title: Clinical and haemodynamic effects of sildenafil in pulmonary hypertension: acute and mid-term effects.
abstract: OBJECTIVE
  The treatment of patients with pulmonary arterial hypertension remains a challenge. We set out to investigate the use of sildenafil, a selective inhibitor of phosphodiesterase type 5, in patients with this disease.
  
  
  RESULTS
  Ten patients (8 females, mean age 34.5+/-3.3 years) with pulmonary hypertension underwent right heart catheterisation with vasodilator testing using incremental doses of intravenous sildenafil without adverse events. All patients were subsequently commenced on oral sildenafil 50 mg t.d.s. Nine patients had repeat right heart catheterisation 3 months after the commencement of oral therapy. There was a significant reduction in mean pulmonary artery pressure (from 55.8+/-5.9 to 50.4+/-6.1 mmHg, p=0.038 ) and pulmonary vascular resistance (from 10.1+/-1.7 to 8.6+/-1.5 Wood units, p=0.009 ), and an increase in cardiac output (from 4.7+/-0.3 to 5.0+/-0.4 l/min, p=0.15 ). Furthermore, there was a significant increase in the 6-minute walk test, a mean of 112 m. In response to a quality-of-life questionnaire, patients indicated marked clinical improvement on sildenafil. Sildenafil was discontinued in 1 patient due to a transient visual disturbance. The only patient previously awaiting transplantation was removed from the active transplantation list.
  
  
  CONCLUSIONS
  Sildenafil is well tolerated in its intravenous and oral forms and appears to improve both pulmonary haemodynamics and the clinical status of patients with pulmonary hypertension after 3 months of oral therapy.
authors.affiliation: Adult Congenital Heart Unit, Royal Brompton and Harefield NHS Trust, Sydney Street, London SW3 6NP UK.
authors.forename: Ghada W
authors.initials: GW
authors.lastname: Mikhail
authors.forename: Sanjay K
authors.initials: SK
authors.lastname: Prasad
authors.forename: Wei
authors.initials: W
authors.lastname: Li
authors.forename: Paula
authors.initials: P
authors.lastname: Rogers
authors.forename: Adrian H
authors.initials: AH
authors.lastname: Chester
authors.forename: Stephanie
authors.initials: S
authors.lastname: Bayne
authors.forename: David
authors.initials: D
authors.lastname: Stephens
authors.forename: Mohammed
authors.initials: M
authors.lastname: Khan
authors.forename: J S R
authors.initials: JS
authors.lastname: Gibbs
authors.forename: Timothy W
authors.initials: TW
authors.lastname: Evans
authors.forename: Andrew
authors.initials: A
authors.lastname: Mitchell
authors.forename: Magdi H
authors.initials: MH
authors.lastname: Yacoub
authors.forename: Michael A
authors.initials: MA
authors.lastname: Gatzoulis
mesh_terms: D000284:Administration, Oral; D000328:Adult; D001794:Blood Pressure / Q000187:drug effects; D005260:Female; D006439:Hemodynamics / Q000187:drug effects*; D006801:Humans; D006976:Hypertension, Pulmonary / Q000188:drug therapy* / Q000503:physiopathology; D007262:Infusions, Intravenous; D008297:Male; D008875:Middle Aged; D010726:Phosphodiesterase Inhibitors / Q000008:administration & dosage*; D010879:Piperazines / Q000008:administration & dosage*; D011687:Purines; D000068677:Sildenafil Citrate; D013450:Sulfones; D014655:Vascular Resistance / Q000187:drug effects
chemical_list: D010726:Phosphodiesterase Inhibitors; D010879:Piperazines; D011687:Purines; D013450:Sulfones; D000068677:Sildenafil Citrate