Mikhail V. Ionov

Background . Home blood pressure monitoring (HBPM) is recommended both for confirming the diagnosis of hypertension (HTN) and for monitoring treatment efficacy. The recommendation of the treating physician plays a key role in promoting active and correct HBPM. Objective . To assess the frequency of HBPM recommendations by cardiologists for outpatients with HTN, identify factors associated with HBPM recommendation, and develop a machine learning–based predictive model of HBPM recommendation using electronic medical record (EMR) data. Materials and methods . A retrospective analysis of EMR data from 44,358 outpatients with HTN seen by cardiologists in 2018–2024 was conducted. A predictive model was developed using the LightGBM algorithm based on structured clinical and demographic parameters and text features from the “Diagnosis Description” field (TF-IDF). Model performance was evaluated on a test set (70 % of 2018–2023 data) and an out-of-time validation set (OOT, 2024 data). Topic modeling (LDA) was applied to analyze recommendation structure. Results . HBPM recommendation was present in 40,180 patients (90.6 %). The machine learning model demonstrated high performance: test set AUC-ROC = 0.809, accuracy = 0.954, sensitivity = 0.810; OOT set AUC-ROC = 0.840, accuracy = 0.979, sensitivity = 0.837. Text features from diagnosis descriptions made the highest contribution (gain = 11,315.1), followed by age (3,461.8) and ICD code (3,138.4). Excluding text reduced AUC-ROC to 0.655–0.673. Higher probability of HBPM prescription was associated with younger age, advanced HTN stage, and uncontrolled blood pressure. LDA identified 6 topics; HBPM was mentioned in most. Conclusion . Cardiologists recommend HBPM to most patients with HTN. The decision to recommend HBPM is associated with objective indicators of disease severity and age. The developed predictive model accurately identifies patients for whom HBPM is indicated and can serve as a foundation for clinical decision support systems.

Aim. To evaluate the impact of Marshall ligament cutting off on the incidence of atrial fibrillation (AF) within 1 month after coronary artery bypass grafting (CABG). Methods. A double-blind, randomized, single-center clinical trial included 60 patients; 30 patients were allocated to the Marshall ligament cutting off group (main group), and 30 patients to the group without Marshall ligament cutting off (control group). The groups did not differ in baseline clinical and demographic parameters. The primary endpoint was the occurrence of AF within 28 days after CABG. Logistic regression was performed to identify efficacy factors. Results. Postoperative AF developed in 9 patients: 7 patients in the control group and 2 patients in the main group. The statistical model revealed two independent factors that significantly reduced the risk of postoperative AF: performing the surgery without cardiopulmonary bypass (off-pump) and Marshall ligament cutting off (p=0.030 and p=0.048, respectively). The logistic regression model demonstrated excellent predictive ability and high patient classification accuracy; sensitivity was 93.8%, specificity was 62.5% at a cutoff of 0.5. The area under the ROC curve (AUC=0.898) indicates the model’s excellent ability to distinguish between patients with and without postoperative atrial fibrillation. Conclusion. Marshall ligament transection during off-pump CABG prevents the development of postoperative atrial fibrillation.

Background . Time in target range (TTR) of blood pressure (BP) is a recently proposed and promising indicator of hypertension (HTN) control. According to several observational studies, TTR appears to have a stronger association with cardiovascular adverse events than snapshot achievement of target BP values. The left ventricular mass index (LVMI), reflecting structural cardiac remodeling, may serve as an additional surrogate endpoint for assessing the prognostic value of TTR. Objective . To determine the presence and strength of the association between longer clinical systolic BP (SBP) TTR and the change in LVMI over 12 months in patients with initially uncontrolled hypertension. Design and methods . This was a prospective, observational, single-center study involving patients of both sexes over the age of 18 with uncontrolled HTN (defined as receiving ≥ 1 antihypertensive medication) based on clinical BP measurements. The follow-up period was 12 months and included mandatory baseline, intermediate (3-month), and final visits for clinical BP assessment (3 visits total) and echocardiographic examinations (baseline and final visits). TTR was calculated using linear interpolation. Linear regression analysis was performed to identify predictors of ∆LVMI between the first and last visits. Results . Seventy-six patients with both baseline and final echocardiographic data were included (19 women; mean age 46 years). At baseline, mean clinical SBP was 156 ± 16 mmHg, and mean LVMI was 120 ± 23 g/m². By the end of follow-up, both SBP and LVMI significantly decreased (∆24 ± 15 mmHg, p < 0,001 and ∆5,5 g/m² [95 % confidence interval (CI): 1,5 to 9,5], p = 0,011). A total of 57 patients (75 %) achieved BP control. The mean TTR was 20,2 % (95 % CI: 13,3–27,0). Multiple linear regression analysis (adjusted R² = 0,72) revealed that TTR (β = −0,167, p = 0,021), higher baseline SBP (β = −0,428, p = 0,028), and absence of active smoking (β = −11,67, p = 0,029) were independent predictors of LVMI regression. Conclusions . In high-risk patients with initially uncontrolled hypertension and no serious complications, significant reductions in clinical SBP and LVMI were observed over 12 months. A longer TTR was independently associated with LVMI regression, irrespective of other clinical parameters, particularly ∆SBP. These findings suggest that not just BP reduction, but sustained maintenance of BP within the target range is a key factor in reversing target organ damage.

Background. Arterial hypertension (HTN) is common in patients with descending thoracic aortic aneurysms (TAA) and abdominal aortic aneurysms (AAA). Lack of blood pressure (BP) control is associated with excess morbidity and mortality and high complication rate after endovascular aneurysm repair ([T]EVAR). Objective. To determine the achievement of target BP in patients with TAA/AAA and HTN before and one year after [T]EVAR and to identify the main factors influencing HTN control in the distant postoperative period. Design and methods. Data from a local registry of patients with TAA/AAA and HTN were analysed. Office BP was measured before and 1 year after [T]EVAR. Treatment adherence was assessed using the Morisky–Green questionnaire (4-point). Multivariate logistic regression analysis was performed to find the main determinants influencing the achievement of controlled BP in the distant postoperative period. Results. Overall, 136 patients (92 with AAA, 44 with TAA, mean age 67,5 ± 8,5 years, 112 men) were included. The predominant comorbidity was ischemic heart disease (n = 91). Initial systolic BP (SBP) was 134 ± 19 mmHg and diastolic BP (DBP) was 80 ± 11 mmHg. Satisfactory preoperative BP control was observed in 82 (60 %) patients. At 1 year after [T]EVAR, 81 patients were examined, office SBP was 136 ± 17 and DBP was 78 ± 11 mmHg (p [pre-post [T]EVAR] = 0,059), and controlled HTN was confirmed in 53 (65 %) patients (p [pre-post [T]EVAR] = 0,62). The median number of medications prescribed remained unchanged (Me = 2), but treatment adherence was higher (p = 0,02). The main determinants positively associated with achieving BP control 1 year after surgery were: age (odds ratio (OR) 1,1 [95 % confidence interval (CI) 1,01–1,2]), presence of TAA (OR 10,1 [95 % CI 1,3–12,2]), lack of preoperative BP control (OR 5,6 [95 % CI 3,1–13,4]). Negative predictors of HTN control: high baseline SBP (OR 0,84 [95 % CI 0,75–0,93]), number of antihypertensive drugs prescribed (OR 0,43 [95 % CI 0,21–0,89]). Conclusions. More than half of patients with HTN and TAA/AAA referred to a large federal centre for [T]EVAR have initially adequate BP control. There is no significant improvement at 1 year after operation despite better adherence and stable number of drugs. The likelihood of maintaining sustained BP control is higher in older TAA patients with initially mild and uncontrolled HTN taking fewer than three medications.

Aim. To survey Russian medical professionals on compliance issues, since high adherence to antihypertensive therapy (AHT) is one of the main conditions for satisfactory control of hypertension (HTN) and reduction of cardiovascular risk. A physician plays a key role in increasing adherence, but in Russia there is insufficient data on how specialists perceive and solve the problem of low compliance.Material and methods. Between March 4 and June 1, 2025, an anonymous online survey was conducted via the website of the Russian Society of Cardiology. The questionnaire included 11 items in different formats and was completed on a voluntary basis.Results. A total of 344 physicians participated, mostly women (78%), cardiologists (83%), with over 10 years of experience (74%), and involved in outpatient care (86%). The average time spent discussing AHT with patients was 1-5 minutes (28%) or 6-10 minutes (38%). Most respondents (73%) believed that only 0-15% of their patients with HTN never initiate the recommended therapy, and 33% estimated that more than half continue treatment one year after initiation. A total of 41,5% of physicians agreed that nonadherence is usually a conscious decision, while most considered adherence improvement possible but doubted the existence of a universal strategy (62,2%). Unstructured patient interviews were the most common method for assessing adherence, while fewer than 25% used direct methods. Physicians primarily rely on patient education and treatment simplification to improve adherence. Shared decision-making and educational programs were less frequently used. Major barriers identified included high workload, limited consultation time, and lack of systemic support.Conclusion. Surveyed physicians perceive low adherence in patients with HTN as a complex and multifaceted construct, but are optimistic about the potential for its improvement. The current level of implementation of modern methods for assessing and improving adherence remains low, partly due to high workload. There is a need to develop simple, easy-to-implement algorithms for identifying and addressing nonadherence, as well as to optimize the organizational conditions of outpatient care in order to provide effective support for patients with HTN.

Low adherence to therapy is one of the main causes of pseudo-resistant arterial hypertension (AH), associated with an increased risk of cardiovascular complications and higher direct and indirect medical costs. Adherence assessment is a crucial step in the management of patients with uncontrolled AH, particularly when therapeutic resistance is suspected. There is no "gold standard" for assessing therapy adherence. Therefore, beyond indirect methods (though simple, they are relatively unreliable), direct approaches are increasingly being utilized. These include witnessed medication intake by medical personnel — conducted alongside repeated ambulatory blood pressure monitoring using portable devices or repeated measurements by a specialist — and therapeutic drug monitoring of medications or their metabolites in biological fluids using ultra-high-performance liquid chromatography-tandem mass spectrometry. This narrative review summarizes key findings from studies on the application of these methods, outlines their respective advantages and limitations, and provides practical recommendations for their integration into everyday clinical practice. Early and simultaneous implementation of these strategies can help avoid unnecessary complex and costly diagnostic procedures in some cases and allows for more accurate identification of truly resistant AH – a patient group of scientific and clinical relevance. The use of these approaches improves the cost-effectiveness of treatment, helps uncover non-medical barriers to adherence, and strengthens the physician–patient relationship.

To date, there are no specific scales in the Russian Federation for the comprehensive assessment of patient satisfaction and experience of outpatient medical care.Objective. To validate the previously translated Norwegian "Patient Experience Questionnaire" (PEQ), a validated patientreported experience measure (PREM) for outpatients.Materials and methods. Patients aged over 18 years were invited to complete the questionnaire within 24 h after visiting a physician by clicking on a link in the QR [quick response] code printed on the medical report. The construct, discriminant validity, and reliability of individual questions, domains, and the entire questionnaire were analyzed.Results. A total of 452 patients (47.3% male, median age 55 [38–68] years) completed the questionnaire. Less than 18% of the responses were missing. These responses were considered "missing at random". Most patients in this cohort had higher education (67.7%), were married (58%), and were seen by a female physician (91.4%). In confirmatory factor analysis, the factor loadings of the questions were all above 0.6 units, and the reliability of each question, individual scales, and the entire questionnaire was above 0.8 units. The overall questionnaire model met all the goodness-of-fit criteria.Conclusions. The construct and discriminant validity of the previously translated into Russian language Patient Experience Questionnaire, has been confirmed. This PREM is proposed to be used in routine clinical practice and scientific studies under the name "RuPEQ".

Aim. To analyze perioperative characteristics, including central hemodynamic parameters, of patients with hypertension (HTN) and descending thoracic aortic aneurysm (TAA) or abdominal aortic aneurysm (AAA) who were referred for endovascular aortic repair ([T]EVAR).Material and methods. Local registry data were used. The study included 126 patients (103 men, 67±9 years). In addition to the basic examination, noninvasive measurement of central blood pressure (BP) and carotid-femoral pulse wave velocity (cfPWV) was performed. Quality of life (QOL) was assessed using the EQ-5D-3L questionnaire.Results. The most common comorbidities were coronary artery disease (68%), obesity (39%), chronic kidney disease (26%), and type 2 diabetes (18%). Patients with AAA were significantly older and had a higher comorbidity burden, but had a better QOL than patients with TAA (59% vs 71%, pConclusion. Patients with HTN and TAA/AAA referred for [T]EVAR have a high comorbidity burden and high QOL. Although the vast majority of patients receive a combination of only two drugs, insufficient adherence to therapy has been revealed. An increase in aneurysm diameter is associated with a decrease in cfPWV and increased central diastolic BP, indicating a potential impact of aneurysm on central hemodynamics in patients receiving antihypertensive therapy.

Blood pressure telemonitoring and remote counseling (BPTM) is mostly effective for management of patients with arterial hypertension (HTN). Nevertheless, its effectiveness decreases as the follow-up is prolonged, probably due to a loss of interest by patients. Objective. To determine the duration of active participation of patients with HTN in the BPTM project andto reveal the predictors of their engagement. Material and methods. Patients with uncontrolled HTN were included, BPTM suggested the home BP telemonitoring and text consultations with the doctor. Duration of the follow-up was 3 months. Mandatory initial and study end visits for measurement of the office BP, quality of life assessment (HYPE (HYpertension imPact quEstionnaire) were provided. Criteria for BPTM discontinuation absence of home BP data transmitted for 2 weeks and/or need for 2 reminders from the physician. Patients were divided into 2 groups: «quitted» and «continuing». Results. Ninety-two patients (69 men, median age 43 years) were included. Initially the median of office systolic BP (SBP) was 155 (144; 162) mm Hg, diastolic BP — 95 (90; 102) mm Hg. The office BP values have decreased significantly over the 3 months (–16 and –11 mm Hg, respectively; p<0.001). There has been a decrease in the level of home SBP (–8 mm Hg, p<0.001). Among those included in the study, 44 patients actively participated, 48 patients stopped their participation (85% of them — after 1 month). There have been no statistically significant differences between groups in the degree of BP decrease. Higher initial office SBP (ß=0.041, p=0.049), male sex (OR 4.15 (95% CI (2.01—4.06), p=0.044) and obesity (OR 3.7 (95% CI (2.06—4.24), p=0.039) were predictors of involvement. Quality of life after 3 months has been higher in the «continuing» patients (∆+9 scores, p=0.015). Conclusion. Telemonitoring and remote counseling contribute to decrease of the office and out-of-office blood pressure level. Even motivated patients stopped active participation, predominantly female non-obese patients with mild HTN. Continuing patients experience a higher quality of life.