Despite a wide range of antihypertensive drugs, blood pressure (BP) control often remains unsatisfactory, and every year the number of people with uncontrolled high BP increases. One of the strategies aimed at improving medical adherence is the use of fixed-dose combinations of 2 antihypertensive drugs for starting therapy, and, if necessary, 3 drugs. Initiation of therapy with 2 drugs in one tablet is recommended for most patients. A review of algorithms for choosing combinations of antihypertensive drugs in different clinical situations, including in patients with various comorbid conditions, is presented. Simplification of treatment regimens makes it possible to choose the most optimal solutions in various clinical situations, in particular, with stage I-II hypertension, with a combination of hypertension with chronic kidney disease, as well as with a combination of hypertension with coronary artery disease and a number of other diseases.

Introduction. It is now recognized that stress plays an important role in the occurrence and exacerbation of chronic pain syndromes. Stress has a modulatory effect on the structures of the nervous system depending on the nature, duration and intensity of the stressor which is reflected in the clinical characteristics of pain.Aim. To study the features of the clinical characteristics of chronic localized pain syndromes depending on the presence of psychosocial stressors at the onset of pain.Materials and methods. The study included 118 patients with chronic localized pain syndromes 38 men (32.2%) and 80 women (67.8%) aged 19 to 66 years (mean age 41 ± 11 years). Depending on the presence of premorbid psychosocial stressors at the onset of pain patients were divided into two groups group I (main), group II (control). The research methods included a general clinical assessment of the pain syndrome characteristics, an assessment of the emotional state, psychosocial indicators and quality of life using special scales and tests. Statistical analysis was carried out using the StatTech v. 2.6.1.Results. Patients of group I experience more than 4-6 episodes of exacerbations per year, the duration of pain is from 8 to 28 days, affecting an average of 4 (3; 6) localizations, using more descriptors (p < 0.001, p = 0.013, p = 0.014, p=0.017, p=0.002 resp.), more likely to suffer from headaches and cervicalgia (p = 0.004 and p < 0.001 resp.), use on average 4 (2; 5) drug group for pain relief (p = 0.004). Among patients with premorbid psychosocial stressors the proportion of women is 6.5 times higher (p < 0.001). A significantly greater number of patients with sleep disorders and anxiety were identified in group I (p < 0.001, p = 0.009 respectively), the total score in assessing fatigue was 24 (19; 39) points which corresponds to moderate fatigue (p = 0.009). The average stress score on the Holmes-Rahe scale was 80 (53; 102) (p < 0.001), the main stressful events are work-related problems. Direct statistically significant relationships between the level of stress and the characteristics of the pain syndrome were established the number of pain localizations, the intensity of pain, the number of descriptors (p < 0.001, p < 0.001, p < 0.001). The life quality index was 2 (2; 4) scores according to the EQ-5D-3L questionnaire which indicates   a decrease in the quality of life (p < 0.001) in group I. It was noted that the chances of stress onset of pain in an active lifestyle are 3.4 times lower (p = 0.012).Conclusion. Premorbid psychosocial stressors are markers of the severity of chronic pain and affective distress. At the same time premorbid psychosocial stressors can be considered a modifiable factor. If it is assessed and recognized in time, the development of chronic pain and associated affective distress can be eliminated and potentially prevented.

One of the main reasons for seeking medical help is myofascial syndrome (MFS), which is manifested by local inflammation with elements of degenerative changes in the affected tissue, pain and muscle spasm due to dysfunctional disorders in the nociceptive system and a decrease in the quality of life. This review discusses etiopathogenesis in detail, taking into account the factors predisposing to the development of MFS, which are divided into anatomical, ergonomic, medical and psychosocial, and also provides diagnostic criteria for pain MFS, including 5 large and 3 small criteria necessary for diagnosis. The second part of the review examines the indications, efficacy, safety, and benefits of topical forms of nonsteroidal anti-inflammatory drugs (NSAIDs), which have a moderate effect on pain, but have a much better safety profile due to reduced systemic absorption. The use of topical drugs allows you to create an effective concentration of the drug directly in the lesion and avoid undesirable systemic effects. Experts strongly recommend prescribing primarily topical, rather than oral, NSAIDs to patients aged 65 years and older who have concomitant cardiovascular and renal pathology, as well as diseases of the gastrointestinal tract. In more detail, the review examines topical forms of diclofenac, which differ in the maximum degree of transdermal penetration compared to other NSAIDs and the effect of slow release of the active substance into the surrounding tissues.

У здоровой женщины при нормально протекающей беременности структурно-функциональные изменения сердца носят адаптивный характер, выражены незначительно и полностью нормализуются после родов. У беременной с теми или иными заболеваниями сердца адаптационные возможности снижены, поэтому на любом этапе беременности могут возникать патологические изменения, осложняющие ее течение и приводящие к неблагоприятным исходам. Кроме того, при любой беременности возможно развитие новых заболеваний сердца, которые могут быть фатальными. Вот почему эхокардиографическая оценка структурно-функциональных изменений сердца является необходимой как при нормальной беременности, так и на фоне сопутствующих сердечно-сосудистых заболеваний. In a healthy woman with a normal pregnancy, structural and functional changes in the heart are adaptive in nature, are slight and are completely normalized after childbirth. A pregnant woman with heart diseases has reduced adaptive capacity, therefore, at any stage of pregnancy, pathological changes can occur that complicate its course and lead to adverse outcomes. In addition, any pregnancy may develop new heart diseases, which can be fatal. That is why an echocardiographic assessment of structural and functional changes in the heart is necessary both during normal pregnancy and in the background of concomitant cardiovascular diseases.

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