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The data collected by Burdenko Military Hospital indicate that in the 1980s hypertensive crisis (HC) occurred in roughly 30% of the patients with AH. This value fell down to 16% by 2012, with a rise in the number of uncomplicated crises from 46 to 62%. Analysis of the causes behind these changes showed that half of the patients simply experienced an elevated arterial pressure with minimal clinical symptoms. The decrease in the number of complicated cases from 54 to 39% is doubtful bearing in mind that ICD-10 gives the status of nosological entities to complications of hypertensive crisis (stroke, myocardial infarction, etc.) but not to the HC syndrome proper requiring urgent hospitalization; due to this hypertensive crisis itself tends to be disregarded and not included in statistics. HC with acute clinically significant lesions of target organs requires intensive care or resuscitation using infusion of vasodilators and loop diuretics to stabilize arterial pressure. In case of uncomplicted HC and aggravation of hypertensive disease, the medications of choice are oral short-acting ACE inhibitors and imidazoline receptor agonists.

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Expert approaches to chronic kidney disease. The basic symptoms that indicate the presence of chronic kidney disease (CKD) are analysed. The authors present the modem classification of CKD, the characteristics of its stages, and requirements for the formulation of a diagnosis. The author's interpretation of the articles of the Regulations on military-medical examination, which are carried out survey of citizens subject to an initial statement on the military registration, conscription and reservists who have given pathology, is given. The necessity of the unification of expert approaches in military-medical and medical-social examination.

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The article considers new approaches to diagnosis, treatment and rehabilitation of patients with arterial hypertension (AH) applied to the Ministry of Defence contingent. For the medical service of the Armed Forces the problem is relevant because of the significant labor losses, high level of dismission, morbidity and mortality of this disease. In the assessment of the patients limitation of life should be considered a variant AH, the stage, availability and seventy of the organ damage, severity and reversibility of complications, the incidence and severity of hypertensive crises, the effectiveness of treatment, comorbidity, education, occupation, the presence of contra-types and conditions of military service or labor. Military medical expertise of soldiers with AH uses the classification of degrees of arterial hypertension of 2010 and a three-stage-classification hypertonic disease created by the World Health Organization, 1996.

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Emergency state of health by arterial hypertension. According to the Burdenko Main Military clinical hospital at the present time the frequency of crisis hypertensive heart disease is 16% from the total number of all patients with this nosology. Rapid relief of hypertensive crisis should be provided for patients' status assessment from the position of development of fatal complications. Herewith the main task when treating hypertensive crisis is not normotension, but reduction of blood pressure to safe level, taking into account potential risk of hypotonia and hypoperfusion in case of too aggressive hypotensive therapy. The main factor of hypertensive crisis development is the absence of compliance. The authors gave recommendations on treatment of complicated and non-complicated forms of hypertensive crisis, and provided indications for hospitalization.

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Resistant hypertension occurs in up to 15% of patients with arterial hypertension in Russia. Medical treatment of resistant hypertension must include minimum 3 medications with maximum or maximum tolerated doses besides one of the medications must be diuretic. According to department of arterial hypertension of the Burdenko Main Military Clinical Hospital to achieve the target levels of arterial blood pressure it was necessary to prescribe 4-5 components antihypertension therapy in patients. Authors suggested an algorithm of diagnosis and treatment of patients with resistant hypertension with the help of surgical method. This method is based on decreasing of sympathic nervous system activity by selective break of neuronal connections with the help of interventional intravascular radio-wave ablation. Endovascular renal sympathetic denervation allows to effectively control arterial blood pressure, to optimize antihypertensive therapy, but this method does not cure from arterial hypertension.

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Type 2 diabetes mellitus (DM2) is one of the clinical outcomes of metabolic syndrome (MS). We observed 201 patients with MS during 10 years. At the study end-point 144 (71.9%) of them developed DM2. The study aimed at evaluating effect of initial parameter of MS on the rate of DM2 development. Results of correlation analysis show that the rate of DM2 development depends in the first place on the patients' age, severity of abdominal obesity, vicious habits and their combination with disturbed lipid metabolism, sympatho-adrenal disbalance , and arterial hypertension rather than on disordered carbohydrate metabolism at the onset of the disease.

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The prevalence of refractory arterial hypertension in Russia is estimated at 15%. We report the first experience with surgical treatment of this pathology. The method is based on the reduction of activity of the sympathetic nervous system by selective breaking of connections between of neurons with the help of interventional intravascular radiowave ablation. Renal endovascular sympathetic denervation allows to more effectively control AP and optimize antihypertensive therapy but does not ensure recovery from AH.

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In the early 20th century hypertension became a medical problem because of the prevalence. The process of clinical research of the etiopathogenesis of hypertension is associated with a scientific and technical progress and state of medical science at every historical stage. The first stage (end of the 19th century--beginning of the 20th (century) was characterised by a research of hypertension and monitoring of its natural history. The second stage (early--mid 20th century) was characterised by attempts to influence on the natural history of hypertension. The basis of the attempts was neurohumoral concept. The third stage (end of 50s--beginning of 70s)--was characterised by the application of angiotensin-converting enzyme inhibitor, calcium channel blocker and thiazide diuretic along with beta-adrenergic blockers. The fourth stage (end of 20th century--beginning of 21st) was characterised by discovery of the renin-angiotensin-aldosterone system, development of complex treatment options for hypertension, based on stratification of risk factors of cardiovascular complication. Clinical picture of hypertension haven't changed significally during the last 100 years. Cerebral and cardiac manifestations of hypertension remain dominat in 21st century as well as in 20th century. In the beginning of 21st century such systems as eyes and kidneys are not affected by the hypertension. Hypertension remains the main cause of progression of cardiac muscle and vessel wall structural changes.

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We undertook analysis of 234 case histories of the patients with HD dated 1985-1987 (group 1) and 2010-2012 (group 2). It showed differences in clinical manifestations of HD between the two periods. First, "cerebral" complaints were less frequent in group 2 while functional state of the cardiovascular system (tolerance of physical load) and efficacy of hypotensive therapy improved. Second, decreased AP did not exclude progression of atherosclerosis and its complications in the presence of other risk factors. MS components (increased body mass, dyslipidemia, hyperglycemia) were more common in group 2 which suggests the necessity of combined prophylaxis of cardiovascular catastrophes. Third, changes in daily AP profile in group 2 require more extensive use of 24 hr AP monitoring for the choice of hypotensive therapy and estimation of its efficacy at specified time. Fourth, modern methods for the treatment of AH slow down the development of renal symptoms of AH.

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Systemic lupus erythematosus (SLE) remains a challenging medical problem. The integral approach to the analysis of underlying pathogenetic processes allows identifying main symptom complexes of SLE and establishing relationship between skin lesions and activity of the disease. We examined 84 patients with SLE (84% women), their mean age was 42.3 +/- 2.3 yr duration of SLE 6.5 +/- 1.2 yr. The subacute and chronic SLE variants were diagnosed in 30 (36%) and 54 (64%) patients respectively. Grade 1 and 2-3 inflammatory process occurred in 53 (63%) and 31 (37%) patients respectively. Symptom complexes "systemic inflammation", "butterfly rash", "wrist petechiae", "enanthema of the oral mucous membrane", and other lesions were regarded as the markers of SLE activity. The relationship of lupus-cheilitis and facial erythema with polyserositis and pericarditis ("visceral pathology-cardiovascular lesions") requires instrumental examination of pericardium, pleural and abdominal cavities in the patients with the above skin symptoms for diagnostics of polyserositis. At the same time, the presence of teleangiectasia on the wrists (symptom complex "visceral pathology-renoparenchymatous lesions") requires thorough examination of the renal function. The presence of erythema at the major joints, mesh livedo, and Raynaud's syndrome (symptom complex "musculoskeletal disorders") implies specialized examination of the locomotor apparatus.

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Analysis of causes of increase of the uncomplicated hypertensive crisis (HC) from 46 to 61% indicates that in the half of cases the cause was only high ABP with minimal clinical symptomatology. To refer all cases of the catadrome of hypertensive disease to hypertensive crisis is inappropriately. It is recommended to use with such concepts as "complicated" and "uncomplicated" HC also term "catadrome of hypertensive disease (instability of ABP)". It allows to except the hyperdiagnosis of HC and to optimize indication for hospital admission. There are recommendations for medical actions in case of complicated and uncomplicated HC and catadrome of hypertensive disease.

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Results of treatment of 84 patients with systemic lupus in specialized units of the Main Military Clinical Hospital n. a. N.N.Burdenko erythematosus are performed. Subacute variant of the disease was diagnosed in 36% of patients, chronic - 64%. Active inflammation grade 1 was observed in 63% of patients, 2-3rd class - 37%. Between changes in the skin and the degree of inflammatory activity, variant of the disease set a definite relationship. The data obtained allowed to propose a diagnostic algorithm in systemic lupus erythematosus in order to optimize the therapeutic effects.

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Diagnostics of hypertensive disease is performed according two-stage scheme recommended by Society of cardiology of Russian Federation (2010) and adapted by us for examination in Central Military Clinical Hospital n. a. N.N. Burdenko. First stage, as possible, should be carried out in out-patient departments, second stage, as it necessary, in specialized medical treatment facilities. Indications for admission of patient with hypertensive disease are abstrusity of diagnosis and necessity of carrying out of special, often invasive study, for updating of information about the form of arterial hypertension, difficulties in adjustment of antihypertensive therapy. Major criterion for adjustment of antihypertensive therapy is degree of cardiovascular risk. In the beginning of treatment monotherapy is preferable for patients with low and average risk of progression of cardiovascular disease, use of combination of two or three medications in small doses is reasonable for patients with high and very high risk of complications. Three medications were prescribed for 21% of patients, four or five for 14% of patients.

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Increase of arterial pressure and the complications connected to it remain one of the main problems of modern medicine. Presence at the patient of an arterial hypertensia is connected to the highest risk of the accelerated development of a cardiovascular pathology. Therefore the big attention is given studying of processes remodelling a myocardium at hypertonic illness and ischemic illness of heart. However the question is not investigated, whether there are also what features of process remodelling at a combination of these two diseases for one patient. The purpose of research was studying features remodelling a myocardium at essential arterial hypertensia (with presence and without chronic ischemic illness of heart) and interrelations of changes of geometry of heart with an opportunity of development of cardiovascular complications.

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Questions of diagnostics and treatment of dermatomyositis-polymyositis in literature are contradictory character. They have scanty description of peculiarities of course of this pathology by men of young and certain age, and character of complications, connected with long ingestion of corticosteroid agents. Medical case, done in the article, is of great interest undoubtedly. By reason of using corticosteroid agents, the patient get a complex of specific complications, but pains in muscles, fever, arthralgia, weakness have disappeared. There was made a decision about speeded decreasing of dose of hormonal agent to 8 mg per day for the term pf 3 months in alternative session with parallel ingestion of disaggregants. On this base was marked epilosis of bioptic damage, was achieved recanalization of deep viens of left leg, was normalized carbohydrate metabolism, generalclinic analyze of blood, transaminase level, body weight was decreased. Now-days it's marked a clinical-laboratorial remission, not requiring a supplying corticosteroid therapy.

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The practical value of metabolic syndrome is defined by it's great popularity, which becomes an epidemy, sometimes--by fatal complications sideways cardiovascular system and by capability of their prevention in conditions of forehanded diagnostics and individual correction of metabolic disorders. The authors, investigated 76 patients with indications of complete metabolic syndrome, for the first time analyzed genetic factors of risk of cardiovascular diseases and proposed the ways of optimization of diagnostics, prophylaxis and treatment of metabolic syndrome and syndrome diseases.

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Ten (1.8%) out of 558 patients with end-stage chronic renal failure on program hemodialysis developed infective endocarditis (IE). The average length of hemodialysis before IE was 17.0 +/- 14.5 months. The main cause of IE was infection of the site of vascular approaches. The diagnosis was difficult; Duke criteria modified by J. Li et al. (2000) allowed evidenced diagnosis of IE only in 30% of cases, while modified criteria offered by the authors did it in 50% of cases. The article discusses rational antibacterial therapy. Hospital lethality in IE is as high as 50%.

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