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Sildenafil Plus Angiotensin Converting Enzyme Inhibitor Improves Endothelial Function More Than Either Agent Alone: Presented at ASH(HYP)

By Maggie Schwarz

NEW YORK, NY -- May 21, 2003 -- Sildenafil does not appear to add any safety risk to patients if taken along with angiotensin converting enzyme inhibitors, and the combination has additive effects with regard to endothelial function, but not blood pressure lowering.

Katarzyna Hryniewicz, MD, of the Yale University School of Medicine, New Haven, Conn, presented results of her group's prospective, randomized, double-blind study of 64 patients here at the 18^th Annual Scientific Meeting of the American Society of Hypertension.

The widespread use of sildenafil is largely due to the millions of men who have cardiovascular disease, which leads to erectile dysfunction. Since both angiotensin converting enzyme (ACE) inhibitors and phosphodiesterase type 5 inhibitors have been reported to enhance endothelium-dependent vasodilation in chronic heart failure (CHF), the investigators looked into whether the 2 classes of drug have additive effects in CHF. They also wanted to determine whether CHF patients taking an ACE inhibitor can use sildenafil safely.

Sixty-four men with CHF took either a single dose of ramipril 10 mg, sildenafil 50 mg, both agents, or placebo. Background ACE inhibitors were stopped 72 hours prior to the study. Endothelial function was assessed by measuring flow-mediated dilation (FMD) on high-resolution ultrasonography of the brachial artery over 4 hours.

Placebo did not change FMD. Ramipril increased FMD versus placebo, but not significantly. Sildenafil increased FMD versus placebo at 1 and 2 hours (P<.05). The combination of ramipril and sildenafil increased FMD significantly versus placebo, at 1, 2, and 4 h (P<.05). Sildenafil did not augment the acute blood pressure lowering effects of ramipril. Both agents were well tolerated.

Dr. Hryniewicz concluded that she doubts any potential of sildenafil for improvement of endothelial function, because it is too short acting.


[Study title: Comparative Effects of Ramipril, Sildenafil, or Both on Endothelial Function in Patients With Chronic Heart Failure. Abstract P-94]

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