Трехкомпонентная комбинированная антигипертензивная терапия у больных артериальной гипертензией с абдоминальным ожирением. Данные 9-месячного наблюдения

Aim. To study the pharmacoepidemiological features of the prescription of antihypertensive fixed dose combinations and their efficacy in hypertensive patients in the real outpatient practice in Vladivostok city. Material and methods . Hypertensive patients aged 1 8 years and older (n=268) observed in Vladivostok polyclinics from October to December 2017 were included into the study. All patients did not have target blood pressure (BP) levels. The analysis of the medical prescriptions of antihypertensive fixed dose combinations in Vladivostok polyclinics was performed. Two-component (perindopril + amlodipine) or three-component (perindopril + amlodipine + indapamide) fixed dose combinations were prescribed by physician in accordance with instructions for medical use and their pharmacological characteristics. The study was non-interventional and included 3 visits for the initial examination, prescription and correction of therapy, considering its efficacy. All patients were determined for glomerular filtration rate using CKD-EPI (Chronic Kidney Disease Epidemiology Collaboration Formula), changes in BP. Patients performed self-esteem on a 1 0-point visual analogue scale (VAS). Results. Only 23.4% of patients reached target BP levels in the first month of observation, and 84.5% of patients after 3 months of observation. 30 (1 1.2%) patients had replacement with double antihypertensive fixed dose to triple combination combinations during the study. 68.6% of patients did not have a replacement for the initial prescribed antihypertensive fixed dose combinations due to the achievement of target BP. The number of patients with moderately and markedly reduced glomerular filtration rate was reduced significantly. Initially, the patients included into the study assessed health (according to adapted VAS) for 5.6±1.4 points, and after 3 months of follow-up - for 7.9±1.7 points. Conclusion. The use of antihypertensive fixed dose combinations containing ACE inhibitor (perindopril), calcium channel blocker (amlodipine) and thiazide-like diuretic (indapamide) resulted in achievement of target BP levels in 84.5% of patients after 3 months of follow-up. Also, the use of double and triple fixed dose combinations had a nephroprotective effect, manifested in an increase in the number of patients ( + 19.3%) with a glomerular filtration rate more than 60 ml/min/1,73 м 2 and a positive effect on the patient's well-being.

Aim. To study the effect of «treat-to-target» antirheumatic therapy on diastolic dysfunction of the left (DDLV) and right (DDLV) ventricles in patients with early rheumatoid arthritis (RA) during 18 months of observation. Material and methods. The study included patients with early RA (n=66; 71% women; age - 56 [46; 61] years) with moderate/high activity (DAS28 5.3 [5.0; 6.2]), seropositive on rheumatoid factor (77%) and/or cyclic citrullinated peptide antibodies (100%), disease modifying anti-rheumatic drugs (DMARD) and glucocorticoids naive. Treatment with methotrexate (MTX) with the escalation of the dose up to 25-30 mg/week subcutaneously was initiated in all the patients. After 3 months in 47 (71%) patients biologics were added to MTX due to its inefficiency. In 18 months remission of RA was achieved in 44% of the patients. 51 (77%) patients had a cardioprotective therapy. The target blood pressure (BP) level was achieved in 38 (58%) patients. Evaluation of traditional cardiovascular risk factors, 24-hour BP monitoring and echocardiography were performed in all patients initially and in 18 months of MTX/MTX + biologics use. Results. After 18 months DDLV incidence decreased by 7% (from 49% to 42%; p>0.05) and DDRV incidence decreased by 5% (from 24% to 17%; p>0.05). A more significant decrease in DDLV incidence [from 23 (62%) to 18 (49%)] and of DDRV incidence (from 12 (32%) to 6 (16%)] (р=0.05), was found in MTX + biologics group than in MTX only group [DDLV incidence remained unchanged - 7 (28%), and DDRV incidence increased from 3(12%) to 4 (16%); p>0.05]. The normalization of left ventricle (LV) diastolic function in early RA patients depended primarily on the efficacy of antihypertensive treatment, and of right ventricle (RV) diastolic function - on the achievement of target BP level and RA remission. Reduced erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) plasma levels were associated with the improved LV diastolic function [E/A LV and ΔESR (r=-0,3; p<0,04), E/A LV and CRP (r=-0,2; p<0.05), A LV and ESR (r=0.3; p<0.01)] and improved RV diastolic function [ΔA RV and ΔCRP (r=0.4; p<0.003), ΔE RV and ΔCRP (r=0.3; p<0.01), E/A RV and DAS28 (r=-0.5; p<0.001), E/A RV and CRP (r=-0,3; p<0.05)] by the 18th month of the study. Conclusion. In early RA patients after 18 months the downward trend of DDLV incidence and a significant reduction of DDRV incidence were found, more expressed in patients treated with MTX + biologics. The achievement of RA remission and target BP level is a prerequisite for the normalization of LV and RV diastolic function and slowing the progression of heart failure.

Objective: Improving an efficiency of resistant hypertension treatment with fixed dose combination of 3-components antihypertensive medicationDesign and method: 180pts with the preliminary diagnosis of RAH,which was confirmed by24-h ambulatory blood pressure monitoring(ABPM),were included in the study. All pts received an average of4.1 ± 0.3 antihypertensive drugs, mainly in free combinations. After ABPM pts were started treatment with 3-component fixed dose combination (FDC) of antihypertensive drugs:the FDC of perindopril10 mg/indapamide2.5 mg/amlodipine10mg(108pts)or the FDC of valsartan320 mg/hydrochlorothiazide25 mg/amlodipine10mg(72pts). The adherence to the treatment was evaluated by the Morisky-Green test (MGT) at the initial examination and after 3 months of treatment with the FDC of antihypertensive drugs. Results: The average level of office systolic BP (SBP) and diastolic BP (DBP)was158.1 ± 1.2 and 91.03 ± 0.9mmHg respectively. After 3 months of treatment with 3-components FDC, according the results of office and ambulatory BP measurements,RAH was confirmed at 78pts and 102pts achieved the target blood pressure level (these pts were classified as pts with controlled arterial hypertension (CAH)). RAH pts were older than CAHpts:52.4 ± 1.2vs49.8 ± 1.6years (p = 0.02). Both groups were dominate by men-60.5%among RAH pts and62.6% among CAH pts. But initial BP levels (office and ambulatory)were higher in RAH group (tab.1). In the CAH group the office SBP decreased by 21%,DBP-by19.5%,the average daytimeSBP and DBP by15.2 and14% respectively,the average nighttime SBP and DBP by16.7 and16.4% respectively. In the RAH group BP lowering was smaller:the office SBP decreased by13.2%,DBP - by9%,the average daytime SBP and DBP by10.3and8.7% respectively,the average nighttime SBP and DBP by11.1and10.2% respectively. All pointed changes of BP were significant (p < 0.001)(tab.1). The results of the Morisky-Green tests show that treatment with FDC of antihypertensive drug leaded to improvement of the adherence to therapy. The initial Morisky-Green rate,which was assessed retrospectively,at RAH pts was1.3 ± 0.1points and at CAH pts1.4 ± 0.1 (p > 0.05),after 3-months of treatment with 3-components FDC it elevated to 2.5 ± 0.2 and 2.6 ± 0.2 points, respectively, in both groups (p < 0.005). Conclusions: Thereby, administration of 3-components FDC (RAAS blocker/diuretic/calcium channel blocker)improves the adherence to treatment, which can probably ameliorate the efficacy of antihypertensive treatment. Perhaps,the use of 3-component FDC in patients with a diagnosis of RAH could help to achieve the effective BP control and reduce the necessity of adding the 4-th antihypertensive drug for achieving of goal BP.

Aim. To assess awareness of blood pressure (BP) level, adherence to therapy and achievement of target BP in residents of Russian regions as part of the 2023 hypertension (HTN) screening campaign.Material and methods. During May 2023, 4613 participants from 23 cities of Russia took part in the screening. Participation was voluntary without restrictions on sex. All patients aged over 18 years. During screening, BP and pulse were measured three times using automatic or mechanical BP monitors, and a questionnaire about behavioral risk factors, concomitant diseases and therapy was filled out. HTN was diagnosed with systolic BP ≥140 mm Hg and/or diastolic BP ≥90 mm Hg and/or taking antihypertensive therapy (AHT).Results. The analysis included data from 4585 respondents aged 18 to 95 years with an average age of 45 [28;59] years, of which 1729 were men (37,7%). The proportion of hypertensive patients was 49,6%. Among them, 62,8% took AHT and achieved target BP in 76,6% and 45,7% with the target BP criterion &lt;140/90 mm Hg and &lt;130/80 mm Hg, respectively. Most patients took dual AHT (37,4%), while monotherapy and triple therapy was registered in 27,5% and 23,4%, respectively. Initiation of therapy was performed with combination AHT in 43,7% of patients with HTN and 41,4% are currently using fixed-dose combination therapy. On-demand therapy was the most common reason for skipping medications and was more common in women, while men more often cited the high drug cost and a history of adverse reactions. Among patients with HTN, home BP measurement was associated with a higher prevalence of achieving target BP as follows: 1000 (60%) vs 100 (17%), p&lt;0,001.Conclusion. The data obtained indicate, on the one hand, a continuing insufficient level of awareness about high BP and the use of antihypertensive drugs among the population, but there is a tendency to improve the effectiveness of the treatment of hypertension, including the use of fixed-dose combinations of antihypertensive drugs.

The majority of patients with stable arterial hypertension require combination therapy which is supported by the clinical evidence. The established target levels of blood pressure below 130/80 mmHg are challenging and demand multiple drug combinations in a single patient. Therefore, the use of dual and triple combination therapy is getting wider, and rational triple fixed combinations are highly relevant. The updated guidelines on the diagnostics, management and treatment of arterial hypertension of the European Society of Hypertension and the European Society of Cardiology confirm and recommend early and wider use of the fixed-dose drug combinations. The paper reviews the main practical issues of the use of combination therapy, including key questions of the change from free dose to fixed dose combinations and their rational choice.

Objective: The aim was to study the ambulatory blood pressure as a predictor of diabetic nephropathy (DN). Materials and Methods: A total of 73 patients with DN at Stage III were selected as DN group and 73 cases with 5-10 years of diabetes were as diabetes group. The results of blood routine, biochemical indexes, dynamic blood pressure and the diversity index, which as the predictors of DN, analyzed by multivariate logistic regression analysis and compared between two groups. Results: Body mass index, the dose of oral glucose (GLU)-lowering drugs, the levels of fasting plasma GLU, HbA1c, total cholesterol, triglyceride, high-density lipoprotein-cholesterol, low-density lipoprotein-cholesterol, and high-sensitivity C-reactive protein index had no statistically significant difference in two groups in the course of the disease. There were significant differences in peripheral blood leukocyte count, platelet count, erythrocyte sedimentation rate, uric acid, estimated glomerular filtration rate, average daytime systolic blood pressure (SBP), average nighttime SBP, average daytime diastolic blood pressure (DBP), average night DBP, 24 h SBP variability, daytime SBP variability and nighttime SBP variability between the two groups. In univariate analysis, we found that platelet count ( P = 0.03), average night DBP ( P = 0.01), nighttime SBP variability ( P Conclusion: Platelet count, average diastolic pressure and SBP at night are the independent predictors of DN.

Aim. To study the microcirculation (MC) status during arterial hypertension (AH) treatment and after the achievement of target blood pressure (BP) levels. Material and methods. The study included 75 patients with essential AH, but withoutprevious regular antihypertensive therapy.Inallparticipants, antihypertensive treatment was started, which resulted in the achievement of target BP levels. Treatment effectiveness was assessed via the office BP measurement, 24‑hour BP monitoring, and self-control diary data. MC dynamics was assessed with conjunctival biomicroscopy (CBMS). Results. In all participants, CBMS demonstrated MS disturbances. Conclusion. BP control with antihypertensive therapy significantly improves MC parameters.

Актуальність. Лікування артеріальної гіпертензії у хворого з абдомінальним ожирінням є дуже складною задачею. Тому найбільш доцільнім вважається застосування для лікування цієї категорії хворих комбінованої антигіпертензивної терапії з використанням двох і більше компонентів. Метою дослідження було вивчення клінічної ефективності фіксованої комбінації периндоприлу, індапаміду, амлодипіну у хворих на артеріальну гіпертензію в поєднанні з абдомінальним ожирінням. Матеріали і методи. Обстежені 32 хворі на неконтрольовану артеріальну гіпертензію з абдомінальним ожирінням у динаміці 12-тижневої терапії фіксованою трикомпонентною комбінацією — периндоприл/індапамід/амлодипін на тлі застосування аторвастатину і дієтичних рекомендацій. Результати. Показано, що використання фіксованої трикомпонентної комбінації — периндоприл/індапамід/амлодипін на тлі середньодозової статинотерапії і дієтичних рекомендацій у хворих на неконтрольовану артеріальну гіпертензію з абдомінальним ожирінням супроводжується позитивними змінами рівнів ліпідів крові і не викликає погіршення показників вуглеводного і пуринового обмінів. Висновки. Установлена висока ефективність апробованої фіксованої трикомпонентної комбінації антигіпертензивних препаратів у цієї категорії хворих.

Objectives: To assess the blood pressure-lowering efficacy and tolerability of perindopril/amlodipine fixed-dose combinations in Chinese patients with mild-to-moderate essential hypertension not adequately controlled with monotherapy alone. Methods: In 2 separate double-blind studies, patients received a 4-week run-in monotherapy of amlodipine 5 mg or perindopril 4 mg, respectively. Those whose blood pressure was uncontrolled were then randomized to receive the fixed-dose combination of perindopril 5 mg/amlodipine 5 mg (Per/Amlo group) or remain on the monotherapy for 8 weeks. Patients who were uncontrolled at the week 8 (W8) visit were up-titrated for the Per/Amlo combination, or received additional treatment if on monotherapy, for a further 4 weeks. The main efficacy assessment was at 8 weeks. Results: After 8 weeks, systolic blood pressure (SBP; primary criterion) was statistically significantly lower in the Per/Amlo group (vs. Amlo 5 mg, p = 0.0095; vs. Per 4 mg, p < 0.0001). Uncontrolled patients at W8 who received an up-titration of the Per/Amlo combination showed a further SBP reduction. These changes were mirrored by reassuring reductions in diastolic blood pressure. The fixed-dose combinations were well tolerated. Conclusions: Single-pill combinations of perindopril and amlodipine provide hypertensive patients with a convenient and effective method of reducing blood pressure.

Aim.To assess the effects of moxonidine-based combination therapy on clinical status, laboratory parameters, and target organs in patients with metabolic syndrome (MS).Material and methods.In total, 60 MS patients with Stage 1-2 arterial hypertension (AH) were randomised into 3 groups. Group I was administered moxonidine (0,2-0,4 mg/d) and amlodipine (5-10 mg/d); Group II received moxonidine (0,2-0,4 mg/d) and hydrochlorothiazide (12,5 mg/d); Group III was treated with moxonidine (0,2-0,4 mg/d) and enalapril (10-20 mg/d). At baseline and after 24 weeks of treatment, the following characteristics were assessed: waist circumference (WC), body mass index (BMI), 24-hour blood pressure monitoring (BMP) parameters, left ventricular myocardial mass index (LVMMI), E/A ratio, isovolumetric relaxation time (IVRT), deceleration time (DT) of early diastolic velocity, peak Em velocity at interventricular septum and lateral wall levels, E/Em ratio (myocardial tissue Doppler echocardiography), pulse wave velocity (PWV) between descending aorta and aortic bifurcation levels (ultrasound method), and stiffness index β of ascending aorta. In addition, lipid, carbohydrate, and purine metabolism parameters were assessed; glomerular filtration rate (GFR) was calculated (MDRD method); and urine albumin levels were measured.Results.In Group I (moxonidine + amlodipine), target blood pressure (BP) levels were achieved in 70% of the patients. Systolic BP (SBP) levels, LVMMI, and DT decreased by 19,3±11,4 mm Hg, 4,4 g/m2 (p=0,09), and 10,6 ms (p&lt;0,05), respectively. The increase in E/A ratio and Em annular velocity (Em av) reached 0,4 (p&lt;0,05) and 1,4 cm/s (p&lt;0,05), respectively, while E/Em av ratio decreased by 0,8 (p&lt;0,05), and PWV decreased by 1,6 ms (p&lt;0,05). The BMI decrease reached 0,7 kg/m2 (p&lt;0,05). In Group II (moxonidine + hydrochlorothiazide), target BP levels were achieved in 40% of the participants, with a decrease in SBP levels by 14,7 mm Hg (p&lt;0,05). DT was reduced by 9,4 ms (p&lt;0,05), E/A ratio increased by 0,1 (p&lt;0,05), while PWV, BMI, and GFR decreased by 1,3 m/s (p&lt;0,05), 0,8 kg/m2 (p&lt;0,05), and 5,6 ml/min/1,73 m2 (p&lt;0,05), respectively. In Group III (moxonidine + enalapril), 60% of the patients achieved target BP levels, and SBP levels were reduced by 21,1 mm Hg (p&lt;0,05). LVMMI decreased by 5,1 g/m2 (p&lt;0,05), Em av increased by 0,3 cm/s (p&lt;0,05), while the respective reduction in PWV, WC, and BMI reached 1,1 m/s (p&lt;0,05), 1,8 cm (p&lt;0,05), and 0,5 kg/m2 (p&lt;0,05). All three groups demonstrated a significant reduction in urine albumin levels.Conclusion.The moxonidine-based combination therapy effectively reduced the levels of BP and urine albumin. The combination of moxonidine with amlodipine or enalapril improved cardiac structure and function, as well as renal excretory function. The combination of moxonidine and hydrochlorothiazide, however, negatively affected renal excretion. All three variants of combination therapy were metabolically neutral and demonstrated beneficial effects on visceral obesity.

Aim. To study the influence of combinational antihypertension therapy including inhibitor of angiotensin converting enzyme (ACEi) or direct renin inhibitor (DRI) on the parameters of 24-hour blood pressure monitoring (ABPM) in postmenopausal women in different obesity patterns. Material and methods. Totally, 168 women studied with arterial hypertension (AH) in postmenopause: 97 with abdominal obesity (AO) and 71 with gluteofemoral (GFO). Patients were randomized to groups of ACEi therapy and diuretic or DRI and diuretic. Follow-up lasted for 24 weeks. Results. In 4 weeks of therapy with the usage of maximal ACEi dosages, target level of blood pressure (BP) was reached in 30 from 42 (71,4%) women with AO and 27 from 32 (84,4%) with GFO, and maximum dose of DRI led to target pressure achievement in 37 from 41 (90,2%) women with AO and 30 from 33 (90,9%) with GFO. Others required addition to the therapy a dihydropyridine calcium antagonist. In 6 months of therapy in all groups of patients there was positive dynamics of the main 24-hour profile parameters. Conclusion . Combination of ACEi or DRI with indapamide retard have significant antihypertension effect in women with AH in AO and GFO. In addition, combination of DRI with diuretic is better than of ACEi that was showed by the prevalence and speed of target BP achievement, more significant dynamics of ABPM parameters and positive changes in patients spread upon physiologic and pathologic types of 24-hour profile in 24-week therapy, especially in AO.

Goal: to study the effectiveness of combination antihypertensive therapy (AHT) and its influence on the indices characterizing the arterial stiffness of various types in patients with arterial hypertension (AH) in combination with obesity and severe obstructive sleep apnea (OSA). Material and methods. The study included 27 male patients with hypertension [143.0 (142.0; 150.0)/91.0 (85.3; 94.8) mm Hg. century], obesity [body mass index of 33.8 (32.0; 37.2) kg/m2] and OSA was severe [the index of apnea/hypopnea - AHI - 46.8 (33.3; 63.4) events per hour] who underwent AHT titration to achieve target values of blood pressure (BP), a fixed combination of the calcium antagonist amlodipine (10 mg) and the angiotensin-converting enzyme inhibitor perindopril (5-10 mg). At baseline and after 4-6 weeks when reaching target blood pressure was assessed pulse wave velocity (PWV) using different instrumental techniques. Carotid-femoral PWV (CFSP) was determined by applanation tonometry (SphygmoСor AtCor, Australia), aortic PWV - ultrasonic technique in the descending aorta (thoracic spine), the ankle-brachial PWV - using volumetric sphygmography (VaseraVS-1000 Fukuda Dens, Japan). Results. The target pressure (according to clinical blood pressure, daily monitoring blood pressure) on the background of amlodipine 10 mg and perindopril 5 mg was 58% patients and 42% of patients reached the target level of blood pressure against the background amlodipine 10 mg and perindopril 10 mg. On a background of 4-6 weeks of admission AHT 33.8% increase in the number of patients with a normal circadian profile of blood pressure - «dipper». Upon reaching the target blood pressure revealed a significant decrease CFSP, ankle-brachial PWV and aortic PWV 11.4, 11.0 and 15.4%, respectively. Conclusion. A fixed combination of perindopril arginine and amlodipine in patients with arterial hypertension of the 1st degree in the presence of obesity and OSA allows achieving a good level of BP control, to improve the performance of the daily profile and to improve the elastic properties of large arteries, which has a beneficial protective effect in these patients.

Hypertension: an urgent need for global control and prevention

Aim. To analyse how effectively the three main risk factors – arterial hypertension (AH), hypercholesterolemia, and Type 2 diabetes mellitus (DM-2) are controlled among male and female patients with coronary heart disease (CHD), who are residents of the Ingush Republic. Material and methods. The study included 300 men and 230 women (mean age 54±0,4 and 55,7±0,5 years, respectively) – residents of the three Ingush Republic regions. The standard questionnaire included items on sociodemographic parameters, behavioural risk factors, and pharmaceutical therapy. Blood pressure (BP) was measured in a sitting position, with a 5-minute interval between two measurements. In all patients, blood levels of total cholesterol (TCH, mmol/l)) and glucose (mmol/l) were measured. Adequate control of AH, hypercholesterolemia, and DM-2 was defined as the achievement of target levels of BP, TCH, and fasting glucose during the treatment. Results. Among CHD patients, hypercholesterolemia was the most prevalent risk factor in both men (95%) and women (81%). Only 11,3% of men and 21% of women received lipid-lowering therapy (typically, statins). Target TCH levels were achieved in 1% and 2%, respectively. AH was registered in 77,3% and 65% of male and female CHD patients, respectively. In men with CHD and AH, 93% received antihypertensive therapy (18%, 49%, and 26% received one, two, or three medications, respectively). Target BP levels were observed in 43% of the treated men. In women with CHD and AH, 28%, 60%, and 7% received one, two, or three antihypertensive medications, respectively; target BP levels were achieved in 49%. DM-2 prevalence reached 17% in men and 13% in women. Among patients with CHD and DM-2, target fasting glucose levels were registered in 41% of men and 21% of women. Conclusion. Among CHD patients, target BP levels were achieved in every second participant, while target glucose levels were observed in 30%, and target TCH concentrations were registered in less than 2%.

Aim. To determine the main socio- demographic, psychological, hemodynamic and meteorological predictors of seasonal blood pressure (BP) increase in the cold season in patients with stable arterial hypertension (AH) in Moscow. Material and methods. The study was conducted at the National Medical Research Center for Therapy and Preventive Medicine from 1997 to 2009. It involved patients with hypertension without severe concomitant diseases requiring regular therapy. At the first and second visits, psychological status (PS) and quality of life (QL) were assessed, daily blood pressure monitoring (ABPM) was performed. All procedures were performed after washout period (3-5 days). Visits were carried out in different months of the same year, and the difference in daily ambient temperatures between the first and second visits was 5 °C or more. PS was assessed using the Mini- Mult test (Russian short version of MMPI questionnaire, Minnesota Multiphasic Personality Inventory), QL — using the "General Well- Being Questionnaire" (GWBQ). The severity of the seasonal blood pressure increase (ΔBP) with a in ambient temperature decrease and indicators was calculated as the difference betweenthe BP levels that were recorded in the colder and warmer seasons. A multivariate regression analysis was performed to assess the relationships between the ΔBP severity and initial hemodynamic data, socio- demographic indicators, and psychological characteristics of AH patients. Results. Data from 137 patients with stable AH (77 (56 %) women, 60 (40 %) men) were analyzed. The average age was 55.7 ± 0.8 years, the AH duration was 11.9 ± 0.8 years, the height — 167.3 ± 0.7 cm, weight — 81.1 ± 1.2 kg, mass index body (BMI) — 28.9 ± 0.4 kg/m2. The initial blood pressure during ABPM were: 1) average daytime systolic BP (SBPd) 144.7 ± 1.4 mm Hg, nighttime (SBPn) — 126.0 ± 1.3 mm Hg; 2) average daytime diastolic BP (DBPd) — 91.6 ± 0.8 mm Hg, nighttime (DBPn) — 75.1 ± 0.8 mm Hg. After regression analysis, the following seasonal BP increase predictors in the cold season were found: 1) for SBPd — DBPd — 5 scale scores of the QL questionnaire; 3) for DBPn — diastolic white coat effect (WCEd). Several seasonal BP decrease predictors were found: 1) for DBPd — systolic WCE (WCEs) and body mass index (BMI). Conclusion. The main hemodynamic predictors of the BP seasonal changes were WCE level. The psychological component of QL was a DBPd seasonal increase predictor, and BMI was a DBPd seasonal decrease predictor in the cold season.