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char = l;code = 108
char = d;code = 100
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char = f;code = 102
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char = l;code = 108
char = ;code = 32
char = i;code = 105
char = n;code = 110
char = c;code = 99
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char = e;code = 101
char = a;code = 97
char = s;code = 115
char = e;code = 101
char = d;code = 100
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char = e;code = 101
char = x;code = 120
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char = c;code = 99
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char = s;code = 115
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char = ;code = 32
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char = t;code = 116
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char = l;code = 108
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char = l;code = 108
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char = a;code = 97
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char = d;code = 100
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char = a;code = 97
char = t;code = 116
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char = M;code = 77
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char = n;code = 110
char = t;code = 116
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char = E;code = 69
char = v;code = 118
char = e;code = 101
char = r;code = 114
char = e;code = 101
char = s;code = 115
char = t;code = 116
char = ;code = 32
char = b;code = 98
char = a;code = 97
char = s;code = 115
char = e;code = 101
char = ;code = 32
char = c;code = 99
char = a;code = 97
char = m;code = 109
char = p;code = 112
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char = ;code = 32
char = a;code = 97
char = ;code = 32
char = r;code = 114
char = a;code = 97
char = n;code = 110
char = d;code = 100
char = o;code = 111
char = m;code = 109
char = i;code = 105
char = z;code = 122
char = e;code = 101
char = d;code = 100
char = ,;code = 44
char = ;code = 32
char = d;code = 100
char = o;code = 111
char = u;code = 117
char = b;code = 98
char = l;code = 108
char = e;code = 101
char = -;code = 45
char = b;code = 98
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char = i;code = 105
char = n;code = 110
char = d;code = 100
char = ,;code = 44
char = ;code = 32
char = p;code = 112
char = l;code = 108
char = a;code = 97
char = c;code = 99
char = e;code = 101
char = b;code = 98
char = o;code = 111
char = -;code = 45
char = c;code = 99
char = o;code = 111
char = n;code = 110
char = t;code = 116
char = r;code = 114
char = o;code = 111
char = l;code = 108
char = l;code = 108
char = e;code = 101
char = d;code = 100
char = ;code = 32
char = c;code = 99
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char = o;code = 111
char = s;code = 115
char = s;code = 115
char = o;code = 111
char = v;code = 118
char = e;code = 101
char = r;code = 114
char = ;code = 32
char = t;code = 116
char = r;code = 114
char = i;code = 105
char = a;code = 97
char = l;code = 108
char = .;code = 46
result sql = Sildenafil increased exercise capacity during hypoxia at low altitudes and at Mount Everest base camp: a randomized, double-blind, placebo-controlled crossover trial.

Sildenafil increased exercise capacity during hypoxia at low altitudes and at Mount Everest base camp: a randomized, double-blind, placebo-controlled crossover trial.

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char = O;code = 79
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char = ;code = 32
char = r;code = 114
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char = d;code = 100
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char = s;code = 115
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char = s;code = 115
char = s;code = 115
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char = a;code = 97
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char = c;code = 99
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char = e;code = 101
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char = a;code = 97
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char = a;code = 97
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char = h;code = 104
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char = %;code = 37
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char = f;code = 102
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char = a;code = 97
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char = t;code = 116
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char = o;code = 111
char = f;code = 102
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char = s;code = 115
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char = l;code = 108
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char = a;code = 97
char = l;code = 108
char = t;code = 116
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char = t;code = 116
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char = e;code = 101
char = s;code = 115
char = s;code = 115
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char = h;code = 104
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char = t;code = 116
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char = M;code = 77
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char = E;code = 69
char = v;code = 118
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char = e;code = 101
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char = <;code = 60
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char = I;code = 73
char = N;code = 78
char = T;code = 84
char = E;code = 69
char = R;code = 82
char = V;code = 86
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char = N;code = 78
char = T;code = 84
char = I;code = 73
char = O;code = 79
char = N;code = 78
char = ;code = 32
char = :;code = 58
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char = a;code = 97
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char = >;code = 62
char = <;code = 60
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char = r;code = 114
char = /;code = 47
char = >;code = 62
char = <;code = 60
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char = R;code = 82
char = E;code = 69
char = S;code = 83
char = U;code = 85
char = L;code = 76
char = T;code = 84
char = S;code = 83
char = ;code = 32
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char = <;code = 60
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char = A;code = 65
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char = 6;code = 54
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char = m;code = 109
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char = 2;code = 50
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char = <;code = 60
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char = .;code = 46
char = 0;code = 48
char = 3;code = 51
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char = .;code = 46
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char = O;code = 79
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char = n;code = 110
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char = l;code = 108
char = ;code = 32
char = i;code = 105
char = n;code = 110
char = c;code = 99
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char = e;code = 101
char = a;code = 97
char = s;code = 115
char = e;code = 101
char = d;code = 100
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char = m;code = 109
char = a;code = 97
char = x;code = 120
char = i;code = 105
char = m;code = 109
char = u;code = 117
char = m;code = 109
char = ;code = 32
char = w;code = 119
char = o;code = 111
char = r;code = 114
char = k;code = 107
char = l;code = 108
char = o;code = 111
char = a;code = 97
char = d;code = 100
char = ;code = 32
char = (;code = 40
char = 1;code = 49
char = 7;code = 55
char = 2;code = 50
char = .;code = 46
char = 5;code = 53
char = ;code = 32
char = W;code = 87
char = ;code = 32
char = [;code = 91
char = C;code = 67
char = I;code = 73
char = ,;code = 44
char = ;code = 32
char = 1;code = 49
char = 4;code = 52
char = 7;code = 55
char = .;code = 46
char = 5;code = 53
char = ;code = 32
char = t;code = 116
char = o;code = 111
char = ;code = 32
char = 2;code = 50
char = 0;code = 48
char = 0;code = 48
char = .;code = 46
char = 0;code = 48
char = ;code = 32
char = W;code = 87
char = ];code = 93
char = );code = 41
char = ;code = 32
char = v;code = 118
char = s;code = 115
char = .;code = 46
char = ;code = 32
char = 1;code = 49
char = 3;code = 51
char = 0;code = 48
char = .;code = 46
char = 6;code = 54
char = ;code = 32
char = W;code = 87
char = ;code = 32
char = [;code = 91
char = C;code = 67
char = I;code = 73
char = ,;code = 44
char = ;code = 32
char = 1;code = 49
char = 0;code = 48
char = 8;code = 56
char = .;code = 46
char = 8;code = 56
char = ;code = 32
char = t;code = 116
char = o;code = 111
char = ;code = 32
char = 1;code = 49
char = 5;code = 53
char = 0;code = 48
char = .;code = 46
char = 0;code = 48
char = ;code = 32
char = W;code = 87
char = ];code = 93
char = );code = 41
char = ;;code = 59
char = ;code = 32
char = P;code = 80
char = ;code = 32
char = <;code = 60
char = ;code = 32
char = 0;code = 48
char = .;code = 46
char = 0;code = 48
char = 0;code = 48
char = 1;code = 49
char = );code = 41
char = ;code = 32
char = a;code = 97
char = n;code = 110
char = d;code = 100
char = ;code = 32
char = m;code = 109
char = a;code = 97
char = x;code = 120
char = i;code = 105
char = m;code = 109
char = u;code = 117
char = m;code = 109
char = ;code = 32
char = c;code = 99
char = a;code = 97
char = r;code = 114
char = d;code = 100
char = i;code = 105
char = a;code = 97
char = c;code = 99
char = ;code = 32
char = o;code = 111
char = u;code = 117
char = t;code = 116
char = p;code = 112
char = u;code = 117
char = t;code = 116
char = ;code = 32
char = (;code = 40
char = P;code = 80
char = ;code = 32
char = <;code = 60
char = ;code = 32
char = 0;code = 48
char = .;code = 46
char = 0;code = 48
char = 0;code = 48
char = 1;code = 49
char = );code = 41
char = ;code = 32
char = c;code = 99
char = o;code = 111
char = m;code = 109
char = p;code = 112
char = a;code = 97
char = r;code = 114
char = e;code = 101
char = d;code = 100
char = ;code = 32
char = w;code = 119
char = i;code = 105
char = t;code = 116
char = h;code = 104
char = ;code = 32
char = p;code = 112
char = l;code = 108
char = a;code = 97
char = c;code = 99
char = e;code = 101
char = b;code = 98
char = o;code = 111
char = .;code = 46
char = ;code = 32
char = A;code = 65
char = t;code = 116
char = ;code = 32
char = h;code = 104
char = i;code = 105
char = g;code = 103
char = h;code = 104
char = ;code = 32
char = a;code = 97
char = l;code = 108
char = t;code = 116
char = i;code = 105
char = t;code = 116
char = u;code = 117
char = d;code = 100
char = e;code = 101
char = ,;code = 44
char = ;code = 32
char = s;code = 115
char = i;code = 105
char = l;code = 108
char = d;code = 100
char = e;code = 101
char = n;code = 110
char = a;code = 97
char = f;code = 102
char = i;code = 105
char = l;code = 108
char = ;code = 32
char = h;code = 104
char = a;code = 97
char = d;code = 100
char = ;code = 32
char = n;code = 110
char = o;code = 111
char = ;code = 32
char = e;code = 101
char = f;code = 102
char = f;code = 102
char = e;code = 101
char = c;code = 99
char = t;code = 116
char = ;code = 32
char = o;code = 111
char = n;code = 110
char = ;code = 32
char = a;code = 97
char = r;code = 114
char = t;code = 116
char = e;code = 101
char = r;code = 114
char = i;code = 105
char = a;code = 97
char = l;code = 108
char = ;code = 32
char = o;code = 111
char = x;code = 120
char = y;code = 121
char = g;code = 103
char = e;code = 101
char = n;code = 110
char = ;code = 32
char = s;code = 115
char = a;code = 97
char = t;code = 116
char = u;code = 117
char = r;code = 114
char = a;code = 97
char = t;code = 116
char = i;code = 105
char = o;code = 111
char = n;code = 110
char = ;code = 32
char = a;code = 97
char = t;code = 116
char = ;code = 32
char = r;code = 114
char = e;code = 101
char = s;code = 115
char = t;code = 116
char = ;code = 32
char = a;code = 97
char = n;code = 110
char = d;code = 100
char = ;code = 32
char = d;code = 100
char = u;code = 117
char = r;code = 114
char = i;code = 105
char = n;code = 110
char = g;code = 103
char = ;code = 32
char = e;code = 101
char = x;code = 120
char = e;code = 101
char = r;code = 114
char = c;code = 99
char = i;code = 105
char = s;code = 115
char = e;code = 101
char = ;code = 32
char = c;code = 99
char = o;code = 111
char = m;code = 109
char = p;code = 112
char = a;code = 97
char = r;code = 114
char = e;code = 101
char = d;code = 100
char = ;code = 32
char = w;code = 119
char = i;code = 105
char = t;code = 116
char = h;code = 104
char = ;code = 32
char = p;code = 112
char = l;code = 108
char = a;code = 97
char = c;code = 99
char = e;code = 101
char = b;code = 98
char = o;code = 111
char = .;code = 46
char = ;code = 32
char = H;code = 72
char = o;code = 111
char = w;code = 119
char = e;code = 101
char = v;code = 118
char = e;code = 101
char = r;code = 114
char = ,;code = 44
char = ;code = 32
char = s;code = 115
char = i;code = 105
char = l;code = 108
char = d;code = 100
char = e;code = 101
char = n;code = 110
char = a;code = 97
char = f;code = 102
char = i;code = 105
char = l;code = 108
char = ;code = 32
char = r;code = 114
char = e;code = 101
char = d;code = 100
char = u;code = 117
char = c;code = 99
char = e;code = 101
char = d;code = 100
char = ;code = 32
char = s;code = 115
char = y;code = 121
char = s;code = 115
char = t;code = 116
char = o;code = 111
char = l;code = 108
char = i;code = 105
char = c;code = 99
char = ;code = 32
char = p;code = 112
char = u;code = 117
char = l;code = 108
char = m;code = 109
char = o;code = 111
char = n;code = 110
char = a;code = 97
char = r;code = 114
char = y;code = 121
char = ;code = 32
char = a;code = 97
char = r;code = 114
char = t;code = 116
char = e;code = 101
char = r;code = 114
char = y;code = 121
char = ;code = 32
char = p;code = 112
char = r;code = 114
char = e;code = 101
char = s;code = 115
char = s;code = 115
char = u;code = 117
char = r;code = 114
char = e;code = 101
char = ;code = 32
char = a;code = 97
char = t;code = 116
char = ;code = 32
char = r;code = 114
char = e;code = 101
char = s;code = 115
char = t;code = 116
char = ;code = 32
char = (;code = 40
char = P;code = 80
char = ;code = 32
char = =;code = 61
char = ;code = 32
char = 0;code = 48
char = .;code = 46
char = 0;code = 48
char = 0;code = 48
char = 3;code = 51
char = );code = 41
char = ;code = 32
char = a;code = 97
char = n;code = 110
char = d;code = 100
char = ;code = 32
char = d;code = 100
char = u;code = 117
char = r;code = 114
char = i;code = 105
char = n;code = 110
char = g;code = 103
char = ;code = 32
char = e;code = 101
char = x;code = 120
char = e;code = 101
char = r;code = 114
char = c;code = 99
char = i;code = 105
char = s;code = 115
char = e;code = 101
char = ;code = 32
char = (;code = 40
char = P;code = 80
char = ;code = 32
char = =;code = 61
char = ;code = 32
char = 0;code = 48
char = .;code = 46
char = 0;code = 48
char = 2;code = 50
char = 1;code = 49
char = );code = 41
char = ;code = 32
char = a;code = 97
char = n;code = 110
char = d;code = 100
char = ;code = 32
char = i;code = 105
char = n;code = 110
char = c;code = 99
char = r;code = 114
char = e;code = 101
char = a;code = 97
char = s;code = 115
char = e;code = 101
char = d;code = 100
char = ;code = 32
char = m;code = 109
char = a;code = 97
char = x;code = 120
char = i;code = 105
char = m;code = 109
char = u;code = 117
char = m;code = 109
char = ;code = 32
char = w;code = 119
char = o;code = 111
char = r;code = 114
char = k;code = 107
char = l;code = 108
char = o;code = 111
char = a;code = 97
char = d;code = 100
char = ;code = 32
char = (;code = 40
char = P;code = 80
char = ;code = 32
char = =;code = 61
char = ;code = 32
char = 0;code = 48
char = .;code = 46
char = 0;code = 48
char = 0;code = 48
char = 2;code = 50
char = );code = 41
char = ;code = 32
char = a;code = 97
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char = d;code = 100
char = ;code = 32
char = c;code = 99
char = a;code = 97
char = r;code = 114
char = d;code = 100
char = i;code = 105
char = a;code = 97
char = c;code = 99
char = ;code = 32
char = o;code = 111
char = u;code = 117
char = t;code = 116
char = p;code = 112
char = u;code = 117
char = t;code = 116
char = ;code = 32
char = (;code = 40
char = P;code = 80
char = ;code = 32
char = =;code = 61
char = ;code = 32
char = 0;code = 48
char = .;code = 46
char = 0;code = 48
char = 1;code = 49
char = 5;code = 53
char = );code = 41
char = .;code = 46
char = ;code = 32
char = A;code = 65
char = t;code = 116
char = ;code = 32
char = h;code = 104
char = i;code = 105
char = g;code = 103
char = h;code = 104
char = ;code = 32
char = a;code = 97
char = l;code = 108
char = t;code = 116
char = i;code = 105
char = t;code = 116
char = u;code = 117
char = d;code = 100
char = e;code = 101
char = ,;code = 44
char = ;code = 32
char = s;code = 115
char = i;code = 105
char = l;code = 108
char = d;code = 100
char = e;code = 101
char = n;code = 110
char = a;code = 97
char = f;code = 102
char = i;code = 105
char = l;code = 108
char = ;code = 32
char = e;code = 101
char = x;code = 120
char = a;code = 97
char = c;code = 99
char = e;code = 101
char = r;code = 114
char = b;code = 98
char = a;code = 97
char = t;code = 116
char = e;code = 101
char = d;code = 100
char = ;code = 32
char = e;code = 101
char = x;code = 120
char = i;code = 105
char = s;code = 115
char = t;code = 116
char = i;code = 105
char = n;code = 110
char = g;code = 103
char = ;code = 32
char = h;code = 104
char = e;code = 101
char = a;code = 97
char = d;code = 100
char = a;code = 97
char = c;code = 99
char = h;code = 104
char = e;code = 101
char = ;code = 32
char = i;code = 105
char = n;code = 110
char = ;code = 32
char = 2;code = 50
char = ;code = 32
char = p;code = 112
char = a;code = 97
char = r;code = 114
char = t;code = 116
char = i;code = 105
char = c;code = 99
char = i;code = 105
char = p;code = 112
char = a;code = 97
char = n;code = 110
char = t;code = 116
char = s;code = 115
char = .;code = 46
char = <;code = 60
char = b;code = 98
char = r;code = 114
char = /;code = 47
char = >;code = 62
char = <;code = 60
char = b;code = 98
char = r;code = 114
char = /;code = 47
char = >;code = 62
char = <;code = 60
char = b;code = 98
char = >;code = 62
char = L;code = 76
char = I;code = 73
char = M;code = 77
char = I;code = 73
char = T;code = 84
char = A;code = 65
char = T;code = 84
char = I;code = 73
char = O;code = 79
char = N;code = 78
char = S;code = 83
char = ;code = 32
char = :;code = 58
char = ;code = 32
char = <;code = 60
char = /;code = 47
char = b;code = 98
char = >;code = 62
char = T;code = 84
char = h;code = 104
char = e;code = 101
char = ;code = 32
char = s;code = 115
char = t;code = 116
char = u;code = 117
char = d;code = 100
char = y;code = 121
char = ;code = 32
char = d;code = 100
char = i;code = 105
char = d;code = 100
char = ;code = 32
char = n;code = 110
char = o;code = 111
char = t;code = 116
char = ;code = 32
char = e;code = 101
char = x;code = 120
char = a;code = 97
char = m;code = 109
char = i;code = 105
char = n;code = 110
char = e;code = 101
char = ;code = 32
char = t;code = 116
char = h;code = 104
char = e;code = 101
char = ;code = 32
char = e;code = 101
char = f;code = 102
char = f;code = 102
char = e;code = 101
char = c;code = 99
char = t;code = 116
char = s;code = 115
char = ;code = 32
char = o;code = 111
char = f;code = 102
char = ;code = 32
char = s;code = 115
char = i;code = 105
char = l;code = 108
char = d;code = 100
char = e;code = 101
char = n;code = 110
char = a;code = 97
char = f;code = 102
char = i;code = 105
char = l;code = 108
char = ;code = 32
char = o;code = 111
char = n;code = 110
char = ;code = 32
char = n;code = 110
char = o;code = 111
char = r;code = 114
char = m;code = 109
char = o;code = 111
char = x;code = 120
char = i;code = 105
char = c;code = 99
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char = e;code = 101
char = x;code = 120
char = e;code = 101
char = r;code = 114
char = c;code = 99
char = i;code = 105
char = s;code = 115
char = e;code = 101
char = ;code = 32
char = t;code = 116
char = o;code = 111
char = l;code = 108
char = e;code = 101
char = r;code = 114
char = a;code = 97
char = n;code = 110
char = c;code = 99
char = e;code = 101
char = .;code = 46
char = <;code = 60
char = b;code = 98
char = r;code = 114
char = /;code = 47
char = >;code = 62
char = <;code = 60
char = b;code = 98
char = r;code = 114
char = /;code = 47
char = >;code = 62
char = <;code = 60
char = b;code = 98
char = >;code = 62
char = C;code = 67
char = O;code = 79
char = N;code = 78
char = C;code = 67
char = L;code = 76
char = U;code = 85
char = S;code = 83
char = I;code = 73
char = O;code = 79
char = N;code = 78
char = S;code = 83
char = ;code = 32
char = :;code = 58
char = ;code = 32
char = <;code = 60
char = /;code = 47
char = b;code = 98
char = >;code = 62
char = S;code = 83
char = i;code = 105
char = l;code = 108
char = d;code = 100
char = e;code = 101
char = n;code = 110
char = a;code = 97
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char = i;code = 105
char = l;code = 108
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char = r;code = 114
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char = d;code = 100
char = u;code = 117
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char = e;code = 101
char = s;code = 115
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char = h;code = 104
char = y;code = 121
char = p;code = 112
char = o;code = 111
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char = i;code = 105
char = c;code = 99
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char = u;code = 117
char = l;code = 108
char = m;code = 109
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char = n;code = 110
char = a;code = 97
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char = y;code = 121
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char = h;code = 104
char = y;code = 121
char = p;code = 112
char = e;code = 101
char = r;code = 114
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char = e;code = 101
char = n;code = 110
char = s;code = 115
char = i;code = 105
char = o;code = 111
char = n;code = 110
char = ;code = 32
char = a;code = 97
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char = ;code = 32
char = r;code = 114
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char = s;code = 115
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char = d;code = 100
char = u;code = 117
char = r;code = 114
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char = n;code = 110
char = g;code = 103
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char = e;code = 101
char = r;code = 114
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char = s;code = 115
char = e;code = 101
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char = w;code = 119
char = h;code = 104
char = i;code = 105
char = l;code = 108
char = e;code = 101
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char = m;code = 109
char = a;code = 97
char = i;code = 105
char = n;code = 110
char = t;code = 116
char = a;code = 97
char = i;code = 105
char = n;code = 110
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char = n;code = 110
char = g;code = 103
char = ;code = 32
char = g;code = 103
char = a;code = 97
char = s;code = 115
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char = e;code = 101
char = x;code = 120
char = c;code = 99
char = h;code = 104
char = a;code = 97
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char = g;code = 103
char = e;code = 101
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char = a;code = 97
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char = d;code = 100
char = ;code = 32
char = s;code = 115
char = y;code = 121
char = s;code = 115
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char = e;code = 101
char = m;code = 109
char = i;code = 105
char = c;code = 99
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char = b;code = 98
char = l;code = 108
char = o;code = 111
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char = d;code = 100
char = ;code = 32
char = p;code = 112
char = r;code = 114
char = e;code = 101
char = s;code = 115
char = s;code = 115
char = u;code = 117
char = r;code = 114
char = e;code = 101
char = .;code = 46
char = ;code = 32
char = T;code = 84
char = o;code = 111
char = ;code = 32
char = t;code = 116
char = h;code = 104
char = e;code = 101
char = ;code = 32
char = a;code = 97
char = u;code = 117
char = t;code = 116
char = h;code = 104
char = o;code = 111
char = r;code = 114
char = s;code = 115
char = ';code = 39
char = ;code = 32
char = k;code = 107
char = n;code = 110
char = o;code = 111
char = w;code = 119
char = l;code = 108
char = e;code = 101
char = d;code = 100
char = g;code = 103
char = e;code = 101
char = ,;code = 44
char = ;code = 32
char = s;code = 115
char = i;code = 105
char = l;code = 108
char = d;code = 100
char = e;code = 101
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char = a;code = 97
char = f;code = 102
char = i;code = 105
char = l;code = 108
char = ;code = 32
char = i;code = 105
char = s;code = 115
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char = t;code = 116
char = h;code = 104
char = e;code = 101
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char = f;code = 102
char = i;code = 105
char = r;code = 114
char = s;code = 115
char = t;code = 116
char = ;code = 32
char = d;code = 100
char = r;code = 114
char = u;code = 117
char = g;code = 103
char = ;code = 32
char = s;code = 115
char = h;code = 104
char = o;code = 111
char = w;code = 119
char = n;code = 110
char = ;code = 32
char = t;code = 116
char = o;code = 111
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char = i;code = 105
char = n;code = 110
char = c;code = 99
char = r;code = 114
char = e;code = 101
char = a;code = 97
char = s;code = 115
char = e;code = 101
char = ;code = 32
char = e;code = 101
char = x;code = 120
char = e;code = 101
char = r;code = 114
char = c;code = 99
char = i;code = 105
char = s;code = 115
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char = i;code = 105
char = t;code = 116
char = y;code = 121
char = ;code = 32
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char = g;code = 103
char = ;code = 32
char = s;code = 115
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char = v;code = 118
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char = e;code = 101
char = ;code = 32
char = h;code = 104
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char = o;code = 111
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char = i;code = 105
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char = ;code = 32
char = b;code = 98
char = o;code = 111
char = t;code = 116
char = h;code = 104
char = ;code = 32
char = a;code = 97
char = t;code = 116
char = ;code = 32
char = s;code = 115
char = e;code = 101
char = a;code = 97
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char = l;code = 108
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char = v;code = 118
char = e;code = 101
char = l;code = 108
char = ;code = 32
char = a;code = 97
char = n;code = 110
char = d;code = 100
char = ;code = 32
char = a;code = 97
char = t;code = 116
char = ;code = 32
char = h;code = 104
char = i;code = 105
char = g;code = 103
char = h;code = 104
char = ;code = 32
char = a;code = 97
char = l;code = 108
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result sql = BACKGROUND : Alveolar hypoxia causes pulmonary hypertension and enhanced right ventricular afterload, which may impair exercise tolerance. The phosphodiesterase-5 inhibitor sildenafil has been reported to cause pulmonary vasodilatation.

OBJECTIVE : To investigate the effects of sildenafil on exercise capacity under conditions of hypoxic pulmonary hypertension.

DESIGN : Randomized, double-blind, placebo-controlled crossover study.

SETTING : University Hospital Giessen, Giessen, Germany, and the base camp on Mount Everest.

PARTICIPANTS : 14 healthy mountaineers and trekkers.

MEASUREMENTS : Systolic pulmonary artery pressure, cardiac output, and peripheral arterial oxygen saturation at rest and during assessment of maximum exercise capacity on cycle ergometry 1) while breathing a hypoxic gas mixture with 10% fraction of inspired oxygen at low altitude (Giessen) and 2) at high altitude (the Mount Everest base camp).

INTERVENTION : Oral sildenafil, 50 mg, or placebo.

RESULTS : At low altitude, acute hypoxia reduced arterial oxygen saturation to 72.0% (95% CI, 66.5% to 77.5%) at rest and 60.8% (CI, 56.0% to 64.5%) at maximum exercise capacity. Systolic pulmonary artery pressure increased from 30.5 mm Hg (CI, 26.0 to 35.0 mm Hg) at rest to 42.9 mm Hg (CI, 35.6 to 53.5 mm Hg) during exercise in participants taking placebo. Sildenafil, 50 mg, significantly increased arterial oxygen saturation during exercise (P = 0.005) and reduced systolic pulmonary artery pressure at rest (P < 0.001) and during exercise (P = 0.031). Of note, sildenafil increased maximum workload (172.5 W [CI, 147.5 to 200.0 W]) vs. 130.6 W [CI, 108.8 to 150.0 W]); P < 0.001) and maximum cardiac output (P < 0.001) compared with placebo. At high altitude, sildenafil had no effect on arterial oxygen saturation at rest and during exercise compared with placebo. However, sildenafil reduced systolic pulmonary artery pressure at rest (P = 0.003) and during exercise (P = 0.021) and increased maximum workload (P = 0.002) and cardiac output (P = 0.015). At high altitude, sildenafil exacerbated existing headache in 2 participants.

LIMITATIONS : The study did not examine the effects of sildenafil on normoxic exercise tolerance.

CONCLUSIONS : Sildenafil reduces hypoxic pulmonary hypertension at rest and during exercise while maintaining gas exchange and systemic blood pressure. To the authors' knowledge, sildenafil is the first drug shown to increase exercise capacity during severe hypoxia both at sea level and at high altitude.

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