Antihypertensive & Erectile Dysfunction

• Experimental and clinical have strongly indicated that older antihypertensive drugs exert detrimental effects on erectile function while newer agents exert either neutral or even beneficial effects.

• Accumulating data indicate that antihypertensive drug therapy is associated with erectile dysfunction, that antihypertensive drugs have divergent effects on erectile function which is either

           a)   Detrimental (diuretics, beta-blockers, centrally acting agents)

               b)   Neutral (calcium antagonists, ACE inhibitors)

               c)   Potentially beneficial (angiotensin receptor blockers, nebivolol)

• Older antihypertensive drugs (diuretics and beta-blockers) are not ideal candidates for these patients due to their detrimental effects on erectile function, and should be used only if they are absolutely indicated.

•  In case more than one class is indicated for an individual patient, the choice of an ARB should be considered.

• Switching from a drug with negative to a drug with positive effects on erectile function seems to be beneficial in hypertensive patients with erectile dysfunction.

Choice of ARB in Erectile Dysfunction

Losartan	Based on study, treatment with losartan improved erectile function, sexual satisfaction and frequency of sexual activity in hypertensive patients. Losartan alone or in combination with tadalafil significantly improved ED in diabetic patients, those with mild to moderate ED profiting the most from its use
Irbesartan	In mice, irbesartan was shown to improve penile endothelial function by reduction of vascular and cavernosal oxidative stress
Valsartan	In large prospective studies, the use of valsartan increased the rate of sexual intercourses per week and caused a reduction in ED, with improved orgasmic function, intercourse and overall sexual satisfaction in hypertensive men. In comparative studies, long-term use of valsartan was also shown to significantly improve sexual activity in comparison with the β-blockers carvedilol and atenolol, with the latter also reducing serum testosterone levels

1. Doumas M, Boutari C, Viigimaa M. (2016) Arterial Hypertension & Erectile Dysfucntion : An Under-Recognised Duo. European Society of Cardiology. Retrieved from https://www.escardio.org/Journals/E-Journal-of-Cardiology-Practice/Volume-14/arterial-hypertension-and-erectile-dysfunction-an-under-recognized-duo
2. Dézsi, C. A. (2016). The Different Therapeutic Choices with ARBs. Which One to Give? When? Why? American Journal of Cardiovascular Drugs, 16(4), 255–266. http://doi.org/10.1007/s40256-016-0165-4