The article presents an analysis of the current state of the problem of managing patients with arterial hypertension (AH) and various comorbid backgrounds. Also, it highlights the current guidelines (2018) for the management of arterial hypertension of the European Society of Cardiology and the European Society of Hypertension. Information on new target blood pressure (BP) values in the range of 120–130 mm Hg is emphasized for systolic blood pressure (SBP) and 70–80 mm Hg for the diastolic (DAD) one in the majority of patients with the exception of persons of 65 years and older, as well as patients with chronic kidney disease, who have been recommended to achieve a blood pressure of 130–139 mm Hg. Furthermore, his material presents the current views on the priority of combined (initially double, and triple in the case of failure), mainly fixed antihypertensive therapy, the choice of which requires the presence and nature of comorbid pathology.

In this review are provided relevant positions of the American and European clinical guidelines for antithrombotic therapy in the patients with a combination of atrial fibrillation and coronary heart disease with percutaneous coronary intervention. Similarities and distinctions of positions of two expert communities were discussed. In addition, the evidence-based positions concerning the choice of the optimal antithrombotic therapy are noted. Primary positions of a clopidogrel when choosing the antiagregants for double or triple antithrombotic therapy were designated.

Spectral analysis of heart rate variability can be successfully used to evaluate the effectiveness of therapy. The use of this method gives an idea of the role of the autonomic nervous system in the regulation of chronotropic function of the heart. These data help to define conditions of manifestation of efficiency of antiarrhythmic drugs. In this study, spectral analysis were studied in patients with persistent atrial fibrillation. The effect of amiodarone class III antiarrhythmic drug were studied this study.

Purpose. To assess the progression of atrial fibrillation in middle-aged people with hypertension in combination with comorbid extracardiac diseases.

Materials and methods. In an observational cohort study, 308 patients aged 45–65 years with atrial fibrillation (paroxysmal and persistent forms) with hypertension in combination with extracardiac pathology were observed: diabetes mellitus (n = 40), thyrotoxicosis (n = 42), hypothyroidism (n = 59), abdominal obesity (n = 64) and chronic obstructive pulmonary disease (n = 47). The control group consisted of 56 patients with hypertension + AF without concomitant extracardiac disease. The level of MMP-9 was determined using the Human MMP-9 (total) Immunoassay test-system (USA); NT-proBNP —  using the NTproBNP-IFA-Best reagent kit; galectin-3 —  with ELISA —  Bender MedSystems (Austria). Echocardiography was performed using an Acuson Aspen apparatus (USA), 24-hour ECG monitoring with Schiller Medilog Holter system. All statistical calculations were carried out in the program Rstudio 0.99.879 (RStudio, USA).

Results. In patients with hypertension and atrial fibrillation, the combination of diabetes mellitus (p = 0.041) and abdominal obesity (p = 0.004) is the most prognostic factor for AF progression. In groups of patients with diabetes mellitus, hypothyroidism and abdominal obesity, the most pronounced indicators of diastolic dysfunction of the left ventricle were: E/A, LVMI (men); the size of the left atrium and the end-diastolic size of the left ventricle are increased in all clinical groups. The prognostic value of biomarkers of fibrosis and remodeling of galectin-3 and MMP-9, and NT-proBNP in the progression of atrial fibrillation in patients with hypertension in combination with extracardial diseases is shown.

Conclusion. There is no doubt that in case of hypertension, the decompensation of long-term hypertrophic myocardium is based on a violation of the balanced growth of its various structures and the formation of fibrosis and myocardial dystrophy, which was confirmed in the present study. The detected elevated levels of MMP-9, galectin-3 and NT-proBNP, as well as ultrasonic signs of myocardial remodeling, confirmed that they statistically significantly affect the progression of atrial fibrillation. In this regard, a personalized approach to a patient with atrial fibrillation in combination with comorbid pathology is required, especially in middle-aged people at the stage of comorbidity formation, under the conditions of received diagnostic information on the electrical function of the heart and assessment of the functional capabilities of CVS during its transition to various levels of functioning.

Arterial hypertension remains a socially significant disease. Multicenter studies indicate low patient adherence to treatment. This article discusses the factors that influence commitment. Using the potentials of health centers and prevention departments can increase patient commitment. The study on the regular use of antihypertensive therapy indicates an improvement in cognitive functions and the quality of life of patients against the background of achieving target blood pressure.

The aim of the study was to compare the 1-year results of conservative and invasive tactics of treating myocardial infarction (MI) in patients with different severity of comorbid background.

Material and methods. The presented results are based on registry in City Hospital No. 4 of Sochi. The present analysis included patients with a diagnosis of myocardial infarction (n = 1 176). Upon discharge from the hospital, all patients underwent analysis of the severity of comorbidity using the Charlson Comorbidity Index (CCI). A year later, 791 patients managed to find out the prognosis after discharge from the hospital. 1-year mortality was 12.6 % (n = 100).

Results. The frequency of coronary angiography (CA) and percutaneous coronary intervention (PCI) in patients with CCI = 0 (no or minimal comorbidity, n = 408) was 84.3 % and 63.5 %, with a CCI of 1–2 (moderate comorbidity), n = 438) was 68.0 % and 44.8 %, with CCI ≥ 3 (expressed comorbidity, n = 330) was 50.3 % and 25.8 %, respectively. At the same time, conducting PCI at the hospital observation stage was associated with a decrease mortality during the year after discharge from the hospital from 18.5 % to 5.8 %, p < 0.0001. The greatest positive effect of PCI for optimizing the long-term prognosis of (1 year) was achieved in the group of patients with severe comorbidity (CCI ≥ 3), where the NNT (number needed to treat) was 7. The relative risk of 1-year mortality in patients with severe comorbidity compared to the minimum in the PCI group was 6.75, in the conservative treatment group was 4.63.

Conclusion. The results of this study showed that PCI in MI is more often performed by younger, less comorbid patients with a lower risk on the GRACE scale. At the same time, the 1-year survival of patients with MI was significantly higher after PCI compared to the primary conservative treatment strategy, regardless of the severity of comorbidity, and the greatest improvement in the long-term prognosis of PCI was observed in patients with severe comorbidity, as determined by the CCI ≥ 3.

The clinical case of essential hypertension patient pharmacotherapy using the combination of olmesartan with lercanidipine was described in the article. The authors evaluated the effect of this combination not only on the degree of lowering blood pressure, but also on the levels of markers of endothelial dysfunction such as sPECAM-1 and copeptin. Pharmacotherapy with this combination of medicines was carried out for 28 weeks. It was found that in this patient the combination of olmesartan with lercanidipine led to the achievement of the blood pressure target level and decrease the level of sPECAM-1 by 2.5 times, and the level of copeptin by 5 times compared with the initial levels before treatment. Thus, the authors concluded that the combination of olmesartan and lercanidipine not only leads to the normalization of blood pressure, but also reduces the severity of endothelial dysfunction, which underlies the pathogenesis of essential hypertension.

The article presents the definition of comorbid pathology and the role of comorbidity in the prognosis of diseases. Comorbidity in patients with arterial hypertension and its effect on the course of the disease are considered. Based on the results of the study, an analysis was made of the prevalence of concomitant diseases in patients with hypertensive crisis, as well as the gender characteristics of the prevalence of concomitant diseases.

Psychoemotional stress is a risk factor for cardiovascular disease. The ESC/ESH recommendations for the treatment of hypertension (2018) define psychological stress as a risk factor for hypertension. The basis of hypertension of the ‘white coat’ and masked hypertension are considered psychosocial factors. Stress causes early damage to target organs and uncontrolled blood pressure. The article discusses the mechanisms of formation of arterial hypertension under the influence of stress. On the example of clinical studies, the negative role of psycho-emotional stress in extreme professions is considered. The data of their own research on the effect of stress in locomotive drivers on the development of cardiovascular diseases are presented.