Vaccination against Streptococcus pneumoniae is among the most effective measures for preventing pneumonia and reducing the rate of chronic obstructive pulmonary disease (COPD) exacerbations. The objective of this work was to evaluate the long-term effectiveness of PCV13 and PPV23 for preventing pneumonia and COPD exacerbations. The open-label, prospective, observational cohort study involved 302 male patients aged ≥ 45 years: PCV13 group (n = 123); PPV23 group (n = 32); and vaccine-naïve group (n = 147). The primary endpoint included the frequency of pneumonia episodes and COPD exacerbations per year over a 5-year follow-up period. The secondary endpoints included the dynamics of dyspnea severity (MMRC), the BODE index, FEV1, the CAT index, the SGRQ score, and the results of 6-min walk test. Vaccination with PCV13 and PPV23 significantly reduces the total rate of pneumonia during the first year after vaccination. Starting with the second year, clinical effectiveness in PPV23 group decreases compared with both PCV13 group and vaccine-naïve patients. Pneumonia by year 5 after vaccination was registered in 47% of patients in the PPV23 group, versus 3.3% of patients in the PCV13 group (p < 0.001); COPD exacerbations—in 81.3% versus 23.6%, respectively (p < 0.001). Vaccination with PCV13 significantly reduced and maintained the BODE index over the 5-year follow-up period. Although both vaccines have comparable clinical effects during the first year after vaccination, only PCV13 is characterized by persistent clinical effectiveness during the 5-year follow-up period. Patients older than 55 years who received PPV23 have significantly higher risks of having pneumonia episodes more frequently during the long-term follow-up.

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The main views of the issue of stress and hy�ertension are briefly reviewed. it is well �nown that stress is one of the major ris� factors for cardiovascular disease develo�ment. increase in blood �ressure is a ty�ical manifestation of the acute stress res�onse. This fact is the reason to hy�othesize that chronic stress causes the develo�ment of hy�ertensive disease. an association of hy�ertension with �sychological stress in humans was shown in several wor�s. in addition�� it was demonstrated that hy�ertension was accom�anied by an increase in sym�athetic tone. on the other hand�� there were many �o�ulation studies in which no association was found between different ty�es of chronic stress and arterial hy�er-tension. Thus�� the question is far from being resolved. Even in cases when one managed to obtain a significant hy�ertensive effect in ex�erimental studies with emotional stress�� it was difficult to ex�lain the mechanisms mediating the formation of stressinduced hy�ertension. To clarify the situation�� one of the authors of this review decided to begin the breeding of a rat strain with increased blood �ressure res�onse to emotional stress. This breeding gave rise to inbred rats with �ersistent stressinduced arterial hy�ertension. The short history of develo�ment of the genetic model of stressinduced arterial hy�ertension�� the iSiaH rat strain�� is given. a retros�ective review of the studies �erformed with iSiaH rats is �resented. The contribution of genoty�e changes in the neuroendocrine systems involved in stress and blood �ressure regulation to the develo�ment of stress-de�endent hy�ertension in the iSiaH rat strain is shown.Key words�� stress; arterial hy�ertension; iSiaH rat strain.В кратком о�зоре изложены взгляды на про�лему стресса и артериал��ной гипертонии. Известно�� �то стресс является одним из существенных факторов риска за�олеваний серде�но-сосудистой системы. �овышение артериал��ного давления -типи�ное проявление острой стрессовой реакции. В связи с этим существует гипотеза о том�� �то состояние хрони�еского стресса может �ыт�� при�иной развития гипертони�еской �олезни. Имеется нескол��ко ра�от�� в которых описано нали�ие ассоциации артериал��ной гипертонии с психологи�еским стрессом у л�дей. �оказано�� �то артериал��ной гипертонии сопутствует повышение тонуса симпати�еской нервной системы. Но�� с другой стороны�� ест�� много популяционных ра�от�� в которых не �ыло о�наружено ассоциаций между разными видами хрони�еского стресса и гипертонией. таким о�разом�� вопрос остается далеким от разрешения. Даже в тех слу�аях�� когда удавалос�� полу�ит�� заметный гипертензивный эффект в экспериментал��ных ра�отах с применением эмоционал��ного стресса�� возникали трудности с о�ъяснением механизмов формирования стресс-индуцированной гипертонии. Для прояснения ситуации одним из авторов данной стат��и �ыла на�ата селекция крыс на повышенну� реакци� артериал��ного давления при действии эмоционал��ного стресса�� в резул��тате �его �ыла полу�ена ин�редная линия крыс со стойкой стресс-индуцированной артериал�...