Hemodynamic effects of sildenafil in patients with stable ischemic heart disease

Manfroi, Waldomiro Carlos; Caramori, Paulo; Zago, Alcides José; Melchior, Raquel; Zen, Vanessa Ligocki; Accordi, M; Gutierres, Danielle; Noer, Clarissa

doi:10.1016/s0167-5273(02)00418-7

Cited by 13 publications

(8 citation statements)

References 14 publications

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“…Hemodynamic measurements were taken during right and left heart catheterization in the basal state, and 60 min after 50 mg of oral sildenafil. A single oral dose of sildenafil citrate had no significant hemodynamic effects in supine patients with stable angina and, thus, the authors concluded that isolated administration of sildenafil citrate does not appear to be associated with adverse cardiovascular effects (17). The ACC/AHA consensus statement recommended that patients taking sildenafil citrate with combinations of antihypertensive drugs (such as calcium-channel blockers, ß-blockers, diuretics, and angiotensin-converting enzyme inhibitors) be alerted to the possibility of hypotension, particularly patients with congestive heart failure (18).…”

Section: Use Of Sildenafil Citrate In Patients With Cardiovascular DImentioning

confidence: 94%

Effect of sildenafil citrate on the cardiovascular system

Shinlapawittayatorn

Chattipakorn

2005

Braz J Med Biol Res

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Sildenafil citrate is a drug commonly used to manage erectile dysfunction. It is designated chemically as 1- [[3-(6,7-dihydro-1-methyl-7-oxo-3-propyl-1H-pyrazolo[4,3-d]pyrimidin-5-yl)-4 ethoxyphenyl] sulfonyl]-4-methylpiperazine citrate (C 22 H 30 N 6 O 4 S). It is a highly selective inhibitor of cyclic guanine monophosphate-specific phosphodiesterase type 5. In late March through mid-November 1998, the US Food and Drug Administration (FDA) published a report on 130 confirmed deaths among men (mean age, 64 years) who received prescriptions for sildenafil citrate, a period during which >6 million outpatient prescriptions (representing about 50 million tablets) were dispensed. The US FDA recently reported that significant cardiovascular events, including sudden cardiac death, have occurred in men with erectile dysfunction who were taking sildenafil citrate. These reports have raised concerns that sildenafil citrate may increase the risk of cardiovascular events, particularly fatal arrhythmias, in patients with cardiovascular disease. In the past few years, the cardiac electrophysiological effects of sildenafil citrate have been investigated extensively in both animal and clinical studies. According to extensive data available to date, sildenafil citrate has been shown to pose minimal cardiovascular risks to healthy people taking this drug. Some precautions are needed for patients with cardiovascular diseases. However, the only absolute contraindication for sildenafil citrate is the concurrent use of nitrates. This article is intended to review sildenafil citrate's cardiovascular effects, as well as current debates about its arrhythmogenic effects.

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Section: Use Of Sildenafil Citrate In Patients With Cardiovascular DImentioning

confidence: 94%

Effect of sildenafil citrate on the cardiovascular system

Shinlapawittayatorn

Chattipakorn

2005

Braz J Med Biol Res

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“…Similarly, some studies have found that sildenafil reduces BP acutely in patients with coronary artery disease (CAD), 6,11,12 whereas others have found no effect. 11,13 In hypertensive patients, acute reduction in BP with sildenafil has been demonstrated consistently, although only in studies in which other antihypertensive drugs were also being taken by the participants. 14 -16 Although enhancement of the effects of endogenous NO through PDE5 inhibition may reduce BP in hypertension, the potential of regular PDE5 inhibitor therapy for the chronic treatment of hypertension has not been investigated previously in a controlled clinical trial.…”

mentioning

confidence: 99%

Effect of Regular Phosphodiesterase Type 5 Inhibition in Hypertension

2006

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There are no published controlled clinical trials of regular phosphodiesterase type 5 inhibitor therapy as a long-term treatment of hypertension. In a randomized, double-blind, 2-way crossover study, 25 otherwise untreated hypertensive subjects were administered 50 mg of sildenafil or matched placebo 3 times daily for 16 days, and the effects on ambulatory blood pressure (BP), clinic BP, arterial wave reflection, carotid-femoral pulse wave velocity, and brachial artery flow-mediated dilatation were assessed. Three subjects were withdrawn because of adverse effects, and the data from the remaining 22 subjects were analyzed. Sildenafil reduced ambulatory BP (mean [SE] change from baseline for average daytime BP: systolic -8 [2] mm Hg versus 2 [2] mm Hg with placebo, P<0.01; diastolic -6 [1] mm Hg versus 0 [1] mm Hg, P<0.01) and clinic BP (change from baseline to 1 hour after drug administration on day 16: systolic -5 [2] mm Hg versus 4 [2] mm Hg, P<0.01; diastolic -5 [1] mm Hg versus 2 [2] mm Hg, P<0.01). Compared with baseline, sildenafil, but not placebo, reduced arterial wave reflection both acutely and after chronic treatment, but the chronic change in arterial wave reflection was not statistically different from the chronic change with placebo. Sildenafil did not affect pulse wave velocity or flow-mediated dilatation. The main adverse effects of sildenafil, which were generally transient and rated as mild or moderate in severity, were dyspepsia, headache, and myalgia. In conclusion, regular sildenafil constitutes effective antihypertensive therapy. Further studies are warranted to evaluate the role of longer-acting phosphodiesterase type 5 inhibitors as antihypertensive agents in clinical practice.

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“…It was assumed that they were related to an underlying atherosclerotic cardiac disease resulting in redistribution of arterial blood flow upon sildenafil ingestion that may cause diversion of blood from areas with already inadequate coronary perfusion—a process called coronary steal phenomenon leading to myocardial ischaemia or infarction. Sildenafil may also lead to a prolonged and exaggerated vasodilation causing hypotension in patients with pre-existing cardiovascular disease 14. However, our patient did not receive any nitrate and his blood pressure was normal on admission.…”

Section: Discussionmentioning

confidence: 71%

“…Feenstra et al 10 reported the first case of sildenafil associated MI in a patient with no known cardiac history, and Dakik et al 11 reported a patient with sildenafil-induced acute MI with known coronary artery disease and suggested that the use of sildenafil in patients with underlying coronary artery disease might be dangerous even if the patient is asymptomatic. Although some clinical studies12 13 demonstrated that rates of MI and cardiovascular death are low and similar between men treated with sildenafil and those treated with placebo, suggesting that the use of sildenafil citrate is not associated with an increase in the risk of MI or cardiovascular death, several cardiac adverse events as malignant ventricular arrhythmias, cerebrovascular haemorrhage, transient ischaemic attack and sudden deaths were reported in patients taking sildenafil citrate by postmarketing surveillance data 5 14. It was assumed that they were related to an underlying atherosclerotic cardiac disease resulting in redistribution of arterial blood flow upon sildenafil ingestion that may cause diversion of blood from areas with already inadequate coronary perfusion—a process called coronary steal phenomenon leading to myocardial ischaemia or infarction.…”

Section: Discussionmentioning

confidence: 99%

An unusual adverse effect of sildenafil citrate: Acute myocardial infarction in a nitrate-free patient

et al. 2012

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Myocardial infarction (MI) associated with sildenafil citrate is seen rarely in patients without any history of coronary artery disease. We report a nitrate-free patient with a history of cardiovascular risk factors who developed acute MI after taking sildenafil. A 44-year-old man diagnosed with acute anterior ST segment elevation MI 120 min after self-administration of 150 mg sildenafil was admitted before attempting any sexual intercourse. The coronary angiography revealed 99% occlusion of the left anterior descending artery (LAD) and a bare-metal stent was implanted. He was discharged after 5 days without any complication. Sildenafil may cause coronary steal or may lead to vasodilation causing hypotension in patient with pre-existing cardiovascular disease, especially in patients on nitrate therapy. Our patient was nitrate free, with normal blood pressure values. Emotional stimulation associated with anticipated sexual activity may have been a triggering factor for vulnerable coronary plaque rupture.

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Hemodynamic effects of sildenafil in patients with stable ischemic heart disease

Cited by 13 publications

References 14 publications

Effect of sildenafil citrate on the cardiovascular system

Effect of sildenafil citrate on the cardiovascular system

Effect of Regular Phosphodiesterase Type 5 Inhibition in Hypertension

An unusual adverse effect of sildenafil citrate: Acute myocardial infarction in a nitrate-free patient

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