June 24, 2026Journal of the American College of Cardiology
Acute type 5 phosphodiesterase inhibition with sildenafil enhances flow-mediated vasodilation in patients with chronic heart failure
Key result
Single-dose sildenafil 25 or 50 mg increases flow-mediated vasodilation vs placebo in chronic HF.
- P<0.05
- n=48
Why the study?
Impaired flow-mediated vasodilation in heart failure involves hyporesponsive cGMP-mediated vasorelaxation, but the effect of inhibiting cGMP degradation with sildenafil on flow-mediated dilation was unknown.
Does a single oral dose of sildenafil improve flow-mediated vasodilation in patients with chronic heart failure?
Population
48 patients with chronic heart failure
Comparison
Single oral dose of sildenafil 12.5, 25, or 50 mg vs matching placebo
Design
Randomized, double-blind trial
Follow-up
1 h
Authors
Discussion
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Implication
May support adjunctive PDE5 inhibition in chronic HF; extends mechanistic vasodilation data to randomized clinical populations.
Key Points
- To determine the effects of sildenafil, a type 5 phosphodiesterase inhibitor, on flow-mediated vasodilation in chronic heart failure patients.
- Measured flow-mediated vasodilation in the brachial artery using high-resolution ultrasound imaging
- Conducted a randomized, double-blind trial with 48 patients receiving sildenafil (12.5, 25, or 50 mg) or placebo
- Evaluated changes in vasodilation after transient arterial occlusion for 1, 3, and 5 minutes.
- Sildenafil 25 mg significantly increased vasodilation responses (3.3%, 3.8%, 4.0%) at 1, 3, and 5 min versus placebo (0.7%, 0.2%, 0.6%) with p < 0.05
- Sildenafil 50 mg showed similar improvements (3.7%, 4.1%, 3.9%) compared to placebo across time points, p < 0.05
- Patients receiving sildenafil experienced greater endothelium-dependent vasodilation than those receiving placebo.
Study Design
Type
RCT (n=48)
Blinding
Double-blind
Randomization
randomized
Structured PICO
Does a single oral dose of sildenafil improve flow-mediated vasodilation in patients with chronic heart failure?
P
Population
48 patients with chronic heart failure evaluated 1 hour after a single dose of study drug.
I
Intervention
Single oral dose of sildenafil 12.5, 25, or 50 mg
C
Comparator
Matching placebo
O
Outcome
Flow-mediated vasodilation in the brachial artery after release of 1, 3 and 5 min of transient arterial occlusion, measured with high resolution two-dimensional ultrasound imaging 1 h after administrationsurrogate
Main Result
p-value: p=< 0.05
Acute administration of sildenafil 25 mg or 50 mg significantly improves endothelium-dependent, flow-mediated vasodilation in patients with chronic heart failure.
Cite This Study
Katz et al. (2000) conducted an RCT in chronic heart failure (n=48). sildenafil vs. placebo was evaluated on change in flow-mediated vasodilation after release of 1, 3 and 5 min of transient arterial occlusion (p=< 0.05). A single oral dose of sildenafil 25 mg or 50 mg significantly increased flow-mediated vasodilation compared with placebo in patients with chronic heart failure (p < 0.05).