Acute Sildenafil Use Reduces 24-Hour Blood Pressure Levels in Patients With Resistant Hypertension: A Placebo-Controlled, Crossover Trial

The authors previously demonstrated that acute administration of sildenafila phosphodiesterase 5 (PDE5) inhibitorimproves hemodynamic parameters in patients with resistant hypertensive (RH), but its effect on ambulatory blood pressure monitoring (ABPM) is unknown. This interventional, nonrandomized, single-blinded, placebo-controlled, crossover trial included 26 patients with RH. A dose of sildenafil (187.5mg) was given, and after a washout period of 14 days the patients received a single oral dose of placebo and the protocol was repeated. The patients underwent 24-hour ABPM recordings the day before and immediately after the protocols. The reduction of systolic (-8.8 +/- 1.4 vs 1.3 +/- 1.2 mm Hg, P=.02), diastolic (-5.3 +/- 3.3 vs 1.8 +/- 1.1 mm Hg, P=.03), and mean (-7.9 +/- 3.6 vs 0.8 +/- 0.9 mm Hg, P=.01) 24-hour BP were found after the use of sildenafil compared with placebo. Improvement in daytime BP levels was also observed (systolic -6.0 +/- 4.7 vs 4.4 +/- 1.5 mm Hg [P=.02] and mean -4.8 +/- 3.9 vs 3.5 +/- 1.4 mm Hg [P=.02] for sildenafil vs placebo, respectively). Considering its antihypertensive effect, sildenafil may represent a therapeutic option for RH treatment.