Antihypertensive drugs reduce the risk of stroke and cardiovascular disease in all age groups. However, in elderly and frail patients, antihypertensive treatment is associated with an increased risk of hypotension, syncope, acute kidney injury and hyperkalemia; in these patients, the risk of AEs may outweigh the benefits of antihypertensive treatment, and drug withdrawal is proposed to reduce this risk. The concept of controlled withdrawal of antihypertensive drugs is new and many practical aspects require further study in randomized controlled trials to determine the longterm effects on important clinical outcomes and quality of life in elderly patients. Given the limited evidence on long-term outcomes of controlled withdrawal of antihypertensive drugs, it must be recognized that withdrawal of antihypertensive drugs is an area of limited evidence, with very few clinical trials assessing long-term clinical effects. This review examines the rationale and potential barriers to the implementation of controlled withdrawal of antihypertensive drugs in the elderly. Recommendations for identifying patients at high risk of adverse events and a deprescribing algorithm are provided.

For many decades, cardiovascular diseases have been the leading cause of death worldwide. There is evidence that the total number of cardiovascular diseases has doubled over the past 30 years, and the number of deaths from them has steadily increased by 65 % over the same time. At the same time, the increasing prevalence of arterial hypertension as the most important risk factor for cardiovascular diseases is a global problem for world health. In this situation, the issue of antihypertensive therapy and its quality is relevant. There is still a need for further research into new classes of antihypertensive drugs. The article briefly discusses the evolution of views on the pathogenesis of arterial hypertension, the gradual introduction of drugs that lower blood pressure into widespread clinical practice. The article also presents new groups of drugs and the latest trends in the treatment of arterial hypertension.

NAFLD is an urgent multidisciplinary problem, given its high prevalence worldwide, as well as its role in the development and progression of cardiometabolic disorders and cancer. The review analyzed current data regarding epidemiology, mechanisms of development of non-alcoholic fatty liver disease and current possibilities of its therapy. The problem of NAFLD is well understood. At the same time, new data are published regarding the mechanisms of its development, the impact on other metabolically associated diseases. This proves that a further search for new treatment regimens for such patients is necessary in order to improve the prognosis and reduce cardiometabolic risks. Particular attention in the review was paid to the possibilities of hepatoprotective therapy for hepatic steatosis.

Aim. Study the course of chronic heart failure with paroxysmal and persistent atrial fibrillation (AF) during the early period after catheter cryoballoon ablation of pulmonary vein. 
Material and Methods. Sixty-seven patients (mean age 65.07 ± 7.72 years, 31 (46.3 %) men) with atrial fibrillation and heart failure were divided into two groups: Group I — paroxysmal AF and Group II — persistent AF. All patients underwent primary cryoballoon ablation using standard technique. Before operation and three months post-operation, tests included six-minute walk test, Minnesota Living with Heart Failure Questionnaire, measurement of N-terminal pro-brain natriuretic peptide, and echocardiography. 
Results. The NT-proBNP level was lower in Group I — 151.00 [65.50;249.00] ng/L versus 513,00 [355.25; 948.00] ng/L in Group II (p <0.001). Group II demonstrated larger left atrial dimensions: left atrial diameter 42.50[40.25;45.00] mm (p=0.018), indexed left atrial volume 40.00 [37.50;46.65] mL/m2 (p=0.023), right atrial diameter 43.00 [40.25;45.75] mm (p=0.001) and left ventricular. Left ventricular ejection fraction was lower in Group II — 55.00 [50.50;58.00] % versus 60.00 [57.00;62.00] % (p <0.001). Within-group analysis showed that Group I improved the quality of life and an increased 6-minute walk test distance from 411.0 [377.0;482.5] meters to 455.0 [420.0–515.0] meters (p=0.001). For Group II, dynamic changes revealed an increase in 6-minute walk test distance from 424.00 [390.00;500.75] to 470.00 [410.00–551.50] meters (p<0.001), a significant drop in NT-proBNP level from 513.00 [355.25;948.00] to 153.00 [73.50–171.00] ng/L (p<0.001), reduction in left atrial dimensions, right ventricular siz e, systolic pulmonary artery pressure, and an increase in left ventricular ejection fraction from 55.00 [50.50;58.00] % to 60.00 [55.00–60.00] % (p=0.004). 
Conclusion. Patients with persistent atrial fibrillation, who initially had more severe chronic heart failure, experienced an improvement in their functional status, increased walking endurance, reduction in left atrial and right ventricular dimensions, as well as systolic pulmonary artery pressure, along with an increase in left ventricular ejection fraction and a decrease in NT-proBNP levels, 3 months af ter cryoballoon ablation. Patients with paroxysmal atrial fibrillation benefited from cryoballoon ablation through enhanced physical activity tolerance and improved quality of life.

Background: To present clinical and laboratory characteristics and assess 28-day mortality in patients with liver cirrhosis (LC). 
Materials and Methods: The study included 137 patients (mean age 51±11; 75 (54,7 %) males) with LC. The diagnosis was established based on clinical, laboratory, and instrumental data. According to the CLIF-C OF organ dysfunction score, patients were divided into two groups: the main group (n=72, mean age 52±11; 37 (51,4 %) males) — with acute-on-chronic liver failure (ACLF), and the comparison group (n=65, mean age 49±11; 38 (58,5 %) males) — with decompensated liver cirrhosis (DC) without ACLF. Clinical parameters, inflammatory markers, ammonia and lactate levels, prognostic scores, and 28-day mortality were assessed. Statistical analysis was performed using IBM SPSS 26. 
Results: Among patients with LC, 72 (52,6 %) had DC and 65 (47,4 %) had ACLF. Alcoholrelated etiology was predominant (52,8 % and 63,1 %, respectively). Patients with ACLF were characterized by significantly more severe hepatic and renal dysfunction, systemic inflammation, and higher scores on all prognostic scales (p <0,001). The 28-day mortality rate was 9,7 % in the DC group and 27,7 % in the ACLF group, reaching 71,4 % for ACLF grade 3. Survival analysis showed significant differences between the groups (Log-Rank p <0,001). 
Conclusion: A high prevalence of ACLF was established among hospitalized patients with LC. The use of the CLIF-C OFs scale allows for effective risk stratification of patients, which is important for determining management tactics and timely referral to specialized centers.

Alport syndrome (AS) is a genetically determined disease caused by abnormalities in the genes encoding alpha-3/4/5 chains of type IV collagen. Collagen IV is the most important structural component of the glomerular basement membranes, retina and inner ear, therefore, genetic mutations in this disease lead to kidney damage, vision and hearing impairment. Depending on the type of mutation, the clinical features of AS vary from asymptomatic decrease to early development of end-stage renal disease (ESRD), hearing loss and blindness. At the same time, AS is one of the most common causes of familial proteinuria in the population. Historically, this disease was considered a pediatric disease and more common in males, although currently its prevalence among women is high. The female sex is associated with a milder course and late development of complications, including vision and hearing impairment and ESRD. According to J.P. Jais et al., ESRD is observed by the age of 45 in 12 % of patients with the x-linked variant of AS. Early onset of severe manifestations is quite rare, which leads to insufficient diagnosis of genetically determined kidney diseases, late genetic testing and initiation of treatment, including transplantation. Currently, the problem of detection, therapeutic and surgical treatment of AS remains a difficult issue to resolve.
This article presents a clinical case of diagnosis and management of a young patient with the x-linked COL4A5 variant of AS, complicated by renal parenchymal hypertension and early progression to ESRD, which required renal replacement therapy (dialysis) and kidney transplantation. The subsequent 2.5-year follow-up showed a significant improvement in the condition of target organs against the background of timely treatment.

Secondary arterial hypertension (SAH) is characterised by the presence of a specific potentially treatable cause of hypertension, higher blood pressure (BP) values, often refractory to hypotensive therapy, and higher prevalence in young adults. Diagnosis of VtAH involves searching for causes according to the principle ‘from simple to complex’ at the outpatient and inpatient stages of examination. The article describes a clinical case of a 44-year-old woman without risk factors for AH, hospitalised for hypertensive crisis on the background of uncontrolled AH. Multistage laboratory and instrumental diagnostics was performed to exclude renal, endocrine, vascular pathology. High values of renin with normal values of other hormones of adrenal, pituitary, thyroid and parathyroid glands were the basis for searching for renal and extrarenal renin-producing tumours, which resulted in the diagnosis of hyperrenin essential AH. The article presents the classification of VtAH with a list of recommended diagnostic measures, principles of therapy of hyperreninic AH, which are of practical importance for the therapist, general practitioner, endocrinologist, nephrologist.

Still’s disease (SD) is a rare chronic autoinflammatory disease manifested by the development of high peak fever, joint involvement (arthralgias and arthritis), and the appearance of a salmon-colored maculopapular rash. The 2024 EULAR guidelines unified the diagnostic criteria for Still’s disease including fever ≥39°C (102.2°F), recurrent erythematous rash, musculoskeletal involvement, neutrophilic leukocytosis, and elevated CRP and ferritin. If S100 or interleukin (IL)18 levels can be determined, their elevated values will point in favor of SD. Also, treatment strategy have been modified with the administration of biologics of IL-1 or IL-6 inhibitors if glucocorticoids (GCs) are ineffective, and the use of methotrexate (MTX) is considered if biologic therapy cannot be initiated.
This case report focuses on the situation of timely diagnosis of SD and resistance to standard therapy with GCs (including pulse therapy) and MTX. Due to insufficient availability of biologics, based on the existing experience of colchicine prescription in SD in the scientific literature, the patient’s therapy was modified with the addition of colchicine at a dose of 1 mg orally per day, after the administration of which regression of clinical manifestations and normalization of acute-phase markers were noted.
This clinical experience demonstrates the feasibility of colchicine administration as an alternative to biologics to reduce disease activity if SD is refractory to GC and MTX therapy.