Arterial hypertension (AH) is the major modifiable risk factor for cognitive impairment (CI), including dementia, CI in cerebrovascular and neurodegenerative diseases, including Alzheimers disease. By 2050, the number of people with dementia will approximately 3 times increase due to the aging population and limited opportunities for drug prevention and treatment of severe CI. In connection with the above, it seems necessary to create an expert consensus, which would summarize the evidence-based medicine data available to date on the effect of antihypertensive therapy (AHT) on cognitive function (CF). In the expert consensus, the data of prospective randomized clinical trials, observational and population studies, meta-analyzes on the effect of AHT on the risk of dementia and CI progression, including certain CF, were summarized and analyzed. The consensus considers the effect of antihypertensive drugs (AHD) on various cognitive domains. Literature data give evidence that AHT reduces the risk for dementia, including vascular dementia, reduces the risk of for dementia in Alzheimers disease, as well as reduces the risk and can prevent the progression of non-dementia CI. The effect of AHT on various CF has been little studied. Most meta-analyzes did not reveal the benefits of any class of AHD; however, one study demonstrated the advantage of angiotensin receptor blockers, while another study diuretics. The consensus emphasizes that, given the high incidence of AH in the general population, AHT may be one of the most effective ways to prevent CI or delay CI progression. The effect of different classes of AHD on CF requires further study. It is necessary to conduct a larger number of well-designed randomized clinical trials that would assess the state of executive functions in patients with AH.

Objective: To assess the urodynamics and concentration function of the parenchyma in patients with arterial hypertension and gout. Design and method: We examined 87 patients with arterial hypertension and gout. 83% were men (mean age 55.4 ± 12.3 years). Grade 1 of arterial hypertension was detected in 43.7%, grade 2 - in 36.9%, grade 3 - in 19.3%. All the patients had chronic gouty arthritis, 30% of the patients had tophi. Markers for kidney damage, urine sediment, GFR calculation were evaluated in all the patients. All the patients were given a systemic examination of their nephro-urological condition based on complex renal scintigraphy (SENS-CRS) with the in-depth differential analysis of the impaired renal parenchyma function, upper and lower urinary tract (fig.1). Results: According to the standard method of GFR calculation using the CKD-EPI formula, we found that 10 patients (11.3%) had no CKD symptoms; stage I-II CKD was observed in 56 patients (64.5%), stage III-IV in 21 patients (24.2%). 16 patients with arterial hypertension and serum creatinin level >125 μmol/l were allocated to a subgroup of patients in the category of increased risk of developing high stages of CKD. According to the CKD-EPI formula, those 16 patients had CKD stage I-II and one patient had stage III CKD with a high risk of transition it to stage IV. The reliable difference (p < 0.05) was established only by the D (%) indicator that is by the radiopharmaceutical removal rate from the renal parenchyma when we compared the analyses of complex renal scintigraphy data in the 16 specified patients and in the remaining 71 patients with arterial hypertension (tab.1). Conclusions: Patients with arterial hypertension from the time of gout diagnosis must be included in the nephro-urological control system. It is important to control the risk factors related to the probability of CKD progression. The renocortical parameter D (%) used in the SENS-CRS technology is a prognostically important preclinical marker of intrarenal congestion when the latent development of serious morphological and functional disorders in the renal parenchyma occurs that leads to the CKD development or aggravation of the existing CKD stage.

Osteoarthritis associated with metabolic syndrome (MetOA) is a clinical phenotype defined by the role of obesity and metabolic syndrome as risk factors, as well as mild chronic inflammation. Obesity is an established risk factor for developing osteoarthritis (OA) not only in the knee but also in the hands. Metabolic syndrome is also a risk factor for the development of OA, and the cumulative effect of the various components of the syndrome is combined with the independent action of each individual component (diabetes mellitus, dyslipidemia and/or arterial hypertension). The higher incidence of OA in obese patients is associated with several factors. One of them is a large fat mass, which increases the stress on the joints. Another is the production of pro-inflammatory mediators by adipose tissue, which negatively affect the tissues of the joints. Finally, patients with OA, with or without metabolic syndrome, are at increased risk of cardiovascular mortality, not only due to a sedentary lifestyle, but also due to common risk factors. Among them is the mild inflammation seen in patients with metabolic disorders. Thus, primary prevention and appropriate treatment of obesity and metabolic syndrome can delay the development and slow the progression of OA.

BackgroundOne of the frequent manifestations of gout is the gout nephropathy. For assessment of the urinary system functional reserves and the risk of renal failure routine analyses of urine in combination with a sonography are often not enough. Modern technology of the systemic examination of nephrourological status based on complex renal scintigraphy (SENS-CRS) was developed in the laboratory of radioisotope diagnosis in «N.N. Blokhin National Medical Research Centre» and realised as an automated workplace. SENS-CRS technology is designed for assessment of the urinary system functional reserves and the risk of renal failure at all macrostructural levels, and allows lowest radiation doses (0.6 mSv for one patient).ObjectivesTo define features of kidney function and urodynamics at patients with chronic gout based on the complex renal scintigraphy (CRS) data.Methods59 medical records of patients with gout (2007–2011) were analysed retrospectively. Most of the patients (95%) were men, average age was 54.4±9,5 years. Duration of the disease was 84–11 years. All patients had chronic gouty arthritis, 28% of patients had tophuses. The CRS tests was carried out on a two-detector gamma camera with simultaneous 2 projections recording. 99mTc-technephore was used, a Russian radiopharmaceutical (RP) from the group of bisphosphonates that has hemodynamics of a glomerulotropic product, concentrating mainly in the nephrons via filtration, with partial (10%–15%) involvement of secretion. Working protocol consisted of a base 21 min (1 min angiophase) study with administration of RP and a delayed 21 min study without administration of RP, but after taking 200–300 ml of water and/or an antispasmodic or diuretic drug to identify persistent urodynamic dysfunction. The interpretation of CRS data is based on a concentrational-hydrodynamic model of urinary excretion and SENS-CRS software. The Statistica 10.0 software was used too.ResultsAccording to CRS tests patients with gout had, on average, the level of blood cleansing from RP reduced slightly with a trend to a moderate level, and buffer retention of RP labelled blood in extrarenal structures increased. The signs of a relative hemostasis were found against the background of fast excretion accelerated by taking hypotensive drugs. Quantitative analysis of CRS data allows to estimate sustainability of relative urine delayes in the pyelocaliceal system (PCS): in 70% of patients residual urostasis in the renal parenchyma and groups of calyx remained relatively stable, and the urostasis signs in the renal pelvis were disappearing. This result means that there could be a latent increased residence time of substances such as uric acid as well as nephrotoxic drugs in the kidney parenchyma. This requires control of correct drugs dosage and when prescribing repeated therapy courses.ConclusionsThe SENS-CRS technology provides the quantitative assessment of kidney blood cleansing from RP and concentrational function of parenchyma as well as unique quantitative indicators of urodynamic delays in ...

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