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Sildenafil citrate potentiates the hypotensive effects of nitric oxide donor drugs in male patients with stable angina

David J. Webb, MD^*, Gary J. Muirhead, BSc, Maria Wulff, BSc, J. Andrew Sutton, MD, Roberto Levi, MD and Wallace W. Dinsmore, MD^||

^* Department of Medicine, The University of Edinburgh, Western General Hospital, Edinburgh, United Kingdom
Pfizer Central Research, Sandwich, Kent, United Kingdom
Guildford Clinical Pharmacology Unit, Royal Surrey County Hospital, Guildford, United Kingdom
Department of Pharmacology, Cornell University, Weill Medical College, New York, New York, USA
^|| Department of Genitourinary Medicine, The Royal Victoria Hospital, Belfast, United Kingdom

View larger version (21K): [in a new window]   Figure 1 Mean changes from baseline in sitting systolic (A) and diastolic (B) BP after ISMN administration. Sildenafil plus ISMN caused significant decreases in systolic and diastolic BP compared with placebo plus ISMN. Oral ISMN (20 mg) and oral sildenafil (50 mg) or placebo were administered at time 0, as indicated by the arrows. Baseline (time 0) is the average of the measurements taken immediately before sildenafil or placebo administration. Values represent mean ± SEM; n = 16; BP = blood pressure; ISMN = isosorbide mononitrate.

View larger version (21K): [in a new window]   Figure 2 Mean changes from baseline in standing systolic (A) and diastolic (B) BP after ISMN administration. Sildenafil plus ISMN caused significant decreases in systolic and diastolic BP compared with placebo plus ISMN. Oral ISMN (20 mg) and oral sildenafil (50 mg) or placebo were administered at time 0, as indicated by the arrows. Baseline (time 0) is the average of the measurements taken immediately before sildenafil or placebo administration. Values represent mean ± SEM; n = 16; BP = blood pressure; ISMN = isosorbide mononitrate.

View larger version (22K): [in a new window]   Figure 3 Mean changes from baseline in sitting (A) or standing (B) heart rate after ISMN administration. Oral ISMN (20 mg) and oral sildenafil (50 mg) or placebo were administered at time 0, as indicated by the arrow. Baseline (time 0) is the average of the measurements taken immediately before sildenafil or placebo administration. Values represent mean ± SEM; n = 16; bpm = beats per minute; HR = heart rate; ISMN = isosorbide mononitrate.

View larger version (23K): [in a new window]   Figure 4 Mean changes from baseline in sitting systolic (A) and diastolic (B) BP after GTN administration. Sildenafil plus GTN caused significant decreases in systolic and diastolic BP compared with placebo plus sildenafil. Sublingual GTN (500 µg) was administered 1 h after oral sildenafil (50 mg), as indicated by the arrow. Baseline (time 0) is the average of the measurements taken immediately before sildenafil or placebo administration. Values represent mean ± SEM; n = 15; BP = blood pressure; GTN = glyceryl trinitrate.

View larger version (17K): [in a new window]   Figure 5 Mean changes from baseline in sitting heart rate after GTN administration. Sublingual GTN (500 µg) was administered 1 h after oral sildenafil (50 mg), as indicated by the arrow. Baseline (time 0) is the average of the measurements taken immediately before sildenafil or placebo administration. Values represent mean ± SEM; n = 15; bpm = beats per minute; HR = heart rate; GTN = glyceryl trinitrate.