The effects of tamsulosin and sildenafil in separate and combined regimens on detailed hemodynamics in patients with benign prostatic enlargement.
OBJECTIVE
We measured the detailed hemodynamic effects of tamsulosin and sildenafil separately and together in patients with benign prostatic enlargement.


METHODS
The supine effects of and responses to passive orthostasis (60 degrees for 8 minutes) were measured in 16 patients with benign prostatic enlargement with the finger blood pressure method and whole-body impedance cardiography. The medications, 100 mg sildenafil (single doses) and 0.4 mg tamsulosin (once daily for up to 14 days), were administered in a randomized, double-blind, crossover fashion.


RESULTS
Supine systolic arterial pressure decreased with sildenafil (mean +/- SEM -11 +/- 2 mm Hg) and sildenafil plus tamsulosin (-14 +/- 2 mm Hg) more than with placebo (-2 +/- 4 mm Hg, p <0.05). In comparison to placebo sildenafil plus tamsulosin decreased the systemic vascular resistance index (328 +/- 129 vs -241 +/- 134 dyn.sec/cm.m, p = 0.01). Tamsulosin alone did not cause any significant changes in comparison to placebo. Heart rate, diastolic arterial pressure, stroke index, cardiac index and arterial pulse wave velocity were not affected to a statistically significant degree by any of the treatments compared to placebo. Upon head-up tilt the drugs caused only 1 significant change in that diastolic arterial pressure was significantly higher (-2.7 vs -8.0 mm Hg, p = 0.04) in the placebo group than in the tamsulosin plus sildenafil group.


CONCLUSIONS
Tamsulosin does not disturb hemodynamics in patients with benign prostatic enlargement. Sildenafil decreases blood pressure with the patient supine but not during head-up tilt. The combination treatment also decreases the systemic vascular resistance index in the supine position.
Nieminen
Tuomo
T
Department of Pharmacological Sciences, Medical School, University of Tampere, Medisiinarinkatu, Tampere 33014, Finland. tuomo.nieminen@iki.fi
Tammela
Teuvo L J
TL
Kööbi
Tiit
T
Kähönen
Mika
M
D015106:3',5'-Cyclic-GMP Phosphodiesterases / Q000037:antagonists & inhibitors*; D000317:Adrenergic alpha-Antagonists / Q000627:therapeutic use*; D000368:Aged; D000465:Algorithms; D001794:Blood Pressure / Q000187:drug effects; D002307:Cardiography, Impedance; D018592:Cross-Over Studies; D004311:Double-Blind Method; D004359:Drug Therapy, Combination; D006339:Heart Rate / Q000187:drug effects; D006801:Humans; D008297:Male; D008875:Middle Aged; D010879:Piperazines / Q000008:administration & dosage* / Q000627:therapeutic use; D011470:Prostatic Hyperplasia / Q000188:drug therapy* / Q000503:physiopathology*; D011687:Purines; D000068677:Sildenafil Citrate; D013449:Sulfonamides / Q000008:administration & dosage* / Q000627:therapeutic use; D013450:Sulfones; D000077409:Tamsulosin; D018667:Tilt-Table Test; D014655:Vascular Resistance / Q000187:drug effects
D000317:Adrenergic alpha-Antagonists; D010879:Piperazines; D011687:Purines; D013449:Sulfonamides; D013450:Sulfones; D000068677:Sildenafil Citrate; D015106:3',5'-Cyclic-GMP Phosphodiesterases; D000077409:Tamsulosin