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The impacts of Cialis could be impacted if you have reduced blood pressure, heart tempo issue, high blood pressure, physical deformity of the penis, sickle cell anemia, leukemia, tummy ulcer, chest pain, kidney condition, liver condition, a record of a stroke or heart attack, hemophilia, heart disease, current heart strike or numerous myeloma, which is why your physician needs to be educated of those aspects in breakthrough, before suggesting the dose of Cialis.