Phosphodiesterase-5 inhibitors and their hemodynamic effects.
Level 5 - mechanism / opinion, no new human data
Narrative review without systematic methodology
PubMed 16884667 · doi:10.1007/s11906-006-0075-y
What was done
This narrative review examined the hemodynamic effects of the phosphodiesterase type 5 (PDE5) inhibitors sildenafil, vardenafil, and tadalafil alone and in combination with antihypertensive agents, alpha-1 blockers, and nitrates.
What was found
In healthy individuals, blood pressure reductions were -3.7/-3.6 mm Hg for sildenafil 100 mg, -7.5/-8 mm Hg for vardenafil 20 mg, and -1.6/-0.8 mm Hg for tadalafil 20 mg. Larger blood pressure declines may occur in treated and untreated hypertensive patients. The additive blood pressure reduction when combined with one or multiple antihypertensive drugs is modest. Alpha-1 blockers, excluding tamsulosin, may cause larger blood pressure declines and orthostatic hypotension. Nitrates combined with PDE5 inhibitors cause a profound blood pressure decline and are contraindicated.
Why it matters
The review summarizes the cardiovascular safety profile of PDE5 inhibitors, highlighting safe co-administration with most antihypertensive regimens alongside key contraindications and cautions.
Limits
The abstract describes a narrative review rather than a systematic review. Total sample sizes, study designs of underlying trials, variance measures, and statistical significance testing are not provided in the abstract.
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