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SHR Neuro Cancer Cardio Lipid Metab Microb

Rosengarten, B; Schermuly, RT; Voswinckel, R; Kohstall, MG; Olschewski, H; Weissmann, N; Seeger, W; Kaps, M; Grimminger, F; Ghofrani, HA.
Sildenafil improves dynamic vascular function in the brain: studies in patients with pulmonary hypertension.
Cerebrovasc Dis. 2006; 21(3):194-200 Doi: 10.1159/000090555
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Co-authors Med Uni Graz: Olschewski Horst
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Abstract:: BACKGROUND: Prostaglandins and nitric oxide play a pivotal role in the regulation of macro- and microcirculatory blood flow distribution. Interference with both mediator systems have been implicated in cerebrovascular dysfunction. Inhaled iloprost (long-acting prostacyclin analogue) and the phosphodiesterase-5 inhibitor sildenafil have recently shown efficacy in the treatment of chronic pulmonary hypertension. We investigated the impact of these agents on cerebral microcirculatory regulation in patients suffering from this disease. METHODS: In 11 patients suffering from severe pulmonary hypertension, a functional transcranial Doppler test utilizing a visual stimulation paradigm was undertaken to measure the evoked flow velocity in the posterior cerebral artery. Measurements were performed in parallel to right heart catheterization and pharmacological testing of the pulmonary vasoreactivity. After assessment of baseline measurements, inhaled iloprost and oral sildenafil were given consecutively for testing of cerebral and pulmonary vascular function. The data gained from the Doppler measurements were compared to data from 22 healthy volunteers. RESULTS: Both substances provoked a significant reduction of pulmonary arterial pressure and vascular resistance, accompanied by minor changes in systemic vascular resistance. In contrast to these superimposable hemodynamic profiles opposite effects were observed regarding cerebral vascular tone: cerebral microvascular reactivity, as assessed by attenuation and time rate parameters, was significantly improved by sildenafil, but slightly worsened by iloprost. CONCLUSIONS: Sildenafil has beneficial effects on cerebral vascular reactivity indicative of an improvement in neurovascular coupling in patients with pulmonary hypertension. These results warrant further investigations of the influence of sildenafil on dynamic vascular function in the brain independent of the underlying disease.
Find related publications in this database (using NLM MeSH Indexing): Administration, Inhalation -; Administration, Oral -; Adult -; Aged -; Blood Flow Velocity -; Blood Pressure - drug effects; Brain - blood supply; Case-Control Studies - blood supply; Cerebrovascular Circulation - drug effects; Female - drug effects; Hemodynamic Processes - drug effects; Humans - drug effects; Hypertension, Pulmonary - drug therapy; Iloprost - administration and dosage; Male - administration and dosage; Middle Aged - administration and dosage; Piperazines - administration and dosage; Posterior Cerebral Artery - physiopathology; Pulmonary Gas Exchange - physiology; Ultrasonography, Doppler, Transcranial - physiology; Vascular Resistance - drug effects; Vasodilator Agents - administration and dosage
Find related publications in this database (Keywords): transcranial Doppler; ultrasound; pulmonary hypertension; cerebral vasoreactivity; neurovascular coupling; sildenafil; prostacyclin; nitric oxide; phosphodiesterase inhibitor