Zusammenfassung
Die arterielle Hypertonie ist ein bedeutender Risikofaktor für das Auftreten einer erektilen Dysfunktion (ED). Dementsprechend besteht eine hohe Koinzidenz zwischen arterieller Hypertonie und ED. Die oral-medikamentöse Therapie der ED mit Sildenafil (Viagra®) ist sowohl bei behandelten als auch bei nicht behandelten Hypertonikern wirksam. Die wichtigsten unerwünschten Wirkungen der Sildenafil-Therapie (Kopfschmerzen, Gesichtsrötung, Hypotension) beruhen auf moderaten vasodilatierenden Eigenschaften. Bei gleichzeitiger Einnahme von Sildenafil und organischen Nitraten können sich die blutdrucksenkenden Effekte potenzieren und zu lebensbedrohlichen Blutdruckabfällen führen. Deshalb ist diese Kombination absolut kontraindiziert. Demgegenüber führt die gleichzeitige Gabe von Sildenafil und Antihypertensiva unterschiedlicher Substanzklassen (β-Blocker, α-Blocker, Diuretika, ACE-Hemmer, Ca-Antagonisten) zwar zu additiven, nicht jedoch zu sich potenzierenden blutdrucksenkenden Effekten. Daher ist bei dieser Kombination weder mit bedrohlichen und klinisch relevanten Blutdruckabfällen noch mit einer Zunahme unerwünschter Wirkungen zu rechnen. Dies gilt auch für eine antihypertensive Kombinationstherapie mit zwei oder mehr Antihypertensiva.
Abstract
Hypertension is an important risk factor for erectile dysfunction (ED). Consequently, there is a high coincidence between hypertension and ED. Oral sildenafil (Viagra®) is an effective treatment for ED in patients with treated or untreated hypertension. The most common adverse events of sildenafil (headache, flushing, hypotension) result from its moderate vasodilating properties. The concomitant use of sildenafil and organic nitrates is contraindicated because it may lead to a potentiation of the decreases in blood pressure and thus cause life-threatening hypotension. In contrast, the concomitant use of sildenafil and different classes of antihypertensive agents (β-blockers, α-blockers, diuretics, ACE inhibitors, calcium antagonists) may lead to additive but not to potentiating blood pressure decreases. Thus, this combination is unlikely to cause clinically significant hypotension or an increased incidence of adverse events. Sildenafil is an effective and well-tolerated treatment for ED in patients taking concomitant antihypertensive medication, including those on multidrug regimens.
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