title: Limited hypotensive effect of sildenafil in a high-risk population: a preliminary report.
abstract: Erectile dysfunction (ED) is often associated with cardiovascular disease (CVD) and the risk of sildenafil-induced orthostatic hypotension (OH) in subjects with CVD is a matter of concern. We describe our experience in using the tilt test (TT) with continuous plethysmography to evaluate the occurrence of OH in patients with CVD and ED after a test dose of sildenafil. When sildenafil was added on top of their usual pharmacological treatment two patients out of 32 (6.2%) developed asymptomatic OH, with a maximum blood pressure fall of 40/20 mm Hg. The low prevalence and modest clinical relevance of OH in our high-risk population coupled with the known high sensitivity and reproducibility of the TT seem to suggest that sildenafil is haemodynamically safer than is generally believed even when added on top of vasoactive treatment. These findings should be put into perspective against the growing wealth of evidence that PDE5 inhibitors may have therapeutic potential for a number of CV conditions.
authors: Dipartimento Toraco Polmonare e Cardiocircolatorio, Università di Milano, 20122 Milan, Italy. michele.ciulla@unimi.it
authors: M M
authors: MM
authors: Ciulla
authors: P
authors: P
authors: Nicolini
authors: C
authors: C
authors: Benfenati
authors: C
authors: C
authors: Vecchiato
authors: G
authors: G
authors: Acquistapace
authors: G L
authors: GL
authors: Perrucci
authors: F
authors: F
authors: Magrini
mesh_terms: D000368:Aged; D001794:Blood Pressure / Q000187:drug effects / Q000502:physiology; D007172:Erectile Dysfunction / Q000188:drug therapy* / Q000503:physiopathology; D006801:Humans; D007024:Hypotension, Orthostatic / Q000139:chemically induced* / Q000175:diagnosis / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D058986:Phosphodiesterase 5 Inhibitors / Q000009:adverse effects / Q000627:therapeutic use; D010879:Piperazines / Q000009:adverse effects / Q000627:therapeutic use*; D011159:Population Surveillance / Q000379:methods; D011687:Purines / Q000009:adverse effects / Q000627:therapeutic use; D012307:Risk Factors; D000068677:Sildenafil Citrate; D013450:Sulfones / Q000009:adverse effects / Q000627:therapeutic use*; D016683:Supine Position / Q000502:physiology; D018667:Tilt-Table Test / Q000379:methods; D014665:Vasodilator Agents / Q000009:adverse effects / Q000627:therapeutic use
chemical_list: D058986:Phosphodiesterase 5 Inhibitors; D010879:Piperazines; D011687:Purines; D013450:Sulfones; D014665:Vasodilator Agents; D000068677:Sildenafil Citrate