women with neurocirculatory dystonia by hypertensive type. RESULTS: In group 1 there was an early fall of cardiac performance, higher values of SMIP test according to scales 2 (pessimism), 3 (emotional lability), 4 (impetuosity) and 7 (anxiety). CONCLUSION: The analysis of 24-h AP profiles revealed more persistent and significant rise of AP in patients with essential hypertension than in those with neurocirculatory dystonia. They also demonstrated high AP variability correlating with a risk of cardiovascular diseases.