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Introduction. Up to 20% so-called secondary forms of hypertension are associated with vascular pathology of the kidneys (renovascular hypertension). The lack of effectiveness of drug therapy of this form of hypertension determined the invasive treatment tactics. Objectives. The purpose of this article was to observe the clinical course of renovascular hypertension and determine the tactics of treatment in the long-term period after a previous stenting of the renal arteries. Material and methods. Our patient is a woman, born in 1957. Since 2011, hypertension has been diagnosed, since 2014 - rhythm disturbances, since 2015 edema of the lower extremities, maximum blood pressure up to 250/120 mm Hg, in 2016 - stenting of the renal arteries (RA) was performed according to the angiography results, the patient's condition was satisfactory. Since 2018, due to deterioration, the patient was hospitalized. The main diagnosis: Secondary vasorenal arterial hypertension of the II stage, 3 degree. Bilateral renal artery stenosis (angiography 03.03.2016). Renal artery stenting (03.03.2016). Restenosis of the stent of the right renal artery up to 80% (angiography 15.11.2018). Ventricular extrasystole II gradation according to Laun-Wolf-Rayan. Hyperlipidemia type IIb-III. Very high cardiovascular risk. Complication: Hypertensive crisis (uncomplicated course) (01.1I.2018). HF II A stage, class II with preserved systolic function of the left ventricle (EF 69%). Conducted therapy: perindopril 15 mg, bisoprolol 5 mg, torasemide 5 mg; amiodarone 100 mg bid; indapamide 1.25 mg; amlodipine 5 mg, acetylsalicylic acid 150 mg; rosuvastatin 20 mg. Results. The patient underwent a standard examination at hospital. Identified deviations: laboratory: ESR 20 mm / h, basophils 1.3%, creatinine 83 μmol / L (CKD-EPI 77 ml / min / 1.73 m2), dyslipidemia IIb according to Fredrickson; instrumental: ECG – left axis deviation, signs of left ventricular myocardial hypertrophy (LVMH); Holter - single ventricular and supraventricular extrasystoles; echocardiography - sclerotic changes in the valvular apparatus of the heart, concentric LVMH; ultrasound of the abdominal cavity and retroperitoneal space – the right kidney is reduced in size, microcalculosis of both kidneys, signs of stenotic flow along the left RA at the level of the stent; RA angiography - restenosis in the stent of the right RA up to 80%. Stentoplasty with possible stent-to-stent DES stenting was recommended by an endovascular surgeon. Conclusions. This clinical case demonstrates the need for screening a category of patients with resistance to standard antihypertensive therapy for the presence of secondary arterial hypertension, which will improve the quality of life of the patient and reduce the number of drugs used, in some cases up to their withdrawal. Given the high likelihood of restenosis of stented vessels, it is necessary to carry out primary prevention of the restenosis occurrence.

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Цель работы-определить степень влияния различных режимов гипотензивной терапии на достижение целевых значений и показатели вариабельности артериального давления у пациентов с артериальной гипертензией.

Atrial fibrillation in old people is one of the most common causes of cardiac decompensation. It can also lead to sudden cardiac death and thromboembolism of vital organs. Comorbidities such as diffuse cardiosclerosis, myocarditis or cardiomyopathy, congenital or acquired defects of the valvular apparatus of the heart, pathology of the endocrine system, chronic obstructive diseases of the bronchopulmonary apparatus, malignant course of arterial hypertension or its refractoriness to therapy, uncontrolled intake of antiarrhythmic drugs, can complicate the course of atrial fibrillation the addition of a transverse atrioventricular block, which is called Frederick’s syndrome. This article presents a case of clinical observation of an uncontrolled course of atrial fibrillation with the subsequent development and progression of severe circulatory failure against the background of the addition of complete atrioventricular block. Such an important factor as adherence to medical recommendations can compensate for various pathological conditions for a long time without causing significant harm to health, which was neglected by the patient from the clinical case under consideration. The launched course of arterial hypertension probably launched a cascade of morphological changes in the structures of the heart, which subsequently led to the formation of atrial fibrillation, the development of heart failure, and the addition of complete atrioventricular block. The appearance of rhythm in the heart rate, which is characteristic of this conduction disturbance, is often perceived as an erroneous restoration of the rhythm in case of pre-existing atrial fibrillation; this can complicate the timely diagnosis of pathology, especially in the absence of syncope conditions characteristic of complete atrioventricular blockade. The risks of thromboembolic complications and sudden cardiac death are as high as those associated with isolated atrial fibrillation. During the examination of the patient, the absolute indications for transplantation of an artificial pacemaker were determined. Subsequently, an increase in the minute volume of blood and cardiac output, as expected, led to an improvement in the clinical course of the disease and well-being, however, the pre-existing hemodynamic disorder of a long-term nature in this patient led to irreversible decompensation of cardiac activity, which adversely affects the long-term prognosis for life.