Volokh F. Optimization of diagnosis and treatment of patients with hypertensive encephalopathy considering structural and functional state of the beta-adrenergic system

The thesis deals with the optimization of diagnostic and therapeutic measures of patients with hypertensive encephalopathy (HE) of the first (I) and the second (II) stages of the disease. A comprehensive study of the structural and functional state of the sympathoadrenal system, as a leading link in the pathogenesis of cardiovascular and cerebrovascular disorders, has been performed. For this purpose, it was accomplished a number of clinical-neurological and instrumental physical, biochemical (beta-blockers-based osmotic fragility test, HPLC) and biophysical (EHF dielectrometry) methods of investigation. The data allowed to differentiate the level of beta-adrenergic (β-ARM index) membrane activity, which depends on severity of the disease and a patient's gender. It was shown that monitoring of catecholamine concentrations in erythrocytes and blood plasma, as well as the dielectric permittivity, can serve as an additional criterion for choosing an adequate method and treatment regimen for the initial stages of HE. The determining red blood cell dielectric behavior (Δε*) during therapy would be a promising criterion in prognosis for a disease state. Using the integrated biophysical evaluation and considering the obtained data on changes in the structural and functional properties of cell membranes, specifically their beta-adrenergic receptor sensitivity, the new diagnostic and prognostic criteria for the course of the disease have been developed. This imply that erythrocytes’ beta-adrenergic receptors activity level can be considered as an early diagnostic marker for HE, and the approach proposed here can be used as an adequate assessment of the effectiveness of drug therapy.