Vol 15, No 3 (2018)

Hypertension is one of the most common diseases in the world. That is why guidelines fordiagnostics and treatment of hypertension attract great attention of medical specialists ofvarious fields. A new version of guidelines on hypertension jointly developed by cliniciansof the European Society of Cardiology (ESC) and the European Society of Hypertension (ESH) was presented at the European Meeting on Hypertension and Cardiovascular Protectionplenary meeting in Barcelona on June 8th 2018. After guidelines of the American College of Cardiology (ACC) and American Heart Association (AHA) were published in November 2017 it became one of the most anticipated events. The full text will be published on August 25th 2018 in parallel with an official presentation during the ESC Congress in Munich. Yet we already are able to estimate the degree of European experts and their American colleagues’ concurrence.

The review discusses the results of various clinical studies assessing the impact of physical activity on the cardiovascular system and provides the evidence suggesting that physical inactivity along with psychosocial factors, i.e. smoking, excessive alcohol consumption, unhealthy diet, obesity, arterial hypertension, diabetes, is one of the most significant risk factors leading to the development of cardiovascular disease. The comparative assessment of the indicators of cardiovascular morbidity and mortality adjusted to the level of physical activity and gender in the countries with different socioeconomic development is presented. Thus, there is a need to increase adherence to the recommended levels of physical activity in order to reduce cardiovascular morbidity, overall and cardiovascular mortality in the countries with different income levels.

Objective - to evaluate the association of genetic markers and cardiovascular risk factors with thickening of the intima-media complex among patients with arterial hypertension in the indigenous and non-indigenous population of Mountain Shoriya. Material and methods. The population of Mountain Shoriya in the number of 1409 people was surveyed by a single method (901 people are of indigenous nationality, Shorians, 508 people are non-indigenous 90% of them are Caucasians). Shors are a small Turkic-speaking people. Lipid blood spectrum, fasting plasma glucose, Quetelet index, waist circumference, genetic markers [ACE (I/D, rs4340), AGT (c.803T>C, rs699), AGTR1 (A1166C, rs5186), ADRB1 (p.145A>G, Ser49Gly, rs1801252), ADRA2B (I/D, rs28365031), MTHFR (c.677C>T, Ala222Val, rs1801133) and NOS3 (VNTR, 4b/4a)]. Carotid ultrasound was performed. Hypertension was diagnosed according to the National Guidelines of the Russian Society of Cardiology/the Russian Medical Society on Arterial Hypertension (2010). The study included 226 Shorians and 124 non-indigenous people with arterial hypertension and an increased thickness of the intima-media complex. The control group consisted of individuals with high blood pressure without atherosclerosis of carotid arteries (81 and 66 people, respectively). Results. It was revealed that such risk factors as gender and age are significantly associated with the thickness of the intima-media complex in the shorthand cohort (OR 1.93; 95% CI 1.03-3.62 and OR 20.01; 95% CI 4.79-83.65) and age - in the cohort of representatives of non-indigenous nationality (OR 3.20; 95% CI 1.39-7.36). An important role in the formation of atherosclerosis of carotid arteries in patients with arterial hypertension has a duration of the course of the disease in both ethnic groups, respectively - OR 2.78; 95% CI (1.45-5.33) and OR 4.22; 95% CI (1.97-9.01). A significantly smaller contribution is made by the genetic component: the rs699 polymorphism of the AGT gene, as in the Shorts (OR 3.51; 95% CI 1.10-11.25), and in non-indigenous residents (OR 4.90; 95% CI 1.15-20.92) and polymorphism rs1801133 of the MTHFR gene only in persons of indigenous nationality (OR 10.80; 95% CI 2.35-49.70). Conclusion. Timely establishment of risk factors for subclinical atherosclerosis in hypertension and their correction depending on the national trait will help prevent the progression of the process, reverse it, and reduce the risk of complications, premature disability and mortality.

At present a steady increase of obesity prevalence is observed all over the world. It is known that specifically visceral obesity is associated with high risk of cardiovascular disease and their complications development, but the available verification methods do not determine the real visceral adipose tissue volume accurately. The importance of localized fat depot as a risk factor for cardiovascular diseases and as an early marker of target organs damage in obese patients is discussed in the review. An alternative method of epicardial adipose tissue thickness determined with the use of echocardiography used as waist circumference analogue for a more precise evaluation of visceral obesity in everyday practice is reviewed.