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A violacao dos direitos autorais caracteriza-se como crime incurso no art. Effect of sildenafil in patients with erectile dysfunction taking antihypertensive therapy.

Kloner, Morris Brown, L.Michael Prisant, Mike Collins, for the Sildenafil Study Group, Effect of sildenafil in patients with erectile dysfunction taking antihypertensive therapy, American Journal of Hypertension , Volume 14, Issue 1, January 2001, Pages 70–73, https://doi.org/10.1016/S0895-7061(00)01177-8.

Oral sildenafil is an effective treatment for erectile dysfunction (ED), which is a common complaint for patients with hypertension and those taking antihypertensive agents. This post hoc subanalysis assessed the efficacy and safety of sildenafil in men with ED who were receiving concomitant antihypertensive medication. Efficacy was assessed in 3414 men (1218 of whom were taking antihypertensive medication) who received sildenafil (5 to 200 mg) or placebo for 6 weeks to 6 months in 10 double-blind, placebo-controlled studies. The significant improvements in erectile function demonstrated by sildenafil-treated patients were comparable in patients taking and those not taking antihypertensive medication.

Safety was assessed in 3975 men (1094 of whom were taking one or more antihypertensive agent, classified as a diuretic, ?-blocker, ? 1 -blocker, angiotensin converting enzyme inhibitor, or calcium channel blocker), who received sildenafil or placebo in 18 double-blind, placebo-controlled studies.

For patients taking sildenafil and antihypertensive medication, the incidence of treatment-related adverse events (34%) was similar to that for sildenafil-treated patients not taking any antihypertensive agent (38%).

The incidences of the most common adverse events and of adverse events potentially related to blood pressure decreases (eg, hypotension, dizziness, and syncope) were similar in both sildenafil groups.

The number of antihypertensive medications taken from among the five classes had no effect on the adverse event profile of sildenafil.

Sildenafil is an effective and well-tolerated treatment for ED in patients taking concomitant antihypertensive medication, including those on multidrug regimens.

Am J Hypertens 2001;14:70–73 © 2001 American Journal of Hypertension, Ltd. Erectile dysfunction (ED), the inability to achieve or maintain an erection sufficient for satisfactory sexual activity, 1 is a common problem in patients with hypertension and in those being treated with antihypertensive agents. 2, 3 In the Massachusetts Male Aging Study, a random sample survey of 1290 men aged 40 to 70 years, the age-adjusted prevalence of complete ED (no erections) was 15% in those with treated hypertension and 14% in those taking antihypertensive agents compared with a prevalence of 9.6% in the entire sample.

Sildenafil, an orally active and selective inhibitor of cGMP-specific phosphodiesterase type 5, is an effective and well-tolerated treatment for ED of various causes. 4 By inhibiting the degradation of cGMP in the corpus cavernosum of the penis, sildenafil enables smooth muscle relaxation and penile erection in patients with ED. The most common adverse events associated with sildenafil treatment are headache and flushing, 5 which reflect its modest vasodilating properties.

6 Oral sildenafil (100 mg) produces transient decreases in systolic (8 to 10 mm Hg) and diastolic (3 to 6 mm Hg) blood pressure in healthy male volunteers.

5 Peak decreases are observed 1 h after dosing and coincide with peak plasma concentrations of drug. These changes in blood pressure generally return to pretreatment values by 4 to 8 h after dosing in healthy men.

6 This post hoc analysis assessed the efficacy and safety of sildenafil in men with ED who were receiving concomitant treatment with antihypertensive agents.

Efficacy data were analyzed post hoc for groups of patients enrolled in 10 of 18 randomized, double-blind, placebo-controlled studies of sildenafil in the treatment of ED of various causes.

In these 10 studies that assessed efficacy with the same outcome measure, a total of 3414 patients, 1218 (36%) of whom were taking concomitant antihypertensive medication, were randomized to sildenafil (5 to 200 mg) or placebo for 6 weeks to 6 months.

The patients enrolled were 18 years of age or older with a clinical diagnosis of ED of at least 6 months’ duration and in a stable relationship with a female partner for at least 6 months.

Patients were excluded if they had penile anatomic defects, a recent (within the previous 6 months) history of stroke, myocardial infarction, or life-threatening arrhythmia, a resting blood pressure 170/110 mm Hg, a known history of retinitis pigmentosa, any significant concomitant medical condition that would impair participation in the study, or were receiving regular treatment with nitrates or anticoagulants. All patients provided written informed consent before enrollment. The patients were instructed to take study medication approximately 1 h before sexual activity but not more than one dose daily. Safety data were analyzed for 3975 patients from 18 randomized, double-blind, placebo-controlled studies lasting from 6 weeks to 6 months, which included the 10 studies analyzed for efficacy data.

In the 18 studies, of the 4274 patients randomized to sildenafil (5 to 200 mg) or placebo, 2881 ( n = 1837 sildenafil, n = 1044 placebo) were not taking any antihypertensive medication, 1094 ( n = 704 sildenafil, n = 390 placebo) were taking concomitant antihypertensive medication classified as a diuretic, ?-blocker, ? 1 -blocker, angiotensin converting enzyme inhibitor, or calcium channel blocker, and 346 ( n = 217 sildenafil, n = 129 placebo) were taking two or more of these classes of antihypertensive agent during the studies. The inclusion and exclusion criteria for the 18 studies were the same as mentioned above for the 10 studies. Efficacy was assessed for patients in the sildenafil and placebo groups who were taking antihypertensive medication or who were not taking any antihypertensive agent using end-of-treatment responses to question 3 (ability to achieve an erection) and question 4 (ability to maintain an erection) of the International Index of Erectile Function (IIEF) 7 and responses to a global efficacy question (“Did the treatment improve your erections?”).

The responses to the two IIEF questions were graded on a scale of 1 (almost never or never) to 5 (almost always or always),

with

Physical examinations and standard laboratory tests were performed throughout the studies.

In all studies, investigators recorded all observed and patient-reported adverse events and classified the relationship of the adverse event to the study medication as definitely related, uncertain, or not related. A treatment-related adverse event was defined as any event classified as definitely related, of uncertain relation, or of unspecified relation to the study medication. Adverse events were analyzed for the 2881 patients not taking any antihypertensive medication and for the 1094 patients taking one or more of the following classes of antihypertensive agent: diuretic, ?-blocker, ? 1 -blocker, angiotensin converting enzyme inhibitor, or calcium channel blocker.

The mean responses to the two questions of the IIEF for each of the treatment groups were calculated and the treatment effect was analyzed using an analysis of covariance model, as described previously.

4 Comparisons between mean responses for patients taking versus not taking antihypertensive agents were analyzed using an analysis of covariance model that accounted for the treatment effect. The responses to the global efficacy question were analyzed using a logistic regression model. 4 Intention to treat analyses were performed on all variables, and all statistical tests were two-sided and evaluated at the 5% significance level.

In the 10 double-blind, placebo-controlled studies in which efficacy was assessed, the mean age of the patients was 58 years for those taking antihypertensive medication and 55 years for those not taking any antihypertensive agent. The mean duration of ED in the two groups was 4.7 years and 5.2 years, respectively.

The etiology of ED was 67% organic, 11% psychogenic, and 22% mixed for the patients taking concomitant antihypertensive medication compared with 56% organic, 17% psychogenic, and 27% mixed for those not taking an antihypertensive agent.

The characteristics of the patients randomized to treatment in the 18 double-blind, placebo-controlled studies from which safety data were collected were similar to those described above.

The mean end of treatment scores for question 3 (achieving an erection) and question 4 (maintaining an erection) of the IIEF were significantly higher for the sildenafil group than for the placebo group for both patients taking and those not taking antihypertensive agents ( P values Table 1).

Furthermore, the incidences of the most common adverse events (eg, headache, flushing, and dyspepsia) also were not affected by whether buy generic sildenafil the patients receiving sildenafil were taking antihypertensive medication. Combined incidence (%) of treatment-related adverse events reported in 18 double-blind placebo-controlled studies of patients with ed receiving sildenafil (Sild) or placebo (Pbo) who were taking or not taking different classes of antihypertensive medication * Sildenafil Can Affect Innate and Adaptive Immune System in Both Experimental Animals and Patients.

1 Department of Clinical Immunology, Institute of Transplantology, Medical University of Warsaw, Nowogrodzka 59, 02-006 Warsaw, Poland. Sildenafil, a type 5 phosphodiesterase inhibitor (PDE5-I), is primarily used for treating erectile dysfunction. Sildenafil inhibits the degradation of cyclic guanosine monophosphate (cGMP) by competing with cGMP for binding site of PDE5. cGMP is a secondary messenger activating protein kinases and a common regulator of ion channel conductance, glycogenolysis, and cellular apoptosis.

PDE5 inhibitors (PDE-Is) found application in cardiology, nephrology, urology, dermatology, oncology, and gynecology. Positive result of sildenafil treatment is closely connected with its immunomodulatory effects.

Sildenafil influences angiogenesis, platelet activation, proliferation of regulatory T cells, and production of proinflammatory cytokines and autoantibodies.

Sildenafil action in humans and animals appears to be different.

Surprisingly, it also acts differently in males and females organisms. Although the immunomodulatory effects of PDE5 inhibitors appear to be promising, none of them reached the point of being tested in clinical trials. Data on the influence of selective PDE5-Is on the human immune system are limited. The main objective of this review is to discuss the immunomodulatory effects of sildenafil in both patients and experimental animals.

This is the first review of the current state of knowledge about the effects of sildenafil on the immune system. Phosphodiesterases (PDEs) are critical components in the cyclic adenosine monophosphate/protein kinase A (cAMP-PKA) and the cyclic guanosine monophosphate/protein kinase G (cGMP-PKG) signaling pathways. Phosphodiesterases decompose the cyclic nucleotides, cAMP and cGMP, to inactivate 5?-AMP and 5?-GMP, respectively.

PDE activity is tightly coupled with the activity of adenyl cyclases (AC) and guanyl (GC) which synthesize these cyclic nucleotides: cAMP and cGMP. The cyclic nucleotide-dependent protein kinases (PKA and PKG) control the functional cellular responses such as intracellular calcium level, inflammation, cell proliferation, and transcription.

Therefore, cAMP and cGMP are considered as potential new therapeutic targets [1, 2].

The inhibition of action of PDE results in increased level of cyclic nucleotides.

Several PDEs have been identified and characterized based on their molecular sequence, kinetics, regulation, and pharmacological characteristics.

These enzymes were divided into 11 families (PDE1–PDE11) [3, 4].

PDEs 1, 2, 3, 10, and 11 have affinity to cAMP and cGMP and PDEs 4, 7, and 8 hydrolyze cAMP only, while PDEs 5, 6, and 9 exhibit specificity for cGMP.

Increased activity of PDEs has been implicated in a number of clinical conditions including erectile dysfunction (PDE5), cardiovascular diseases (PDEs 3, 4, and 5), pulmonary inflammatory conditions (PDE4), autoimmune diseases (PDEs 3 4, 5, and 7), and cognition and memory disorders (PDEs 1, 2, 3, 4, 7, 9, and 10 A) [5–7].

All PDEs are composed of 3 main domains: the catalytic core (highly conserved), the regulatory N-terminus, and the carboxyl C-terminus.

N-terminal domains are responsible for regulation and subcellular localization of PDEs.

They contain domains involved in ligand binding, PDE oligomerization, kinase recognition, and phosphorylation.

The N-terminal domains are flanked by the catalytic core. The catalytic c-domain of PDEs possesses an active pocket composed of 3 helical subdomains: the N-terminal cyclic-fold region, the linker region, and the C-terminal helical bundle. A deep hydrophobic pocket is formed at the interface of the three subdomains. The hydrophobic pocket is composed of four subsites: a metal binding site (M), a core pocket (Q pocket), hydrophobic pocket (H pocket), and a lid-region (L region).

At the bottom site is a metal binding domain which probably contains zinc or magnesium ions. Stabilization of the enzyme structure and activation of hydroxide are the presumable roles of metal ions [7, 8]. Substrate specificity of PDEs was suggested to depend on the ability to rotate of one glutamine which forms hydrophobic bonds with cAMP or cGMP [9, 10].

The fixed glutamine orientation allows to bind only one substrate [11].

that Gln-817 is critical for cGMP, sildenafil, and vardenafil affinity.

The analogous atoms to substituents at N-1 and C-6 in cGMP form a bidentate H-bond with Gln 817 [11].