This document updates previous documents of Russian Society of Hypertension and provides a condensed overview of the existing information. It aims to support healthcare professionals in developing optimal approaches to managing patients struggling with hyperuricemia and its related health conditions. Particular attention will be given to pointing to the need to standardize the definition of hyperuricemia and to hyperuricemia values associated with the risk of various cardiovascular diseases, paying attention to hyperuricemia in patients with chronic kidney disease.The present consensus regulates the prescription of uratelowering therapy depending on the severity of the detected hyperuricemia. Allopurinol continues to be the preferred initial choice for uric acid-lowering therapy in patients with high cardiovascular risk.

Non-alcoholic fatty liver disease (NAFLD) is one of the most common causes of chronic liver diseases. According to modern concepts, a unique feature of this pathology is that patients with NAFLD have a significantly increased risk of developing not only liver diseases, but also extrahepatic pathologies, mainly cardiovascular diseases (CVD). Various studies have clearly demonstrated the predictive role of NAFLD in the development of arterial hypertension, coronary heart disease, myocardial infarction, cardiac arrhythmias, and cardiovascular mortality. The commonality of pathogenetic mechanisms underlying NAFLD and CVD is discussed, primarily such as: dyslipidemia, hypertriglyceridemia, insulin resistance, lipotoxicity and chronic sterile inflammation. This review article analyzes the relationship between NAFLD and CVDs, describes the pathophysiological mechanisms of the bidirectional influence of these pathologies.

The positive effect of smoking cessation has been proven by epidemiological studies. Changes in the microcirculation (MC), the most sensitive link in the cardiovascular system, in hypertensive patients who have quit smoking are of particular interest.

Objective. To evaluate the MC in young patients with stage I/II hypertension who have quit smoking depending on the duration of abstinence in comparison with those who continue to smoke.

Materials and methods. Young outpatients with stage I/II hypertension who have quit smoking (n=55) were examined – group 1. All were divided into 3 subgroups: 1.1. subgroup (n=16) – quit smoking for 1 month to 1 year inclusive, 1.2. subgroup (n=18) – quit smoking for 2 to 5 years, 1.3. subgroup (n=21) – 6 years and older. The comparison group consisted of smoking patients matched by age and gender (n=66) – group 2. All underwent outpatient examination according to the 2020 clinical guidelines for hypertension in adults. MC was studied by direct biomicroscopy of the bulbar conjunctiva. The average diameter of microvessels, the number of capillaries per 1 mm2 of the conjunctival surface, and the prevalence of intravascular red blood cell aggregation (RBCA) in four areas of the temporal region of the bulbar conjunctiva were assessed. The parameters of those who quit smoking were compared with smokers.

Results. In all subgroups of patients who quit smoking, the MC parameters differ significantly in the positive direction from those who continue to smoke, these highly reliable differences begin with 1.1. subgroups who quit smoking during the first year. The maximum prevalence of RBCA in all analyzed areas of the conjunctiva was found in the group of smoking hypertensive patients; with an increase in the abstinence period, there is a statistically significant decrease in RBCA with minimum values in the 1.2. subgroup with a subsequent increase in the 1.3. subgroup, who quit smoking 6 or more years ago.

Conclusions. In young patients with hypertension stages I/II who quit smoking, all analyzed parameters of the MC differ significantly in the positive direction compared to those who continue to smoke. Positive shifts in the MC were recorded in the 1.1. subgroup of those who quit smoking during the first year and persisted further with an increase in the abstinence period, which indicates the restoration of the endothelial function impaired by smoking, with a low smoking intensity and duration of hypertension at a young age.

The aim of the study: to investigate the association of plasma resistin concentration with the vascular stiffness index CAVI and to identify factors associated with increased vascular stiffness in patients with arterial hypertension (AH).

Materials and methods. 72 patients (34 men and 38 women) with AH aged 48 to 84 years were included in the study. Type 2 diabetes mellitus (T2DM) was diagnosed in 16 (22.2%) patients. Together with the standard investigations, all patients underwent determination of plasma resistin concentration and measurement of vascular stiffness based on the CAVI index.

Results. All patients with AH were divided into 2 groups: patients with increased vascular stiffness (CAVI≥9) – 32 people (group 1) and patients with normal vascular stiffness (CAVI<9) – 40 people (group 2). A significantly higher concentration of resistin in blood plasma was observed in patients of group 1 – 6.23 [4.99; 8.35] ng/ml compared to group 2 – 4.1 [3.8; 5.58] ng/ml, p=0.036. Univariate linear regression analysis revealed a direct relationship between plasma resistin concentration and CAVI index (beta1=0.34; SD=0.08; p<0.001). According to multivariate regression analysis, independent markers of increased vascular stiffness in patients with AH were: age (OR=1.19, CI=1.06-1.30), T2DM (OR=2.39, CI=1.16-5.99), plasma resistin concentration (OR=1.46, CI=1.09-2.27), p<0.05. Resistin level more than 4.95 ng/ml with sensitivity of 65.2% and specificity of 56.5% allows to diagnose increased arterial stiffness in patients with AH (AUC=0.673, p<0.05).

Conclusion. Independent markers of vascular stiffness in patients with AH are not only age and T2DM, but also a plasma resistin concentration of more than 4.95 ng/ml.

Pulmonary arterial hypertension (PAH) is a life-threatening condition that leads to early disability and death. As one of the complications of systemic sclerosis (SSc), it is important to develop screening models to improve diagnosis of PAH in these patients.

Aim: To test recommended PAH screening models in a Russian population of SSc patients to identify those at high risk for PAH using both previous and current hemodynamic definitions of PAH.

Material and methods. The study included 138 patients with SSc who underwent a one-stage clinical, laboratory, and instrumental examination at the Institute of Rheumatology between November 2011 and November 2019. We analyzed the sensitivity, specificity, positive and negative predictive values of two screening models (algorithm DETECT and EchoCG screening), according to two definitions of PH and PAH.

Results. The sensitivity of the algorithm DETECT in identifying patients at high risk of PAH according to the 2022 definition was lower (99%) than the 2016 definition (100%), while the specificity remained the same (24%). When using EchoCG, the sensitivity was lower than the detection algorithm (95% for the new definition, 96% for the old definition), but the specificity was higher (38% for both definitions).

Conclusions. The effectiveness of the two screening models appears to be equivalent, although their low specificity raises concern. Further research is needed to identify new markers or to narrow the target population for the EchoCG screening test for PAH in SJS.