Comparative effectiveness of sildenafil for pulmonary hypertension due to left heart disease with HFrEF

Jiang, Rong; Wang, Lan; Zhu,
Chang-Tai; Yuan, Ping; Pudasaini, Bigyan; Zhao, Qin-Hua; Gong, Su-Gang;
He, Jing; Liu, Jin-Ming; Hu, Qing-Hua.

Hypertension Research, December 2015, Vol. 38 Issue: Number 12 p829-839, 11p;


There is no cure for pulmonary hypertension due to left heart disease (PH-LHD), but
the rationale for using sildenafil to treat pulmonary arterial
hypertension with heart failure with reduced ejection fraction (HFrEF)
has been supported by short-term studies. We performed a meta-analysis
to evaluate the effectiveness of sildenafil for PH-LHD with HFrEF. A
systematic literature search of PubMed, EMBASE and the Cochrane Central
Register of Controlled Trials was conducted from inception through
October 2014 for randomized trials and for observational studies with
control groups, evaluating the effectiveness of sildenafil to treat
PH-LHD with HFrEF. Sildenafil therapy decreased pulmonary arterial
systolic pressure both at the acute phase and at the 6-month follow-up
(weighted mean difference (WMD): −6.03 mm Hg, P=0.02; WMD:
−11.47 mm Hg, P<0.00001, respectively). Sildenafil was found to reduce
mean pulmonary artery pressure (WMD: −3 mm Hg, P=0.0004) and pulmonary
vascular resistance (WMD: −60.0 dynes cm−5, P=0.01) at the 3-month
follow-up. Oxygen consumption at peak significantly increased to
3.66 ml min−1kg−1(P<0.00001), 3.36 ml min−1kg−1(P<0.00001) and
2.60 ml min−1kg−1(P=0.03) at 3, 6 and 12 months, respectively. There
were significant reductions in ventilation to CO2production slope of
−2.00, −4.68 and −7.12 at 3, 6 and 12 months, respectively (P<0.00001).
Sildenafil was superior to placebo regarding left ventricular ejection
fraction at the 6-month follow-up (WMD: 4.35, P<0.00001), and it
significantly improved quality of life. Sildenafil therapy could
effectively improve pulmonary hemodynamics and cardiopulmonary exercise
testing measurements of PH-LHD with HFrEF, regardless of acute or
chronic treatment.