Kidney transplantationComplication: NephropathyAcute Effects of a Single Dose of Phosphodiesterase Type 5 Inhibitor (Sildenafil) on Systemic Arterial Blood Pressure During Exercise and 24-Hour Ambulatory Blood Pressure Monitoring in Heart Transplant Recipients
Section snippets
Study Subjects
We analyzed patients who underwent OHT with at least 1 year follow-up. Twenty-four orthotopic heart transplant recipients were consecutively selected for the study (Table 1). Seventeen hypertensive patients, defined as 24-hour blood pressure >140/90 mm Hg, were presented antihypertensive medications. All patients were in stable clinical condition without required changes in treatment within the last 3 months. The protocol was approved by the Ethical Review Committee of the Heart Institute
Results
Twenty-two patients completed the Sil and Pl phases of the protocol. Two men were excluded during the Pl phase, due to an episode of intense fatigue and headache. Seventeen patients who had a diagnosis of systemic hypertension were receiving antihypertensives. Five patients had normal systemic blood pressure. Patients underwent the 6-minute cardiopulmonary treadmill walking test 70 ± 12 minutes after Pl oral ingestion, and 71 ± 11 minutes after Sil (P = not significant [NS]). The maximal
HR, SBP, and DBP
In comparison with Pl, Sil did not change the heart rate at rest, last minute heart rate in the 6-minute cardiopulmonary walking test, or during the peak maximal cardiopulmonary treadmill exercise tests (Table 2).
The 50 mg Sil dose reduced the systemic SBP and DBP at rest and exercise in both tests. In hypertensive subjects, Sil decreased both systemic SBP and DBP at rest, during the 6-minute walking test, and maximal exercise. In normotensive patients, Sil reduced the systemic DBP at the last
Discussion
Our results demonstrated that 50 mg Sil, a selective PDE5 inhibitor, reduced systemic SBP and DBP at rest, during exercise, and during 24-hour monitoring after OHT, mainly among hypertensive OHT patients. Sil did not change the heart rate, the VE/VCO2 slope, the VO2, or the exercise capacity during both exercise tests. Sil was well tolerated and increased resting neurohormonal activation as measured by Nor plasma levels.
References (43)
- et al.
Controversies in hypertension
Lancet
(2006) - et al.
Arterial disease in dipper and nondipper hypertensive patients
Am J Hypertens
(1997) - et al.
Transcriptional induction of endothelial nitric oxide gene by cyclosporine AA role for activator protein-I
J Biol Chem
(2000) - et al.
Vascular effects of sildenafil in hypertensive cardiac transplant recipients
Am J Hypertens
(2003) - et al.
Treadmill exercise in assessment of functional capacity of patients with severe left ventricular disease
Am J Cardiol
(1972) - et al.
Effects of sildenafil citrate on human penile blood vessels
Urology
(2000) - et al.
Acute type 5 phosphodiesterase inhibition with sildenafil citrate enhances flow-mediated vasodilation in patients with chronci heart failure
J Am Coll Cardiol
(2000) - et al.
A comparison of 24-h average blood pressure and blood pressure load following exercise
Am J Hypertens
(1997) - et al.
Acute aerobic exercise reduces ambulatory blood pressure in borderline hypertensive men and women
Am J Hypertens
(1996) - et al.
Ambulatory blood pressure after acute exercise in older men with essential hypertension
Am J Hypertens
(2000)
Impact of cardiac transplantation in 24 hours circadian blood pressure and heart rate profile
Transplant Proc
Exercise capacity in heart transplant recipients: relation to impaired endothelium-dependent vasodilation of the peripheral microcirculation
Am Heart J
Exaggerated blood pressure response to exercise is associated with carotid atherosclerosis in apparently healthy men
J Hypertens
Effects of blood pressure and glucose on endothelial function
Curr Hypertens Rep
Endothelial function and nitric oxide: clinical relevance
Heart
Cyclic nucleotide phosphodiesterase: functional implications of multiple isoforms
Physiol Rev
Effects of sildenafil citrate on the relaxation of human corpus cavernosum tissue in vitro and on the activities of cyclic phosphodiesterase isozyme
J Urol
Effects of sildenafil citrate on human hemodynamics
Am J Cardiol
Sildenafil effects on exercise, neurohormonal activation, and erectile dysfunction in congestive heart failure: a double-blind, placebo-controlled, randomized study followed by a prospective treatment for erectile dysfunction
Circulation
Treatment of pulmonary arterial hypertension
N Engl J Med
Chronic inhibition of cyclic GMP phosphodiesterase 5A prevents and reverses cardiac hypertrophy
Nat Med
Cited by (17)
Effects of acute phosphodiesterase type 5 inhibition on skeletal muscle interstitial PO<inf>2</inf> during contractions and recovery
2024, Nitric Oxide - Biology and ChemistryImprovement in functional capacity with spironolactone masks the treatment effect on exercise blood pressure
2022, Journal of Science and Medicine in SportCitation Excerpt :The key finding of this study was that the full treatment effect of spironolactone on submaximal exercise systolic BP was hidden by an improvement in functional capacity. Other studies have reported the effects of antihypertensive therapy on exercise BP separate from the effects on functional capacity7,12 or exercise test duration.21–23 To our knowledge, this current study is the first to take into consideration the relative changes in both exercise BP and functional capacity (cardiorespiratory fitness).
Exercise training improves ambulatory blood pressure but not arterial stiffness in heart transplant recipients
2015, Journal of Heart and Lung TransplantationCitation Excerpt :impaired endothelial function37; and nephrotoxicity by drugs, mainly calcineurin inhibitors.38,39 In this context, it is reasonable to speculate that the large BP reduction after ET observed in the present study may be mediated by the mechanisms commonly found in relatively healthy populations15,17,19,25,37 as well as by reducing deleterious effects on BP of cardiac denervation, immunosuppressive, and nephrotoxicity.
Short term effects of sildenafil citrate therapy in secondary pulmonary hypertension
2014, Egyptian Heart JournalCitation Excerpt :Gregory et al.,9 showed that sildenafil did not significantly change resting heart rate and mean arterial pressure. In contrast, Guimaraes et al.,10 reported that sildenafil significantly reduced blood pressure in the basal position and during exercise. It also promoted a significant reduction in SBP and DBP during 24 h, daytime and night time.
Oral sildenafil: Potential role in heart transplantation. Review of the literature and personal experience
2010, Journal of CardiologyEffects of sildenafil on maximum walking time in patients with arterial claudication: The ARTERIOFIL study
2019, Vascular PharmacologyCitation Excerpt :In the present study, 83.3% of patients were hypertensive. The extent of blood pressure reduction induced by sildenafil observed herein is similar to that reported in previous studies in healthy controls, hypertensive patients, and patients with cardiac disease subsequent to acute sildenafil administration [41–43]. After the treadmill test, two women sustained symptomatic but transient hypotension.