In the metabolic syndrome, the main cause of death is cardiovascular events due to the high rate of damage to target organs, lb treat patients with the metabolic syndrome, it is necessary to more thoroughly choose drugs or their combination to prevent adverse metabolic effects and at the same time to adequately monitor blood pressure. It has been long considered that β-blockers exert a negative effect on lipid and carbohydrate metabolism and they arc able to deteriorate brain perfusion in patients with arterial hypertension. This study was undertaken to evaluate the effects of bisoprolol on the daily BP profile, lipid and carbohydrate metabolism and brain perfusion in patients with the metabolic syndrome and hypertension.

Despite certain success in the recent years, the problem of cardiovascular disease (CVD) in women remains one of the greatest challenges of the 21st century. Its social and economic burden will continue to increase, due to increasing proportion of older women in the population. Recently, cardiologists have been focusing on menopause as a specific CVD risk factor in women. At the same time, other conditions, also increasing CVD risk, such as certain pregnancy complications and premature menopause, have not received enough attention. Hormone replacement therapy (HRT) remains the first-line treatment and the most effective strategy in young women with estrogen deficiency and postmenopausal women with menopausal symptoms. HRT effectiveness and safety is based on its timely start, low dose, and individually appropriate combination of estrogens and progestins. Interdisciplinary approach is essential for early identification of high-risk women, since lifestyle modification recommendations, diagnostic procedures, and, if needed, an active therapeutic intervention could reduce future CVD incidence in these women.

The paper presents modern views on cardiovascular aspects of menopause and metabolic therapy of menopausal disturbances with meldonium (Mildronate®). The role of estrogen deficiency in climacteric disturbance development, key pathogenetic mechanisms of menopausal metabolic syndrome (MS), and relevant features of arterial hypertension and endothelial dysfunction development are discussed. The data on Mildronate® clinical use for cardiovascular prevention are summarized. The wide prevalence and multiple clinical manifestations of menopausal disturbances point to the need for their complex therapy. Mildronate® therapy is a new approach for systemic correction of metabolic disturbances in women with climacteric symptoms and menopausal MS.

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Aim.To compare the effects of Mildronate and hormone replacement therapy (HRT) with estradiol (1 mg) and drospirenone, DSPR (2 mg) on circadian blood pressure (BP) profile, arterial structure and function, and vascular stiffness parameters in women with early postmenopause and climacteric syndrome (CS).Material and methods.The study included 94 women with early postmenopause and CS, who provided written informed consent to participate and were divided into two groups. Group I included 36 women receiving Mildronate (500 mg twice a day), while Group II included 28 women who were administered, according to clinical indications, HRT (1 mg 17β-estradiol and 2 mg DRSP once a day). The control group (CG) included 30 women who did not receive either Mildronate or DRSP. At baseline and 16 weeks later, all participants underwent the assessment of blood biochemistry; intima-media thickness (IMT) of common carotid artery (CCA); endothelium-dependent vasodilatation (EDVD) of brachial artery (BA); antithrombogenic activity of vascular wall; aortal pulse wave velocity (aPWV); arterial stiffness; and 24-hour BP monitoring (BPM).Results.The study demonstrated positive effects of Mildronate therapy and HRT (1 mg 17β-estradiol and 2 mg DRSP) on metabolic status, circadian dynamics and variability (Var) of BP, and arterial structure and function. The largest positive changes in blood lipid profile were observed in Group I and II patients. By the end of the study, these patients demonstrated significantly decreased levels of systolic and diastolic BP and reduced BP Var, particularly in Group II. Mildronate therapy, but not HRT, was associated with normalisation of vascular wall antiaggregant potential. Group II demonstrated a significant reduction in CCA IMT levels, with a similar tendency in Group I. In both groups, the degree of endothelial dysfunction (ED) decreased, which was manifested in increased BA EDVD, decreased aPWV, and reduced arterial stiffness and was more pronounced in Group II.Conclusion.In menopausal women with CS, the effects of Mildronate and HRT on metabolic, structural, and functional disturbances were similar. Therefore, Mildronate therapy could be a new method of correction of these systemic disturbances.