From the Research
Sildenafil (Viagra) does not appear to increase the risk of pulmonary embolism in patients with hypertension, and its use is generally safe when blood pressure is adequately controlled and nitrates are not being taken. The medication works by inhibiting phosphodiesterase type 5 (PDE5), increasing cyclic GMP levels which promotes smooth muscle relaxation in the corpus cavernosum and pulmonary vasculature, facilitating erection and reducing pulmonary vascular resistance respectively 1.
Key Considerations
- Sildenafil can cause modest drops in blood pressure, so hypertensive patients should ensure their blood pressure is well-controlled before using the medication 2, 3, 4.
- The combination of sildenafil with nitrates (like nitroglycerin) is absolutely contraindicated as it can cause dangerous hypotension 2, 5, 3, 4.
- Patients with cardiovascular disease, including those with hypertension, can generally use sildenafil safely when their condition is stable and they are not taking contraindicated medications 5, 1.
- The standard dosing for erectile dysfunction typically starts at 50mg taken approximately one hour before sexual activity, with adjustments between 25-100mg based on response and tolerability 2, 4.
Safety and Efficacy
- Sildenafil has been shown to be effective and safe in patients with erectile dysfunction, including those with hypertension and cardiovascular disease 2, 5, 3, 4, 1.
- The medication has minimal adverse effects in men with stable ischemia, hypertension, and/or severe coronary artery disease 1.
- Sildenafil has been found to decrease both elevated pulmonary vascular resistance and elevated pulmonary artery pressures in patients with pulmonary vascular disease 1.