Moderate
Bisoprolol × Sildenafil
Selective beta-adrenergic blockers×Phosphodiesterase type 5 inhibitors (PDE5)
Mechanism
Sildenafil is a vasodilator via PDE5 blockade. Combined with bisoprolol: risk of symptomatic hypotension, especially with the first dose.
Symptoms
Lower blood pressure, postural dizziness, fatigue. Older patients: fall risk.
Management
The combination is acceptable in stable hypertension with a well-titrated beta-blocker. Take the first sildenafil dose lying down; do not exceed 25–50 mg. Warn the patient about orthostatic hypotension.