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Antihypertensive Drug Therapy and Erectile Dysfunction

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Erectile Dysfunction in Hypertension and Cardiovascular Disease

Abstract

The prevalence of erectile dysfunction is higher in treated compared with untreated hypertensive patients, suggesting a detrimental effect of antihypertensive therapy on erectile function. This chapter aims to summarize the effects of the various antihypertensive drug categories on erectile function, highlight the differences between drug categories, and discuss the effects of switching antihypertensive drug class on erectile function. Experimental data suggests that significant between-class and in-class differences exist regarding the effects of antihypertensive agents on erectile function. Observational and small randomized studies, large clinical trials, and meta-analyses point towards the same direction. Diuretics and beta-blockers seem to exert detrimental effects on erectile dysfunction, ACE inhibitors and calcium antagonists seem to exert neutral effects, while ARBs and nebivolol seem to be associated with beneficial effects on erectile function. However, further studies are needed to confirm these effects.

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References

  1. Mancia G, Fagard R, Narkiewicz K et al (2013) 2013 ESH/ESC guidelines for the management of arterial hypertension. J Hypertens 31:1281–1357

    Article  CAS  PubMed  Google Scholar 

  2. Laurent S, Briet M, Boutouyrie P (2009) Large and small artery cross-talk and recent morbidity-mortality trials in hypertension. Hypertension 54:388–392

    Article  CAS  PubMed  Google Scholar 

  3. Schifrin EL (2010) Circulatory therapeutics: use of antihypertensive agents and their effects on the vasculature. J Cell Mol Med 14:1018–1029

    Google Scholar 

  4. MacMahon S, Peto R, Cutler J et al (1990) Blood pressure, stroke, and coronary heart disease. Prolonged differences in blood pressure: prospective observational studies corrected for the regression dilution bias. Lancet 335:765–774

    Article  CAS  PubMed  Google Scholar 

  5. Lewington S, Clarke R, Qizilbash N et al (2002) Age-specific relevance of usual blood pressure to vascular mortality: a meta-analysis of individual data for one million adults in 61 prospective studies. Lancet 360:1903–1913

    Article  PubMed  Google Scholar 

  6. Law MR, Morris JK, Wald NJ (2009) Use of blood pressure lowering drugs in the prevention of cardiovascular disease: meta-analysis of 147 randomised trials in the context of expectations from prospective epidemiological studies. BMJ 338:b1665

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  7. Turnbull F, Blood Pressure Lowering Treatment Trialists’ Collaboration (2003) Effects of different blood-pressure-lowering regimens on major cardiovascular events: results of prospectively-designed overviews of randomized trials. Lancet 362:1527–1535

    Article  CAS  PubMed  Google Scholar 

  8. Manolis A, Doumas M (2008) Sexual dysfunction: the ‘prima ballerina’ of hypertension-related quality-of-life complications. J Hypertens 26:2074–2084

    Article  CAS  PubMed  Google Scholar 

  9. Viigimaa M, Doumas M, Vlachopoulos C et al (2011) European Society of Hypertension Working Group on Sexual Dysfunction. Hypertension and sexual dysfunction: time to act. J Hypertens 29:403–407

    Article  CAS  PubMed  Google Scholar 

  10. Manolis A, Doumas M (2012) Antihypertensive treatment and sexual dysfunction. Curr Hypertens Rep 14:285–292

    Article  CAS  PubMed  Google Scholar 

  11. Doumas M, Douma S (2006) The effect of antihypertensive drugs on erectile function: a proposed management algorithm. J Clin Hypertens 8:359–364

    Article  CAS  Google Scholar 

  12. Manolis A, Doumas M (2009) Hypertension and sexual dysfunction. Arch Med Sci 5:S337–S350

    Google Scholar 

  13. Douma S, Doumas M, Tsakiris A, Zamboulis C (2007) Male and female sexual dysfunction: is hypertension an innocent bystander or a major contributor? Rev Bras Hypertens 14:139–147

    Google Scholar 

  14. Doumas M, Douma S (2006) Sexual dysfunction in essential hypertension: myth or reality? J Clin Hypertens 8:269–274

    Article  Google Scholar 

  15. Manolis AJ, Doumas M, Viigimaa M, Narkiewitz K (2011) Hypertension and sexual dysfunction. European Society of Hypertension Scientific Newsletter: Update on Hypertension Management 32

    Google Scholar 

  16. Vlachopoulos C, Rokkas K, Ioakeimidis N, Stefanadis C (2007) Inflammation, metabolic syndrome, erectile dysfunction, and coronary artery disease: common links. Eur Urol 52:1590–1600

    Article  CAS  PubMed  Google Scholar 

  17. Vlachopoulos C, Rokkas K, Ioakeimidis N et al (2005) Prevalence of asymptomatic coronary artery disease in men with vasculogenic erectile dysfunction: a prospective angiographic study. Eur Urol 48:996–1002

    Article  PubMed  Google Scholar 

  18. Vlachopoulos C, Ioakeimidis N, Terentes-Printzios D, Stefanadis C (2008) The triad: erectile dysfunction, endothelial dysfunction, cardiovascular disease. Curr Pharm Des 14:3700–3714

    Article  CAS  PubMed  Google Scholar 

  19. Vlachopoulos C, Jackson G, Stefanadis C, Montorsi P (2013) Erectile dysfunction in the cardiovascular patient. Eur Heart J 34:2034–2046

    Article  PubMed  Google Scholar 

  20. Vlachopoulos C, Ioakeimidis N, Terentes-Printzios D et al (2013) Plasma total testosterone and incident cardiovascular events in hypertensive patients. Am J Hypertens 26:373–381

    Article  CAS  PubMed  Google Scholar 

  21. Doumas M, Tsakiris A, Douma S et al (2006) Factors affecting the increased prevalence of erectile dysfunction in Greek hypertensive compared with normotensive subjects. J Androl 27:469–477

    Article  PubMed  Google Scholar 

  22. Toblli J, Stella I, Inserra F et al (2000) Morphological changes in cavernous tissue in spontaneously hypertensive rats. Am J Hypertens 13:686–692

    Article  CAS  PubMed  Google Scholar 

  23. Tobbli J, Stella I, Mazza ON et al (2004) Candesartan cilexetil protects cavernous tissue in spontaneously hypertensive rats. Int J Impot Res 16:305–312

    Article  Google Scholar 

  24. Toblli J, Stella I, Mazza NO, Ferder L, Inserra F (2004) Protection of cavernous tissue in male spontaneously hypertensive rats. Beyond blood pressure control. Am J Hypertens 17:516–522

    Article  PubMed  Google Scholar 

  25. Toblli JE, Cao G, Casas G, Mazza ON (2006) In vivo and in vitro effects of nebivolol on penile structures in hypertensive rats. Am J Hypertens 19:1226–1232

    Article  CAS  PubMed  Google Scholar 

  26. Mazza ON, Angeros M, Becher E, Toblli JE (2006) Differences between candesartan and hydralazine in the protection of penile structures in spontaneously hypertensive rats. J Sex Med 3:604–611

    Article  CAS  PubMed  Google Scholar 

  27. Toblli JE, Stella I, Mazza ON et al (2004) Different effect of losartan and amlodipine on penile structures in male spontaneously hypertensive rats. Am J Nephrol 24:614–623

    Article  CAS  PubMed  Google Scholar 

  28. Toblli JE, Stella I, Mazza ON et al (2006) The effect of different antihypertensive drugs on cavernous tissue in experimental chronic renal insufficiency. J Nephrol 19:419–428

    CAS  PubMed  Google Scholar 

  29. Oger S, Behr-Roussel D, Gorny D et al (2009) Combination of doxazosin and sildenafil exerts an additive relaxing effect compared with each compound alone on human cavernosal and prostatic tissue. J Sex Med 6:836–847

    Article  CAS  PubMed  Google Scholar 

  30. Doumas M, Tsiodras S, Tsakiris A et al (2006) Female sexual dysfunction in essential hypertension: a common problem being uncovered. J Hypertens 24:2387–2392

    Article  CAS  PubMed  Google Scholar 

  31. Cordero A, Bertomeu-Martinez V, Mazon P et al (2010) Erectile dysfunction in high-risk hypertensive patients treated with beta-blockers agents. Cardiovasc Ther 28:15–22

    Article  CAS  PubMed  Google Scholar 

  32. Fogari R, Zoppi A, Corradi L et al (1998) Sexual function in hypertensive males treated with lisinopril or atenolol: a cross-over study. Am J Hypertens 11:1244–1247

    Article  CAS  PubMed  Google Scholar 

  33. Fogari R, Zoppi A, Poletti L et al (2001) Sexual activity in hypertensive men treated with valsartan or carvedilol: a crossover study. Am J Hypertens 14:27–31

    Article  CAS  PubMed  Google Scholar 

  34. Fogari R, Preti P, Derosa G et al (2002) Effect of antihypertensive treatment with valsartan or atenolol on sexual activity and plasma testosterone in hypertensive men. Eur J Clin Pharmacol 58:177–180

    Article  CAS  PubMed  Google Scholar 

  35. Fogari R, Preti P, Zoppi A et al (2004) Effect of valsartan and atenolol on sexual behavior in hypertensive postmenopausal women. Am J Hypertens 17:77–81

    Article  CAS  PubMed  Google Scholar 

  36. Medical Research Council Working Party on mild to moderate hypertension, report of 1981. Adverse reactions to bendrofluazide and propranolol for the treatment of mild hypertension. Lancet. 1981;2:539–543

    Google Scholar 

  37. Wassertheil-Smoller S, Blaufox MD, Oberman A et al (1991) Effect of antihypertensives on sexual function and quality of life: the TAIM study. Ann Intern Med 114:613–620

    Article  CAS  PubMed  Google Scholar 

  38. Grimm RH, Grandits GA, Prineas RJ et al (1997) Long-term effects on sexual function of five antihypertensive drugs and nutritional hygienic treatment in hypertensive men and women. Treatment of Mild Hypertension Study (TOMHS). Hypertension 29:8–14

    Article  CAS  PubMed  Google Scholar 

  39. Brixius K, Middeke M, Lichtenthal A, Jahn E, Schwinger RH (2007) Nitric oxide, erectile dysfunction and beta-blocker treatment (MR NOED study): benefit of nebivolol versus metoprolol in hypertensive men. Clin Exp Pharmacol Physiol 34:327–331

    Article  CAS  PubMed  Google Scholar 

  40. Böhm M, Baumhäkel M, Teo K (2010) ONTARGET/TRANSCEND Erectile Dysfunction Substudy Investigators. Erectile dysfunction predicts cardiovascular events in high-risk patients receiving telmisartan, ramipril, or both: the ongoing telmisartan alone and in combination with ramipril global endpoint trial/telmisartan randomized Assessment study in ACE intolerant subjects with cardiovascular disease (ONTARGET/TRANSCEND) trials. Circulation 121:1439–1446

    Article  PubMed  Google Scholar 

  41. Ko DT, Hebert PR, Coffey CS et al (2002) Beta-blocker therapy and symptoms of depression, fatigue, and sexual dysfunction. JAMA 288:351–357

    Article  CAS  PubMed  Google Scholar 

  42. Della Chiesa A, Pfifner D, Meier B et al (2003) Sexual activity in hypertensive men. J Hum Hypertens 17:515–521

    Article  CAS  PubMed  Google Scholar 

  43. Dusing R (2003) Effect of the angiotensin II antagonist valsartan on sexual function in hypertensive men. Blood Press 12:S29–S34

    Article  Google Scholar 

  44. Baumhakel M, Schlimmer N, Bohm M (2008) Effect of irbesartan on erectile function in patients with hypertension and metabolic syndrome. Int J Impot Res 20:493–500

    Article  CAS  PubMed  Google Scholar 

  45. Doumas M, Tsakiris A, Douma S et al (2006) Beneficial effects of switching from beta-blockers to nebivolol on the erectile function of hypertensive patients. Asian J Androl 8:177–182

    Article  CAS  PubMed  Google Scholar 

  46. Silvestri A, Galetta P, Cerquetani E et al (2003) Report of erectile dysfunction after therapy with beta-blockers is related to patient knowledge of side effects and is reversed by placebo. Eur Heart J 24:1928–1932

    Article  CAS  PubMed  Google Scholar 

  47. Douma S, Doumas M, Petidis K, Triantafyllou A, Zamboulis C (2008) Beta blockers and sexual dysfunction: bad guys – good guys. In: Momoka Endo, Narami Matsumoto (eds) Beta blockers: new research. Nova Science Publishers Inc., Hauppauge, NY pp 1–13.

    Google Scholar 

  48. Yang L, Yu J, Ma R et al (2013) The effect of combined antihypertensive treatment (felodipine with either irbesartan or metoprolol) on erectile function: a randomized controlled trial. Cardiology 125:235–241

    Article  CAS  PubMed  Google Scholar 

  49. Doumas M, Viigimaa M, Papademetriou V (2013) Combined antihypertensive therapy and sexual dysfunction: terra incognita. Cardiology 125:232–234

    Article  CAS  PubMed  Google Scholar 

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Correspondence to Vasilios Papademetriou .

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Papademetriou, V., Lazaridis, A., Papadopoulou, E., Papadopoulou, T., Doumas, M. (2015). Antihypertensive Drug Therapy and Erectile Dysfunction. In: Viigimaa, M., Vlachopoulos, C., Doumas, M. (eds) Erectile Dysfunction in Hypertension and Cardiovascular Disease. Springer, Cham. https://doi.org/10.1007/978-3-319-08272-1_18

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  • DOI: https://doi.org/10.1007/978-3-319-08272-1_18

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  • Publisher Name: Springer, Cham

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