The possibility of slowing down vascular remodeling in hypertensive patients with the combined effect of antihypertensive drugs and statins has been studied in few works. The effect of spironolactone on vascular stiffness in relation to the severity of the hypotensive effect in combination therapy has also been insufficiently studied. The aim of the research was to study the dynamics vascular stiffness parameters in hypertension patients of high/very high cardiovascular risk in addition rosuvastatin or spironolactone to combined two-component amlodipine and lisinopril therapy. 90 patients with hypertension were randomized into groups: the first group received a fixed combination of amlodipine/lisinopril, the secons one followed the same regimen of therapy with addition of 20 mg rosuvastatin, the third - in addition to the combination of amlodipine / lisinopril received spironolactone. After 6 months of the therapy, office and average daily blood pressure decreased in all groups, to a greater extent in the group adding spironolactone to therapy. In the rosuvastatin group, a greater degree of decrease in office diastolic blood pressure was noted. The augmentation index significantly decreased in all groups, mainly in the statin supplementation group. In patients who received a fixed combination of amlodipine/lisinopril, only the speed of propagation of the pulse wave in the carotid-femoral decreased, and with the addition of spironolactone and rosuvastatin - and in the carotid-radial.

Timely and adequate medical treatment of the patients with sudden cardiac arrest in the prehospital phase is vital for the disease outcomes. A study was conducted at the Yakutsk City Emergency Department with the purpose of assessing the quality of prehospital resuscitation and the impact of simulation trainings on life support. The sampling method was used to study all deaths and resuscitation cases in the period 2017-2020. It was established that the average figure for successful cardiac resuscitation was 29.8%, increasing to 36.8% when the circulatory arrest happened in the presence of an emergency medical team. The study assessed the quality of resuscitation after the staff completed training course in the new techniques of Four-Step Approach for emergency medical teams and Three-Step Approach for resuscitation teams. It revealed the significance of simulation trainings for keeping paramedics ready for high-quality professional resuscitation. In addition to analyzing and monitoring the resuscitation provided by emergency medical teams, it is important to develop an optimum strategy and to improve the forms of conducting simulation trainings.

The article presents the peculiarities of interventional intervention in elderly patients with acute coronary syndrome (ACS) basing on the data from the hospital register of the Regional Vascular Center, Republic’s Hospital No. 2 - Center for Emergency Medical Aid for 5 years. The analysis covered 981 patients aged 75 and over. In the period 2015-2019, for this category of patients, coronary angiography was performed in 50% of hospitalized patients, whereas percutaneous coronary intervention (PCI) - only in 1/3 of the patients with ACS. Compared with the general group of patients, less frequent use of coronary angiography and PCI in this category of patients is most often due to late admission to hospital, multivessel coronary artery disease, coronary calcinosis, the presence of a severe multimorbid pathology, refusal to undergo an examination, and the predictable impossibility of taking necessary antithrombotic drugs in the coming months. The study group showed a high hospital mortality rate of 9.9%, especially in the patients with Q-positive MI (31.4%). The analysis of this study will improve patient management and treatment, and improve outcomes for patients of 75 years of age and older.

The results of ischemic stroke thrombolytic therapy in the primary vascular department in Yakutia in 2019-2020 were studied. The proportion of ischemic stroke patients who received intravenous thrombolytic therapy (IVT) was 6.3% (n = 9). We investigated groups of patients with and without IVT (n = 9 and n = 62, respectively), comparable in age and sex. One third of patients had the cardioembolic ischemic stroke. 80.2% of intravenous thrombolytic therapy’s contraindications were associated with hospitalization beyond the 4.5-hour “therapeutic window”. There were no fatal outcome or symptomatic hemorrhagic complications in the IVT group. At the end of the acute period, the neurological status according to the NIHSS scale was comparable (p = 0.488), as was the degree of functional independence according to the Rankin Scale (p = 0.819) between groups with and without intravenous thrombolytic therapy. In the Yakutia, taking into account the low population density, large territory, complex transport scheme and peculiarities of climatic conditions, it is advisable to use the possibilities of telemedicine for conducting thrombolytic therapy of ischemic stroke. In the republic, for the increasing the account of intravenous thrombolytic therapy it is necessary to introduct the telethrombolysis method in regional hospitals that have computed tomography devices, as well as in primary vascular departments for the providing teleconsulting with the neuroimaging analysis in difficult clinical cases. The creation of a telethrombolysis network will increase the availability of modern methods of specialized medical care for patients with acute cerebrovascular accidents in areas with vast territories and low population density.

Acetylsalicylic acid is one of the most widely prescribed antiplatelet drugs in medicine. For the evaluation of the effectiveness of antiplatelet drugs in clinical practice, laboratory testing is used as an aggregometry method. This method makes it possible to estimate the aggregation activity of platelets in persons under treatment with acetylsalicylic acid preparations. High aggregation activity of platelets is thought to be associated with aspirin resistance, a state in which acetylsalicylic acid preparations are unable to prevent excess platelet aggregation and platelet events. This is due to the early increase in neurological deficits and the repeated development of ischemic stroke in patients in the acute period. A large number of factors, including race, sex and the carrying of certain genetic polymorphisms, influence the development of aspirin resistance. According to some sources, low aggreragative activity of platelets means increased sensitivity to the drug, which may lead to complications with aspirin, haemorrhagic events of various localizationsin particular. A study of the aggregate activity of platelets in the population will make it possible to avoid unnecessary aspirin intake as a primary and secondary prevention of cardiovascular diseases.

As one of the most dynamically developing sectors in the world economy now, the drug market is worth a particular interest, The beginning of 2020 showed that one of the main threats to the life and health of mankind are diseases of viral etiology. The description and analysis of the market structure, range of antiviral drugs became an obvious necessity in order to make timely and rational decisions on providing the population with drugs. To conduct a reliable and high-quality analysis of any group of drugs, it is very important to switch from an array of drugs to specific commodity items. Any antiviral drug must meet a number of requirements that determine its broad safety profile, the weight of its use in a number of nosologies, and its stability in the pharmaceutical market. The purpose of the presented work was to conduct a commodity analysis and marketing research of the Normomed drug, while using such methods as content analysis, logical, structural, graphic-analytical, comparative, complex analysis. Upon completion of an extended marketing analysis of the antiviral Normomed drug, it was found that the drug has a wide safety profile, an extensive list of indications for use. According to the studied characteristics, Normomed has shown itself to be a drug fully represented in the assortment of a pharmaceutical organization, which has obvious advantages for maintaining a significant position in the market over similar drugs.

This article contains an analysis of the ACS mortality in 2020 in the Intensive Care Unit of the Regional Vascular Center No. 1, Republic’s Hospital No. 2 -Center for Emergency Medical Aid in 2020. The aim was to assess the mortality rates, the influence of concomitant diseases, age, and the coronavirus infection; to assess the impact of primary percutaneous coronary intervention (PCI) on survival in the department; and to improve the quality of medical services provided to the population. The study covered 115 patients who died in the Cardiac Intensive Care Unit. The severity of the condition at admission, concomitant diseases, and the effect of a new coronavirus infection were taken into account. Compared to 2019, the mortality rate increased by 83%. The factors that negatively affect the level of hospital mortality are as follows: cardiogenic shock, female sex, old and senile age, kidney disease, diabetes mellitus, previous myocardial infarction, hospitalization period, distance from the PCI center, and the severity of the condition upon admission. Concomitant pathologies were detected in more than 90% of the patients. The peculiarities of the course of coronavirus infection in patients with coronary artery disease have become an increase in the class of angina pectoris, an increase in the risk of acute coronary events; however, we have yet to study the effect of the new coronavirus infection and analyze the new data.

The article analyzes the performance of the Neurological Department for patients with acute cerebrovascular accidents at the Regional Vascular Center for 10 years (2011-2020). The opening of the Regional Vascular Center and primary vascular departments made it possible to reduce significantly the rates of mortality and disability from stroke in the republic. The modern technologies introduced there for providing treatment to patients with stroke reduced the mortality from hemorrhagic stroke from 23.8% in 2010 to 13.4% in 2019, with the indicator increased in 2020 to 23.5%, and from subarachnoid hemorrhage - from 40.9% in 2010 to 16.1% in 2020. The proportion of the patients capable of self-care increased from 55.8% to 67.2%. The facilities at the Regional Vascular Center allow 100% inpatient admission of the patients living in Yakutsk City.

According to the official data of the Federal State Statistics Service, circulatory diseases (SD) rank first in the structure of diseases in the Russian Federation [1]. Since 1990, CDs have also been the leading cause of death and disability in the population of Yakutia [2]. The article describes the characteristics of the Regional Vascular Center (RVC), Republic’s Hospital No. 2 - Center for Emergency Medical Aid” (RH No. 2 - CEMA). A retrospective analysis of the work of the RVC in 2011-2020 was carried out. for the provision of specialized medical care to patients with acute coronary syndrome (ACS) and acute cerebrovascular accident (ACVI). The opening and optimization of the work of the Regional Vascular Center during 10 years has improved the results of treatment of patients with ACS and ACVI. New endovascular surgeries have been introduced into clinical practice, contributing to the effective treatment of patients with various cardiovascular pathologies. The analysis of the results of treatment of patients with ACS and ACVI in 2011-2020 indicate an increase in the volume of specialized care provided to this category of patients, as well as improved continuity, quality and accessibility of the treatment. Further work should be aimed at introducing new high-tech methods of treating ACS and acute ischemic stroke, taking into account international experience, which will undoubtedly reduce the frequency of complications and the mortality rate in patients with ACS and stroke.

We studied the results of the implementation of stroke novel treatment methods in a ten-year period in the Regional Vascular Center (Yakutsk). Since the Regional Vascular Center opening in 2011, new stroke treatment methods have been introduced, including intravenous thrombolytic therapy and endovascular thrombectomy for ischemic stroke; microsurgical clipping of ruptured cerebral aneurysms in the acute stage of subarachnoid hemorrhage; microcoil embolization for aneurysms with / without balloon or stent assistance; transcranial surgical treatment of intracerebral non-traumatic hemorrhages, including endoscopic methods; decompressive craniotomy for massive cerebral infarctions; continuous intraventricular pressure monitoring; telemedicine consulting. In the period 2018-2020, at the Regional Vascular Center, the reperfusion of ischemic stroke was provided in 4.1% of the patients, including intravenous thrombolytic therapy in 3.0%, endovascular thrombectomy in 1.1%. Surgical treatment was performed in 35.1% hemorrhagic stroke patients in 2017-2019. Microsurgical clipping for cerebral aneurysms in the acute period of subarachnoid hemorrhage was performed in 51.9%. Microspiral embolization for cerebral aneurysms was performed in 18,4%. Transcranial surgical treatment of intracerebral hemorrhage was performed in 18,9%. The implementation of stroke novel treating methods in the Regional Vascular Center has proved effective. Over the ten-year period, the ischemic stroke hospital mortality significantly decreased from 12.5% in 2007-2009 to 6.5% in 2017-2019 (p < 0,0001; χ2 = 37,676; df = 1; OR = 2,044; 95% CI: 1,621-2,577). The hemorrhagic stroke hospital mortality decreased from 30.6% to 19.8% (p <0,001; χ2 = 22,564; df = 1; OR = 1,790; 95% CI: 1,405-2,279) during this period.