Viagra May Be More Than Impotence Drug

Adding it to standard medicine helped those with pulmonary hypertension

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HealthDay Reporter

(HealthDay is the new name for HealthScoutNews.)

WEDNESDAY, July 2, 2003 (HealthDayNews) -- Viagra may soon be used to treat more than just erectile dysfunction.

The impotence drug helps patients with pulmonary hypertension walk farther and do better overall, a new German study has found.

When used to treat erectile dysfunction, Viagra relaxes the smooth muscle of blood vessels and increases blood flow. The same effect seems to help those with pulmonary hypertension, claims lead researcher Dr. Hossein A. Ghofrani, a physician at the University Hospital, Justus-Liebig-University Giessen in Giessen, Germany. His finding appears in the July 2 issue of the Journal of the American College of Cardiology.

Ghofrani and his colleagues evaluated 73 patients with pulmonary hypertension, a condition in which the blood pressure in the arteries that supply the lungs is extremely high. All were treated with iloprost, a drug that helps open up blood vessels. It's commonly used overseas, but it's not marketed in the United States.

Then, the researchers added Viagra for the 14 patients whose conditions worsened despite their initial good response to iloprost.

Adding Viagra reversed their deterioration on the standard walk test given to measure their progress. Before the iloprost, these patients could walk about 712 feet in six minutes. Once they took the iloprost, they could walk 1,000 feet. After 18 months, however, the results declined to 840 feet, on average. But when Viagra was added, their six-minute walk distance went up to 1,135 feet.

The results exceeded expectations, Ghofrani says: "The best thing we expected to achieve was to stabilize the patients, but they stabilized and then improved."

"And they were no longer on the transplant list," he adds. Patients with the condition who deteriorate even on long-term therapy are commonly considered urgent candidates for lung transplants.

No serious adverse events were reported with the Viagra use, Ghofrani adds, including no reports of unwanted erections.

In the United States, more than 100,000 women and 67,000 men were hospitalized with pulmonary hypertension in 1998, the latest year posted by the U.S. Centers for Disease Control and Prevention. Sometimes, doctors call the condition secondary pulmonary hypertension if it is the result of another condition such as heart or lung disease. It's termed primary pulmonary hypertension if the cause can't be pinpointed, although genetics are thought to play a role.

The new study is believed to be the first report of this particular combination of drugs to treat pulmonary hypertension.

But other combination therapies have been studied and are being prescribed, says Dr. Bruce H. Brundage, medical director of The Heart Institute of the Cascades in Oregon, who is familiar with the latest study.

"The importance of this study is it is one of the first to report the fact that two drugs are better than one" for pulmonary hypertension treatment, he says.

Brundage predicts the approach will ultimately become common.

It makes sense, Brundage says, because the condition is a complex disease. "In the pathophysiology of pulmonary hypertension, we recognize that there are at least three pathways of internally generated compounds that affect the pulmonary arteries," he explains.

"All these compounds are made in our own vessels," he says. They are prostacyclin and nitric oxide, which open up blood vessels, and endothelin, which constricts them.

Viagra works, Brundage says, by inhibiting a compound that breaks down nitric oxide: "You prevent the breakdown of nitric oxide and the vessel does not constrict."

Iloprost works by opening up the blood vessels, as does Flolan (epoprostenol), a similar drug marketed in the United States. Other medications affect the action of endothelin.

Ghofrani says he hopes to do additional studies on the drug combination.

More information

For frequently asked questions about pulmonary hypertension, see the Pulmonary Hypertension Association. For a discussion of pulmonary hypertension, see the American Heart Association.

SOURCES: Bruce H. Brundage, M.D., president, Pulmonary Hypertension Association, and medical director, The Heart Institute of the Cascades, Bend, Ore.; Hossein A. Ghofrani, M.D., researcher, University Hospital, Justus-Liebig-University Giessen, Giessen, Germany; July 2, 2003, Journal of the American College of Cardiology

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