Monday, August 29, 2016

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

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