ABSTRACT
OBJECTIVE: To evaluate whether the response to on-demand vardenafil could be improved by its daily usage in hypertensive men with erectile dysfunction (ED) who previously did not answer to on-demand regime. METHODS: Our main efficacy criterion was per patient percentage of positive answers on the Sexual Encounter Profile question 3 (SEP3). Carotid intima-media thickness (IMT), flow-mediated dilation (FMD), and nitrate-mediated dilation on brachial artery were considered as vascular parameters. A total of 74 hypertensive men with ED aged 50 to 70 years with no major cardiovascular disease were selected from 284 patients initially referred. After vardenafil on-demand usage during 4 weeks, patients with more than 50% of positive answers on the SEP3, or 50% and more than 6 points on the International Index of Erectile Function-Erection Function Domain (IIEF-EF) basal score or positive answer to global evaluation question were considered "responders." "Nonresponders" (n = 35) were randomized to daily vardenafil 10 mg or placebo during 5 weeks along with open 10 mg of vardenafil before intercourse. RESULTS: In the active group, 38.8% of patients became responders to vardenafil (P < .05). Clinical response to continuous vardenafil correlated with sexual frequency (r = .68, P < .01), Framingham risk score (r = -.65, P < .01), carotid IMT (r = -.61, P = .01) and low-density lipoprotein (LDL)-cholesterol (r = -.64, P < .01). CONCLUSION: Daily vardenafil during 5 weeks rescued response to on-demand regime among ED hypertensive men with no major cardiovascular disease. Further clinical trials and cost-effectiveness studies are necessary to confirm these findings.
Subject(s)
Erectile Dysfunction/drug therapy , Imidazoles/administration & dosage , Phosphodiesterase 5 Inhibitors/administration & dosage , Piperazines/administration & dosage , Aged , Blood Glucose/metabolism , Brachial Artery/drug effects , Brachial Artery/physiology , Carotid Intima-Media Thickness , Cholesterol, LDL/blood , Erectile Dysfunction/blood , Erectile Dysfunction/complications , Humans , Hypertension/complications , Logistic Models , Male , Middle Aged , Multivariate Analysis , Nitrates/pharmacology , Sulfones/administration & dosage , Surveys and Questionnaires , Treatment Outcome , Triazines/administration & dosage , Vardenafil DihydrochlorideABSTRACT
OBJECTIVES: To investigate whether vasculogenic erectile dysfunction (ED) severity and the clinical response to vardenafil were associated with structural and functional vascular changes in patients with uncomplicated hypertension. METHODS: Sexually active hypertensive men (n = 100), aged 50-70 years, completed the International Index of Erectile Function, Erection Function Domain (IIEF-EF) and were divided into 2 groups: 74 men with mild to moderate, moderate, or severe ED (IIEF-EF score ≤18) and without major cardiovascular disease and 26 controls (IIEF-EF score ≥25). Clinical and laboratory evaluations were performed, followed by measurement of the carotid intima-media thickness (IMT) and brachial flow-mediated dilation (FMD) before 4 attempts with 20 mg of vardenafil. The responders had ≥50% positive answers on sexual encounter profile question 3. RESULTS: The carotid IMT was significantly greater and the FMD was significantly lower in patients with ED than in the control patients. The baseline IIEF-EF score correlated negatively with the carotid IMT (r = -0.48, P < .001) and with the Framingham score (r = -0.41, P < .001) among those with ED. After multivariate logistic regression analysis, the baseline IIEF score was independently and only associated with the carotid IMT (ß = 6.105, P = .019). Responders were younger, had a lower cardiovascular risk profile and carotid IMT, and greater baseline IIEF-EF score and FMD than did the nonresponders. On logistic regression analysis, the response to vardenafil was independently associated with the brachial FMD (ß = 1.085, P = .002). CONCLUSIONS: In hypertensive men with vasculogenic ED and no other clinical evidence of arteriosclerosis, the ED severity correlated with the carotid IMT, and phosphodiesterase-5 effectiveness correlated with brachial FMD.
Subject(s)
Brachial Artery/physiopathology , Hypertension/complications , Imidazoles/therapeutic use , Impotence, Vasculogenic/drug therapy , Impotence, Vasculogenic/physiopathology , Phosphodiesterase 5 Inhibitors/therapeutic use , Piperazines/therapeutic use , Dilatation, Pathologic , Humans , Impotence, Vasculogenic/etiology , Male , Middle Aged , Prospective Studies , Regional Blood Flow , Severity of Illness Index , Sulfones/therapeutic use , Triazines/therapeutic use , Vardenafil DihydrochlorideABSTRACT
We report a case of thymolipoma in a 11-year-old boy. Cough was the unique symptom. The diagnosis was suspected by CT and surgery was the treatment. A review of pathology is presented.
