Background-Phosphodiesterase type 5 (PDE5) is a novel therapeutic target for the treatment of pulmonary hypertension.This study examined the distribution of PDE5 in normal and hypoxic lung and the effect of chronic PDE5 inhibition with sildenafil, initiated before and during exposure to hypoxia, on pulmonary artery pressure (PAP) and structure. Methods and Results-Sprague-Dawley rats were exposed to hypoxia (10% O 2 ) for up to 42 days. PAP, measured continuously by telemetry, increased gradually by 20 to 40 mm Hg, reaching a plateau between 10 and 14 days, and declined to normal levels on return to normoxia. PDE5 immunoreactivity was localized to smooth muscle cells in the medial layer of pulmonary arteries and veins in the normal lung and in distal muscularized arteries (Ͻ25 m diameter) after hypoxia-induced pulmonary hypertension. Sildenafil (25 or 75 mg · kg Ϫ1 · d
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