Key result
The combination of single oral doses of sildenafil and ISMN produced a maximum brachial blood pressure reduction of 26/18 mm Hg compared with placebo in treatment-resistant hypertension.
Why the study?
Does a combination of single oral doses of sildenafil and isosorbide mononitrate reduce blood pressure in patients with treatment-resistant hypertension?
Does a combination of single oral doses of sildenafil and isosorbide mononitrate reduce blood pressure in patients with treatment-resistant hypertension?
Effect estimate: maximum brachial BP reduction of 26/18 mm Hg
A single oral dose combination of sildenafil and isosorbide mononitrate acutely reduces blood pressure in patients with treatment-resistant hypertension, suggesting potential as a novel therapeutic strategy.
Acute sildenafil-ISMN combination substantially lowers BP in resistant hypertension; extends proof-of-concept data but requires larger trials.
NO donor drugs (eg, isosorbide mononitrate; ISMN) and phosphodiesterase 5 inhibitors (eg, sildenafil) have antihypertensive properties, and the combination can markedly reduce blood pressure (BP). The objective of this "proof-of-concept" study was to investigate the effect on BP of a combination of single oral doses of sildenafil (50 mg) and ISMN (10 mg) in patients with treatment-resistant hypertension. Six subjects with treatment-resistant hypertension were included, and their usual antihypertensive medication was continued during the study. Sildenafil alone, ISMN alone, and the combination all reduced brachial and central aortic BPs compared with placebo. The combination of sildenafil and ISMN produced the largest fall in BP (maximum brachial BP reduction of 26/18 mm Hg compared with placebo), without producing significant adverse effects. ISMN, alone and in combination with sildenafil, also reduced arterial wave reflection and central BP. In summary, in patients with treatment-resistant hypertension maintained on their usual antihypertensive treatment, sildenafil given alone and ISMN given alone both acutely reduced BP. There was additional BP reduction when these drugs were given in combination. In this therapeutically challenging group of patients, the combination of an NO donor drug and a phosphodiesterase 5 inhibitor may represent an effective treatment. Longer studies in larger numbers of patients are now justified.
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Oliver et al. (2010) studied Treatment-resistant hypertension (n=6). Combination of sildenafil and isosorbide mononitrate (ISMN) vs. Placebo, sildenafil alone, and ISMN alone was evaluated on Blood pressure reduction (maximum brachial BP reduction of 26/18 mm Hg). The combination of single oral doses of sildenafil and ISMN produced a maximum brachial blood pressure reduction of 26/18 mm Hg compared with placebo in treatment-resistant hypertension.