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Sildenafil (Viagra) Effective In Treating Pulmonary Hypertension

One dose of sildenafil (Viagra) is as effective as inhaled nitric oxide for patients with severe pulmonary hypertension, the results of a small Canadian study suggest.

In a study of 13 severely ill patients, referred for possible heart-lung transplant, or as a guide to medical therapy, researchers from the University of Alberta found that the fall in pulmonary vascular resistance was similar for both drugs.

But, patients taking a single 75 mg dose of sildenafil, either alone or in combination received other cardiovascular benefits. Sildenafil or in combination with inhaled nitric oxide increased cardiac output, and tended to reduce pulmonary capillary wedge pressure (inhaled nitric oxide increased capillary pressure).

Systemic arterial pressure was found to be similar in all three treatment groups, and did not rise during treatment.

Cyclic guanosine monophosphate (cGMP) levels were measured, increasing after both inhaled nitric oxide and sildenafil treatment. The levels remained elevated more than when either drug was given alone.

The pulmonary hypertension patients were functional class III or IV, and their prognosis was poor. Nine patients had primary pulmonary hypertension; two had pulmonary arterial hypertension, and two had secondary pulmonary hypertension.

The researchers conclude that sildenafil is an effective and selective pulmonary vasodilator, and say it may be superior to inhaled nitric oxide because it boosts cardiac output and does not increase wedge pressure. They call for further studies to assess the effect of sildenafil when given for longer periods.
Circulation 2002; 105: 2398. "Oral Sildenafil Is an Effective and Specific Pulmonary Vasodilator in Patients With Pulmonary Arterial Hypertension: Comparison With Inhaled Nitric Oxide"

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