Sildenafil (Viagra™): new data, new confidence in treating erectile dysfunction in the cardiovascular patient
Abstract
S ildenafil citrate (Viagra TM) began life in development as an antianginal drug. Its haemodynamic profile is similar to a nitrate preparation with a modest fall in pulmonary artery pressure and an 8-10 mmHg fall in systolic blood pressure. 1 Studies in patients with cardiovascular disease and erectile dysfunction (ED) have consistently demonstrated efficacy and safety with the proviso that the patient is properly assessed and is not taking nitrates or nitric oxide donors, such as nicorandil.2 Hypertensive patients on mono or multiple therapy have experienced no increase in adverse effects compared with placebo. Patients with stable angina have not had their exercise ability impaired or ischaemia increased on treadmill testing in small pilot studies.1 At the American Heart Association (November 200 I) a randomised double blind trial of Viagra 100 mg or placebo was reported. One hundred and forty-four men with stable angina were enrolled, of whom I 08 were evaluable; I 00 mg of Viagra or placebo was given one hour before exercise, with the primary endpoint being time to limiting angina during treadmill exercise testing. Secondary endpoints included time to angina, I mm ST segment depression, total exercise time, blood pressure, heart rate and rate pressure product. All enrolled had documented coronary artery disease and were stable on conventional medical therapy. Viagra significantly increased the time to onset of limiting angina (primary endpoint), time to angina onset,…
How strong is the evidence?
Evidence Hub reads this as a randomized trial, done in people. Its evidence level is 2 of 5 (High · randomized trial). Randomized trials of a reasonable size are the strongest single-study design. Reported size: 105 participants or records.
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