Abstract
<jats:p>Background. Prolonged war-related psychoemotional stress has emerged as an important non-traditional cardiovascular risk factor. Relatives of military personnel represent a particularly vulnerable population, as sustained stress may modify the course of hypertension and coronary heart disease. In the presence of diabetic nephropathy, this influence may be amplified through cardiorenal and autonomic mechanisms. Materials and methods. The study tested these associations in a single-center observational cross-sectional design including 66 patients aged 40 years and older with hypertension and coronary heart disease. Participants were stratified into two groups: patients with diabetic nephropathy without military family status; those with diabetic nephropathy who were relatives of military personnel. The study assessed perceived chronic stress, anxiety and depressive symptoms, heart rate variability indices, renal functional markers. Results. Patients with diabetic nephropathy who were relatives of military personnel demonstrated the highest levels of perceived stress, anxiety, and depressive symptoms. Consequently, this group exhibited higher prevalence of adverse circadian profiles. Heart rate variability analysis revealed a marked reduction in overall variability and parasympathetic activity, accompanied by sympathetic predominance. Renal involvement was more severe, with lower estimated glomerular filtration rates and higher levels of albuminuria; moreover, stress severity showed a positive association with urinary albumin excretion. Conclusions. The combination of diabetic nephropathy and chronic war-related psychoemotional stress is associated with the most unfavorable cardiorenal and autonomic profile in patients with hypertension and coronary heart disease. These findings highlight a synergistic adverse effect of metabolic renal impairment and sustained stress, supporting the benefits of integrating psychoemotional assessment into comprehensive cardiovascular risk stratification and personalized patient management under conditions of prolonged stress.</jats:p>