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Hemodynamic Effects of Sildenafil in Patients with Coronary Disease

Because serious cardiovascular events have been reported occasionally in patients taking sildenafil for erectile dysfunction, we need more information on the hemodynamic and coronary effects of the drug. In this manufacturer-supported study, researchers from the University of Pennsylvania studied the effects of sildenafil in 14 men who underwent percutaneous revascularization for coronary stenoses of at least 70 percent. At the time of catheterization, each patient was given 100 mg of sildenafil; hemodynamic measurements were taken before the drug was given and again after about an hour.

Significantly reduced aortic systolic and diastolic blood pressures (mean decreases, 10 and 4 mm Hg, respectively) and pulmonary artery systolic pressure (mean decrease, 2 mm Hg) were associated with sildenafil use. There were no significant changes in pulmonary-capillary wedge pressure, cardiac index, and systemic or pulmonary vascular resistance. In addition, coronary blood flow (in both normal and stenosed arteries) was not affected adversely by sildenafil.

Comment: These data are reassuring, although this small study obviously does not rule out important hemodynamic effects in some patients. According to the authors, last year's consensus guidelines on the use of sildenafil in patients with cardiovascular disease remain appropriate (see JW Mar 1 1999, p. 38, accession number 990219002, and J Am Coll Cardiol 1999; 33:273).

— AS Brett

Published in Journal Watch General Medicine June 16, 2000

Citation(s):

Herrmann HC et al. Hemodynamic effects of sildenafil in men with severe coronary artery disease. N Engl J Med 2000 Jun 1 342 1622-1626.

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