Verapamil: prevention and treatment of cardio-renal syndromes in diabetic hypertensive patients?

Patients with diabetes mellitus (DM) often present other chronic comorbidities including arterial hypertension (AH), chronic kidney disease (CKD), ischemic heart disease (IHD) and heart failure with preserved ejection fraction (HFpEF). The frequent association of the latter conditions is considered part of the spectrum of cardio-renal syndromes (CRS), a group of disorders of the heart and kidneys whereby acute or chronic dysfunction in one organ may induce acute or chronic dysfunction of the other. Verapamil is a non-dihydropyridine calcium channel blocker (CCB) widely used in the treatment of hypertension, chronic stable angina, secondary prevention of reinfarction, paroxysmal supra-ventricular tachycardia and for rate control in atrial fibrillation/flutter. In addition to its antihypertensive and anti-ischemic actions verapamil exerts favorable effects also on glycemic control, proteinuric diabetic nephropathy, left ventricular diastolic dysfunction and sympathetic nervous system overactivity which may potentially benefit patients with DM and CRS. In this narrative review, we summarize the current evidence on the potential role of verapamil in the prevention and treatment of CRS in diabetic hypertensive patients.

Neuroendocrine markers in aging brain: clinical and neurobiological significance of dexamethasone suppression test.

The dexamethasone suppression test (DST) is commonly accepted as an indicator of hypothalamus-pituitary-adrenal (HPA) axis functioning in clinical practice. In this study, DST was carried out in a geriatric population composed of patients with dementia of Alzheimer type (DAT), stroke and age-matched controls. The stress state of the subjects was also functionally assessed by the Symptoms Rating Test (SRT). The results disclosed no significant differences in basal cortisol levels in the three groups. A positive correlation between age and log-transformed basal cortisol levels was found in the entire population as well as in each group. After dexamethasone administration, 20% of controls, 49% of DAT patients, and 48% of stroke patients were non-suppressors. At 8.00 a.m. and 11.00 p.m. after dexamethasone, cortisol levels were significantly lower (p less than 0.02) in controls than in pathological groups. A significant positive correlation between age and symptoms of depression and anxiety was found. One-third of stroke patients showing lesions in the right hemisphere were non-suppressors, and presented mostly subcortical infarcts, while 1/4 of them had depressive disorders. This study demonstrated a progressive increase in basal cortisol levels and depressive symptoms with age, a poor diagnostic value of DST in age-related pathological conditions such as DAT and stroke, and the role of these cerebral pathologies in amplifying the neuroendocrine dysregulation due to the ageing process itself. DST is a useful biological marker for disclosing the vulnerability of the ageing brain, but it has no diagnostic value.

[Whole blood filterability in chronic cerebrovascular disorders: effects of the use of buflomedil hydrochloride]. / La filtrabilità del sangue intero nelle cerebrovasculopatie croniche (CVC): effetti dell'impiego del buflomedil cloridrato.

Buflomedil chlorhydrate is a newly synthesized molecule with a notable effect of vasodilatation even on cerebral blood vessels. It is effective in the treatment of Chronic Cerebrovascular Disorders (CCVD) as it reduces membrane rigidity in red blood cells. Since, however, new techniques for the evaluation of this haemorheological parameter suggest it may no longer be considered the sole expression of whole blood filterability we decided to monitor the haemorheological effect of Buflomedil once again. The aim of this random blind vs. Placebo study was to monitor whole blood filterability (Reid and coll., 1976) and its main determinants (hematocrit, leucocyte count, fibrinogen levels, plasma viscosity and red blood cell deformability) in 20 (10 male and 10 female) CCVD patients (Ad Hoc Committee, Paris, 1980), aged between 66 and 75 years of age before and after intravenous injection in bolus of 150 mg Buflomedil chlorhydrate. Our results showed a significant increase in whole blood filterability, confirming those of recent studies on other molecules with a known effect on the haemorheological pattern but not only on the plasticity of red blood cells. Further studies are therefore necessary to define the rheological activity of this drug more precisely.