Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Original Article
  • Published:

Effect of sildenafil on blood pressure and arterial wave reflection in treated hypertensive men

Journal of Human Hypertension volume 15, pages 707–713 (2001)Cite this article

Abstract

As the effects of sildenafil are in part mediated by enhancing the action of nitric oxide and nitrates given acutely markedly reduce early wave reflection, we explored the effects of a single oral dose of sildenafil citrate (50 mg) on blood pressure and arterial wave reflection in treated hypertensive men in a single-blind randomised placebo controlled crossover study. Eight men (aged 57–76 years) with well controlled hypertension and erectile dysfunction and no contraindications to the use of sildenafil, were given either sildenafil 50 mg or placebo orally, with the second drug being given 2 weeks later. Blood pressure and heart rate with an automated digital oscillometric device (Omron® HEM-705 CP) and the augmentation index, a measure of arterial wave reflection in the aorta derived using radial applanation tonometry, were measured before and at 15-min intervals for 2 h thereafter. The extent of individual maximum reductions (mm Hg) from baseline in systolic (24 ± 10 vs 6 ± 8, P < 0.05) and diastolic blood pressure (8 ± 5 vs 3 ± 2, P < 0.05) occurred on the sildenafil study day. On average the brachial blood pressure at 75 min following sildenafil was 17/11 mm less than on the placebo day (P < 0.01). Augmentation index was also reduced significantly at 90 min (P < 0.05) suggesting reduced vascular tone in the arteries. The area under the brachial and aortic blood pressure and augmentation index time curve (by the trapezoidal rule corrected for baseline reading) was significantly lower (P < 0.05) on the sildenafil study day. The study shows that the peripheral vasodilatory effects of sildenafil, possibly related to nitric oxide, are accompanied by a fall in systemic blood pressure and reduced arterial wave reflection.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

Similar content being viewed by others

References

  1. Cheitlin MD et alUse of sildenafil (Viagra) inpatients with cardiovascular disease. ACC.AHA Expert Consensus Document Circulation 1999 99 168–177

    Article  CAS  PubMed  Google Scholar 

  2. Tomlinson JM Viagra and its use in cardiovascular disease J Hum Hypertens 1999 13 593–594

    Article  CAS  PubMed  Google Scholar 

  3. Kloner RA Cardiovascular risk with sildenafil Am J Cardiol 2000 36 (Suppl) 57F–61F

    Article  Google Scholar 

  4. Shakir SA et alCardiovascular events in users of sildenafil: results from first phase of prescription event monitoring in England BMJ 2001 322 651–652

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  5. European Agency for Evaluation of Medicinal Products, Committee for Proprietary Medicinal Products European Public Assessment Report: Viagra, CPMP 1136/98, London 1998

  6. Jackson G, Benjamin N, Jackson N, Allen MJ Effect of Sildenafil citrate on human haemodynamics Am J Cardiol 1999 83 13–20C

    Article  Google Scholar 

  7. Morales A et alClinical safety of oral Sildenafil citrate (Viagra) in the treatment of erectile dysfunction Int J Impot Res 1998 10 69–74

    Article  CAS  PubMed  Google Scholar 

  8. Westling H, Hansson L, Jenson B, Nilsen R Vasoactive drugs and elastic properties of human arteries in vivo, with special reference to the action of nitroglycerine Eur Heart J 1984 5 609–616

    Article  CAS  PubMed  Google Scholar 

  9. Breithaupt-Grogler K, Belz GG Epidemiology of the arterial stiffness Pathol Biol 1999 47 604–613

    CAS  PubMed  Google Scholar 

  10. O’Rourke MF, Kelly RP, Avolio AP (Eds) The Arterial Pulse Lea & Febiger: London 1992 pp 36–37

    Google Scholar 

  11. O’Rourke MF, Kelly RP Wave reflection in the circulation and its implications in ventricular function J Hypertens 1993 11 327–337

    Article  PubMed  Google Scholar 

  12. O’Rourke MF, Gallagher DE Pulse wave analysis J Hypertens 1996 14 (Suppl 5) S147–S157

    Google Scholar 

  13. Kelly R et alNon-invasive registration of the arterial pressure pulse waveform using high-fidelity applanation tonometry J Vasc Med Biol 1989 1 142–149

    Google Scholar 

  14. Karamanoglu M, O’Rourke MF, Avolio AP, Kelly RP An analysis of the relationship between central aortic and peripheral upper limit pressure wave in man Eur Heart J 1993 14 160–167

    Article  CAS  PubMed  Google Scholar 

  15. O’Rourke M Arterial stiffening and ventricular/vascular interaction J Hum Hypertens 1994 8 (Suppl 1) S1–S15

    Google Scholar 

  16. Kelly RP et alNitroglycerin has more favourable effects on left ventricular afterload than apparent from measurement of pressure in a peripheral artery Eur Heart J 1990 11 138–144

    Article  CAS  PubMed  Google Scholar 

  17. Viagra (sildenafil citrate) package insert. NY Pfizer Inc: New York 1998

  18. Wilkinson IB et alReproducibility of pulse wave velocity and augmentation index measured by pulse wave analysis J Hypertens 1998 16 2079–2084

    Article  CAS  PubMed  Google Scholar 

  19. Siebenhofer A, Kemp CRW, Sutton AJ, Williams B The reproducibility of central aortic blood pressure measurements in healthy subjects using applanation tonometry and sphygmocardiography J Hum Hypertens 1999 13 625–629

    Article  CAS  PubMed  Google Scholar 

  20. Boolell M et alSildenafil, an orally active Type 5 cyclic GMP-specific phosphodiesterase inhibitor for the treatment of penal erectile dysfunction Int J Impot Res 1996 8 47–52

    CAS  PubMed  Google Scholar 

  21. Herrman HC, Chang G, Flugherz BD, Mahoney PD Haemodynamic effects of sildenafil in men with severe coronary artery disease N Engl J Med 2000 342 1622–1626

    Article  Google Scholar 

  22. Van Popele NM et alArterial stiffness as underlying disagreement between an oscillometric blood pressure monitor and a sphygmomanometer Hypertension 2000 36 484–488

    Article  CAS  PubMed  Google Scholar 

  23. Webb DJ, Freestone S, Allen MJ, Muirhead GJ Sildenafil citrate and blood pressure lowering drugs: results of drug interaction studies with an organic nitrate and a calcium antagonist Am J Cardiol 1999 83 21C–28C

    Article  CAS  PubMed  Google Scholar 

  24. Philips BG et alSympathetic activation by sildenafil Circulation 2000 102 3068–3073

    Article  Google Scholar 

  25. Williams D, Feely J Initial uptake of sildenafil in general practice Eur J Clin Pharmacol 2001 56 912–914

    Article  Google Scholar 

  26. Hedner T et alEnhanced blood pressure lowering effect in hypertensivepatients on combined sildenafil and lercanidipine treatment. (Abstract) J Hypertens 2000 18 S165

    Article  Google Scholar 

  27. Stein RA Cardiovascular response to sexual activity Am J Cardiol 2000 86 (Suppl) 27F–29F

    Article  Google Scholar 

  28. El Sakka AI, Lue TF Does a heart attack mean the end of sexual life? ACC Educational Highlights 1996 Winter 6–9

    Google Scholar 

  29. Kimmel SE Sex and myocardial infarction: an epidemiologic perspective Am J Cardiol 2000 86 (Suppl) 10F–13F

    Article  Google Scholar 

  30. Mahmud A, Feely J Favourable effects on arterial wave reflection and pulse pressure amplification of adding angiotensin II receptor blockade in resistant hypertension J Hum Hypertens 2000 14 (Suppl) S41–S46

    Google Scholar 

  31. Chen CH et alDifferent effects of fosinopril and atenolol on wave reflection in hypertension Hypertension 1995 25 1034–1041

    Article  CAS  PubMed  Google Scholar 

  32. Ting CT et alArterial haemodynamics in human hypertension: effects of adrenergic blockade Circulation 1991 84 1099–1057

    Article  Google Scholar 

  33. Wallis RM, Corbin JD, Francis SH, Ellis P Tissue distribution of phosphodiesterase families and the effects of sildenafil on tissue cyclic nucleotides, platelet function and contractile response of trabeculae cornae and aortic rings in vitro Am J Cardiol 1999 83 3C–12C

    Article  CAS  PubMed  Google Scholar 

  34. Yagimima T et alEffect of glyceryl trinitrate on peripheral arteries alters left ventricular hydraulic load in man Cardiov Res 1986 20 153–160

    Article  Google Scholar 

  35. Webb DJ et alSildenafil citrate potentiates the hypotensive effects of nitric oxide donor drugs in malepatients with stable angina J Am Coll Cardiol 2000 36 25–31

    Article  CAS  PubMed  Google Scholar 

  36. Stief CG et alEffects of sildenafil on cAMP and cGMP levels in isolated human cavernous and cardiac tissue Urology 2000 55 146–150

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Pharmacology and Therapeutics, Trinity Centre and Hypertension Clinic, St. James’s Hospital, Dublin, 8, Ireland

    A Mahmud, M Hennessy & J Feely

Authors
  1. A Mahmud
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. M Hennessy
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. J Feely
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to J Feely.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Mahmud, A., Hennessy, M. & Feely, J. Effect of sildenafil on blood pressure and arterial wave reflection in treated hypertensive men. J Hum Hypertens 15, 707–713 (2001). https://doi.org/10.1038/sj.jhh.1001244

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/sj.jhh.1001244

Keywords

This article is cited by

Search

Advanced search

Quick links