benzodiazepine , ipertensione e cortisolo ...

[wind636]

... domanda secca ...
in un paziente al quale si diagnostica una ipertensione da stress che viene successivamente trattata con benzodiazepine e betabloccanti si puo' riscontrare come effetto secondario E NON ASSOLUTAMENTE CERCATO un controllo pressochè totale del cortisolo fino ad abbassarlo drasticamente ?
grazie

[wind636]

Nessuno ?

[wind636]

è una domanda cosi' dificile ?

[fenix91]

Si, potresti sperimentare un calo dei livelli di cortisolo, soprattutto se questi sono elevati a causa di stress psico-fisico cronico.
Tuttavia, non credo ci possa essere un drastico calo dei suddetti livelli.
Ci sono anche alcuni studi che correlano l'utilizzo di benzodiazepine ad un calo del cortisolo, soprattutto nelle ore pomeridiane, calo che tuttavia non và ad intaccare l'asse ipotalamo-ipofisi-surrene.

Long-term benzodiazepine use and salivary cortisol: the Netherlands Study of Depression and Anxiety (NESDA).

Manthey L, Giltay EJ, van Veen T, Neven AK, Vreeburg SA, Penninx BW, Zitman FG.
Source

Department of Psychiatry, Leiden University Medical Centre, Leiden, The Netherlands. L.manthey@lumc.nl

Abstract

BACKGROUND:

As benzodiazepines (BZDs) have anxiolytic effects, it is expected that they influence the stress system. During short-term treatment, BZD use was found to suppress cortisol levels. However, little research has been done on the effects of long-term BZD administration on the hypothalamic-pituitary-adrenal (HPA) axis.
METHODS:

The association between long-term BZD use and cortisol levels was investigated in subjects of the Netherlands Study of Depression and Anxiety with a lifetime diagnosis of anxiety or depression (n = 1531). The subjects were categorized as "daily BZD users" (n = 96), "infrequent BZD users" (n = 172), and "nonusers" (n = 1263). Possible associations between characteristics of BZD use (dose, duration, and dependence) and salivary cortisol levels were analyzed.
MAIN OUTCOME MEASURE:

Subjects provided 7 saliva samples, from which 4 cortisol indicators were calculated: the cortisol awakening response, diurnal slope, evening cortisol, and cortisol suppression after ingestion of 0.5 mg of dexamethasone.
RESULTS:

Daily users used BZDs for a median duration of 26.5 months and had a median daily dosage of 6.0 mg as measured in diazepam equivalents. Evening cortisol levels were significantly lower in daily users (P = 0.004; effect size: d = 0.24) and infrequent users (P = 0.04; effect size: d = 0.12) compared to nonusers. We did not find significant differences in the cortisol awakening response, diurnal slope, or in the dexamethasone suppression test.
CONCLUSIONS:

Despite the finding of slightly lower evening cortisol levels in daily and infrequent BZD users compared to nonusers, results indicate that long-term BZD use is not convincingly associated with HPA axis alterations.




Benzodiazepine suppression of cortisol secretion: a measure of anxiolytic activity?

Gram LF, Christensen P.
Abstract

Clinical studies on spontaneous afternoon cortisol levels in depressed patients revealed that oxazepam given a few hours before blood sampling, may suppress the cortisol levels. This was confirmed in a volunteer study, where oxazepam 30 and 60 mg caused a dose-dependent suppression of the cortisol level only lasting 2 or 3 hours in spite of persisting high oxazepam levels in plasma. Subsequently, a study in 28 depressed patients showed a substantial suppression of afternoon cortisol after oxazepam 45 mg given 2 hrs prior to sampling. It may be postulated that this effect is mediated through GABA-ergic receptors inhibiting the hypothalamic release of corticotropin releasing factor (CRF). This is interesting since CRF may have neurotropic effects related to the behavioral responses to stress, and the inhibitory effect thus may represent a mechanism of action for the anxiolytic effect of benzodiazepines.

[wind636]

uhmmm ... grazie , cerchero' di approfondire.