Aim. To study the features of time characteristics of heart rate variability during isolated chronic obstructive pulmonary disease, as well as in association with arterial hypertension and ischemic heart disease. Methods. The characteristics of heart rate variability using Holter electrocardiography monitoring, echocardiography and duplex scanning of carotid arteries were studied. The results of investigations of 298 individuals of both sexes aged 37-78 years were included into the analysis, including 79 patients with chronic obstructive pulmonary disease who were divided into three groups. The first group included 19 patients with isolated chronic obstructive pulmonary disease, the second group consisted of 25 patients with chronic obstructive pulmonary disease and arterial hypertension, the third group included 35 patients with chronic obstructive pulmonary disease and ischemic heart disease, who were divided into two subgroups: patients with (n=9) and without (n=26) a prior history of myocardial infarction. For comparison, examined were 48 patients with isolated hypertension, 132 patients with ischemic heart disease and 39 practically healthy individuals. Results. In patients with isolated chronic obstructive pulmonary disease an autonomic imbalance occurs in the form of a uniform decrease in the activity of the parasympathetic nervous system during the day and an increase of the night time heart rate, identifiable are the signs of subclinical cardiac pathology in the form of thickening of the «intima-media» complex and the formation of atherosclerotic plaques in the carotid arteries, hypertrophy of the myocardium and left ventricular diastolic dysfunction, reduced systolic velocity of the mitral valve fibrous annulus. If chronic obstructive pulmonary disease is combined with aerterial hypertension and ischemic heart disease, as opposed to isolated cardiac pathology, a monotonic tachycardia develops during the day. In cases of concomitant chronic obstructive pulmonary disease and arterial hypertension during a simultaneous decrease in all time characteristics of heart rate variability, in most patients hypertrophy of both ventricles can be visualized. Conclusion. In patients with chronic obstructive pulmonary disease the time characteristics of heart rate variability depend on the presence or absence of concomitant diseases of the cardiovascular system.

Aim. To specify the sequence of changes in the functional parameters of arterial hypertension in patients with chronic obstructive pulmonary disease and asthma according to the results of echocardiography, carotid arteries duplex scan and ambulatory blood pressure monitoring.Methods. Ambulatory blood pressure monitoring, tissue Doppler echocardiography and carotid artery duplex scan were performed in 160 patients with chronic obstructive pulmonary disease, arterial hypertension, asthma, and 33 apparently healthy volunteers of both sexes aged 39-70 years.Results. In patients with chronic obstructive pulmonary disease, an increase in hypertensive indices of time and area with the development of non-dipper or inverse-dipper 24-hour blood pressure profile disturbances is registered only at night hours. In chronic obstructive pulmonary disease, unlike asthma, carotid arteries thickening, combined hypertrophy and diastolic dysfunction of both ventricles develop. The prevalence of the thickening of «intima-media» complex and atherosclerotic plaques among patients with comorbid pathology (chronic obstructive pulmonary disease + arterial hypertension) occurs significantly more frequently than in the groups with hypertension or chronic obstructive pulmonary disease, confirming the synergistic effect of the considered nosologies on the atherosclerotic process.Conclusion. In patients with chronic obstructive pulmonary disease changes of the ultrasonic and functional indicators of the cardiovascular system, typical for arterial hypertension are registered starting with stage I and amplified with increase in the disease severity, leading to the need of diagnostic and therapeutic management correction.

Significance. Cardiovascular diseases occupy one of the leading places in the structure of disease incidence in the adult population and are the leading cause of death. The purpose of the study is to analyze the relationship between all-cause disease incidence and cardiovascular morbidity in the adult population and socio-economic indicators in the Republic of Tatarstan and the Republic of Mari El, which differ in terms of living standards. Material and methods. The analysis included data from official federal and regional statistics on disease incidence and cardiovascular morbidity, as well as socio-economic indicators (gross regional product, employment/unemployment ratio, number of unemployed people, proportion of people with monetary incomes below the subsistence minimum, the Gini coefficient, R/P ratio) of the studied regions for 2000–2019. The trend dynamics is assessed by the coefficient of determination (R2). Statistical significance of time series differences was assessed by the Mann-Whitney U test, and the median was calculated with 95% CI. The relationship between the indicators was determined by the Spearman and Pearson correlation coefficient with a time lag of one year or more. Results. In the studied regions, the all-cause disease incidence in the adult population in 2000–2019 was higher than the national average with an upward trend in the Republic of Mari El (R2=0.452) and a downward trend in the Republic of Tatarstan (R2=0.455). The incidence of cardiovascular diseases in the adult population in the Republic of Tatarstan, while remaining relatively stable (R2=0.315), was higher than in the Republic of Mari El with a steady increase in the number of new cases (R2=0.729). During the analyzed period, the republics report a statistically significant increase in per-capita gross regional product and employment, due to decreased number of unemployed people and decreased proportion of people with monetary incomes below the subsistence minimum. All-cause disease incidence and cardiovascular morbidity in the adult population both in the Republic of Tatarstan and in the Republic of Mari El were in correlation with the gross regional product over a long-time interval - up to 13 years (r=0.63-0.92; p<0.05). However, the dependence vector in the regions was opposite. Correlations similar in the sign were also determined in relation to other considered socio-economic indicators that have different temporal effects on the morbidity under study. Conclusions. Regional socio-economic indicators have a statistically significant correlation with both overall incidence and cardiovascular morbidity in the adult population with the effect of cumulative and potentiated impact.

A prevalence of carotid atherosclerosis in patients with chronic obstructive pulmonary disease and hypertension SummaryThe objective of this study was to analyze results of duplex scanning of the carotid arteries in 77 patients with acute exacerbation of COPD includ ing those with co existing hypertension. Control groups included 36 patients with hypertension and 33 healthy individuals. In COPD patients, the prevalence of carotid atherosclerosis increased from 33.3 % in GOLD stage I to 72.2 % in severe disease. In the group with combined COPD and hypertension, proportion of patients with carotid atherosclerosis was independent of COPD stage and ranged from 50 % to 73.9 %. Intima media thickening and / or atherosclerotic plaques were found in all patients with COPD and two thirds of patients with COPD and hypertension having the right ventricular hypertrophy.