Aim. In routine clinical practice, to evaluate the antihypertensive efficacy, 24-hour blood pressure (BP) control, tolerability and effect on arterial stiffness of the triple fixed-dose combination (FDC) of amlodipine/indapamide/perindopril according to office and 24-hour ambulatory BP monitoring (ABPM) in patients with uncontrolled hypertension (HTN) using previous therapy.Material and methods. The study included 78 both sex outpatients over 18 years of age with essential HTN. The main inclusion criterion was HTN with inadequate BP control against the background of previous combination therapy including amlodipine, indapamide and perindopril as part of free- or fixed-dose combinations of antihypertensive drugs. All patients were prescribed triple FDC of amlodipine/ indapamide/perindopril (Triplixam) in accordance with the medication instruc tions. The patient’s condition was assessed during four follow-up visits: visit 1 — inclu- sion visit, visit 2 — after 4 weeks, visit 3 — after 12 weeks, visit 4 — after 24 weeks. At each visit, achievement of the target BP levels <140/90 mm Hg and <130/80 mm Hg was assessed, as well as the 24-hour BP profile. The dynamics of BP decrease, achievement of target BP values, 24-hour BP profile, and the effect of therapy on arterial stiffness according to ABPM were also assessed.Results. In the analyzed group of patients, the initial office BP was 160,8± 10,3/91,5±8,1 mm Hg. After 24 weeks, there was a significant BP decrease to 121,3±3,5/73,6±4,2 mm Hg (p<0,001). According to ABPM, an average daytime BP significantly (p<0,001) decreased from 153,9±9,04/8,38±9,18 to 120,3±4,7/73,4±4,7 mm Hg after 24 weeks of amlodipine/indapamide/perindopril FDC therapy. Similar patterns were also found for the average values of nighttime BP. Target BP <140/90 mm Hg after 4 weeks reached the majority (87,2%) of patients, and after 12 weeks, the proportion of pa tients who reached the target BP was 100%.Conclusion. In hypertensive patients with previous ineffective multiagent therapy, the triple FDC of amlodipine/indapamide/perindopril (Triplixam) provided high antihypertensive efficacy, good tolerability and adherence to therapy, and also demonstrated additional organ protection.

Although myocardial revascularization is one of the most studied types of medical interventions, there is a heated discussion in cardiology about the feasibility and indications for it in patients with stable coronary artery disease (chronic coronary syndrome). The recently completed ISCHEMIA trial is the largest current study comparing conservative versus invasive strategies in this category of patients. The article discusses the rationale for revascularization to improve prognosis according to the ISCHEMIA trial.

Coronary revascularization is one of the most studied treatment modalities in cardiology; however, there is no consensus among experts about its indications in patients with stable coronary artery disease (SCAD). Contemporary data regarding the role of revascularization in SCAD are in clear conflict with the current European guidelines. This article discusses the main statements of the most significant American and European Guidelines on myocardial revascularization of the last decade and also analyzes the appropriateness of revascularization to improve the prognosis and symptoms in SCAD in the light of new research data, primarily the ISCHEMIA study (NCT01471522) and the ACC/AHA 2021 Revascularization Guidelines based on them. Data on the revascularization in SCAD obtained after the completion of ISCHEMIA (including the interim analysis of ISCHEMIA-EXTEND) and their potential significance are discussed. The results of ISCHEMIA sub-analyses in the most important “controversial” subgroups (3-vessel disease, proximal left anterior descending artery disease, strongly positive stress test, etc.) are reviewed, as are the results of the ISCHEMIA-CKD substudy in patients with severe chronic kidney disease (CKD).

Objective. To assess the relationship between arterial stiffness parameters in hypertensive patients with and without atherosclerotic lesions.Design and methods. We included 127 subjects who were divided into 3 groups: patients with hypertension (HTN) without atherosclerosis (n = 42); patients with HTN and subclinical atherosclerosis (SА) (n = 52) and control group which consisted of individuals without HTN, SA, or coronary artery disease (n = 33). All groups matched by age and gender. All subjects underwent following examinations: ultrasonography of extracranial segments of carotid arteries, 24-hour blood pressure monitoring with the assessment of arterial stiffness parameters.Results. In subjects with HTN compared to controls, pulse wave velocity in aorta (PWVao) was significantly higher (11,3 ± 1,5; 12,3 ± 1,8 vs 10,4 ± 1,3 m/s; p < 0,05), as well as pulse pressure (PP) (46,4 ± 9,8; 45,6 ± 10,6 vs 39,9 ± 6,5 mmHg; p < 0,05), central pulse pressure (PPао) (35,5 ± 8,5; 34,9 ± 8,5 vs 30,9 ± 5,4 mmHg; p < 0,05), and arterial stiffness index (ASI) (141 (127, 159); 139 (128,5, 160,5) vs 126 (118, 138) mmHg; p < 0,05). In subjects with HTN and SA, PWVao was significantly higher compared to other groups (p < 0,05). No significant difference in augmentation index was found (–32,5 (–45, –12); –22 (–36, –12); –37 (–50, –17); p = 0,25). Аmbulatory arterial stiffness index was higher in controls (0,5 ± 0,2) compared to HTN group (0,4 ± 0,2; p = 0,05), while HTN and SA group did not differ significantly (0,5 ± 0,2; p = 0,3). PWVao above 11,15 m/s is associated with 4,3 (2,3–8,2) times higher rate of atherosclerosis plaque detection.Conclusions. In HTN patients, arterial stiffness is changed compared to healthy individuals. PWVao above 11,15 m/s is associated with 4,3 (2,3–8,2) times higher rate of atherosclerosis plaque detection. In patients with HTN and SA arterial stiffness is higher, which might have additional predictive value in risk stratification.

Aim      Analysis of inter- and intra-study variability of changes in the atherosclerotic plaque (ASP) total height and total area, the main quantitative indexes that were planned to be used in the present study for assessment of the atherosclerotic load of carotid arteries. Material and methods  The incidence of recurrent cardiovascular complications (CVC) within 1 year after acute coronary syndrome (ACS) ranges from 7-9 % (in studies) to 34 % (in clinical practice). This indicates insufficient efficacy of traditional approaches to secondary prevention of coronary heart disease. We proposed a study to test a hypothesis that the dynamics of ASP parameters in carotid and subclavian regions can serve as an alternative criterion for the adequacy of secondary prevention after ACS. The analysis was performed on subgroups of main study participants. These patients had ACS of any type documented by coronary angiography with an ASP confirmed by ultrasound of the brachiocephalic arteries (BCA) during the index hospitalization. BCA ultrasound was performed to analyze the inter- and intra-study variability of BCA atherosclerotic load, the ASP total height (Hsum) and total area (ASPTA), in 20 and 24 patients of the main study, respectively. Results of the repeated ultrasound were evaluated in 30 patients of the main study after 6 months of follow-up. Results The inter-study variability of each index was significantly higher than the intra-study variability which was consistent with results of previous studies. The intra-study variability of Hsum was 0.10 (95 % confidence interval, CI – 0.23–0.44) mm and ASPTA, 1.05 (95 % CI, – 0.54–2.63) mm ² . The variability values were considerably smaller than the changes for 6 months: Hsum, 0.92 (95 % CI, – 0.64–2.49) mm and ASPTA, 3.67 (95 % CI, 0.42–6.91) mm ² , although the difference did not reach statistical significance. The above results were obtained at an early stage of the study during the adaptation of specialists to the protocol. Conclusion The study results suggest a possibility of a fairly reliable assessment of the dynamics of quantitative indexes of carotid ultrasound 6 months after ACS.

Aim. To characterize the association between cardiovascular risk factors and clinical and paraclinical variables with the severity of concomitant carotid and subclavian atherosclerosis in patients with acute coronary syndrome (ACS).Material and methods. Patients with ACS of any type, having obstructive coronary artery disease (CAD) confirmed by coronary angiography, underwent an ultrasound of the carotid and subclavian arteries with quantitative plaque assessment. The most important clinical, echocardiographic, angiographic and laboratory variables that contribute to atherosclerosis and/or affect the cardiovascular prognosis were evaluated. In patients with ACS considered ad the CAD onset, retrospective calculation of Systematic Coronary Risk Evaluation2 (SCORE2) score was performed.Results. A total of 312 patients aged 64 (56, 72) years (male, 69,2%) were studied. The detection rate of carotid/subclavian plaque was 86% and was higher in patients with more severe CAD — 79,4, 87,0, 92,6% in patients with 1-, 2- and 3-vessel disease respectively (p=0,027). However, 20% of patients with 2-/3-vessel CAD had no carotid/ subclavian atherosclerosis. Most of the traditional cardiovascular risk factors and other studied echocardiographic, angiographic, laboratory variables, as well as SCORE2 in patients with CAD onset did not demonstrate independent association with the severity of carotid/ subclavian atherosclerosis. The variability of the total plaque area (TPA) was explained by related multifactor regression model only to a small extent, R²=13%. Age (β 0,76, 95% CI 0,24-1,29, p=0,004), glomerular filtration rate (β -0,44, 95% CI -0,76 — -0,13, p=0,006); peripheral artery disease (β 19,50, 95% CI 1,63-37,37, p=0,033) demonstrated a significant independent association with TPA.Conclusion. In patients with ACS, only age, glomerular filtration rate and history of peripheral artery disease demonstrated the independent associations with carotid/subclavian atherosclerotic burden. Assessed variables explained 13% of TPA variability.