Background: Aortic stiffness and wave reflections are independent prognosticators of cardiovascular risk and may be impaired in men with erectile dysfunction (ED) considered as the first clinical manifestation of a generalized vascular disease. We investigated the chronic effect of a long-term daily sildenafil administration on aortic elastic properties and wave reflections.

Methods: The chronic effect of a 2-week long treatment with sildenafil on aortic stiffness and wave reflections were studied in 11 men (age 58±15 years) with non-hormonal and non-psychogenic ED. The study was carried out on two separate arms, one with sildenafil (100 mg) and one with placebo according to a randomized, placebo-controlled, double-blind, cross over design. All measurements were performed 24 hours after the last sildenafil or placebo intake. Aortic stiffness was evaluated with carotid-femoral pulse wave velocity (PWV) and wave reflections with augmentation index (AIx) of the aortic pressure waveform using high-fidelity pulse wave analysis.

Results: Daily sildenafil intake led to a significant sustained decrease in PWV and AIx, indicating a decrease in aortic stiffness and wave reflections (p < 0.05, figure). There were no significant changes in systolic and pulse pressure.

Conclusions: The present study shows for the first time that chronic treatment with sildenafil has a favourable effect on aortic stiffness and wave reflections in patients with ED. This finding may have important implications in patients with increased cardiovascular risk.