Hypertension medications and erectile dysfunction

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madman

Super Moderator
Sexual health is an integral part of overall health, and an active and healthy sexual life is an essential aspect of a good life quality. Cardiovascular disease and sexual health share common risk factors (arterial hypertension, diabetes mellitus, dyslipidemia, obesity, and smoking) and common mediating mechanisms (endothelial dysfunction, subclinical inflammation, and atherosclerosis). This generated a shift of thinking about the pathophysiology and subsequently the management of sexual dysfunction. The introduction of phosphodiesterase type 5 inhibitors revolutionized the management of sexual dysfunction in men. This article will focus on erectile dysfunction and its association with arterial hypertension. This update of the position paper was created by the Working Group on Sexual Dysfunction and Arterial Hypertension of the European Society of Hypertension. This working group has been very active during the last years in promoting the familiarization of hypertension specialists and related physicians with erectile dysfunction, through numerous lectures in national and international meetings, a position paper, newsletters, guidelines, and a book specifically addressing erectile dysfunction in hypertensive patients. It was noted that erectile dysfunction precedes the development of coronary artery disease. The artery size hypothesis has been proposed as a potential explanation for this observation. This hypothesis seeks to explain the differing manifestation of the same vascular condition, based on the size of the vessels. Clinical presentations of the atherosclerotic and/or endothelium disease in the penile arteries might precede the corresponding manifestations from larger arteries. Treated hypertensive patients are more likely to have sexual dysfunction compared with untreated ones, suggesting a detrimental role of antihypertensive treatment on erectile function. The occurrence of erectile dysfunction seems to be related to undesirable effects of antihypertensive drugs on the penile tissue. Available information points toward divergent effects of antihypertensive drugs on erectile function, with diuretics and beta-blockers possessing the worst profile and angiotensin receptor blockers and nebivolol the best profile.


CONCLUSION

Assessment of sexual function should be part of routine history taking by all physicians treating patients with arterial hypertension, not only as a part of a holistic approach of the patient but in the effort to pursue significant and tangible benefits. The essential first step for the treating physician is to initiate the discussion about sexual function and function to engage in an open dialogue with the patient and the sexual partner. In this, the patient (couple) shall be informed about the magnitude of the problem and ensured that effective and safe treatment is available. Finally, a realistic plan in co-operation with the couple in terms of shared-decision making should be developed.
 

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madman

Super Moderator
TABLE 1. Prognostic biomarkers of cardiovascular disease in patients with erectile dysfunction
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madman

Super Moderator
Screenshot (1522).png

FIGURE 1 Management of erectile dysfunction patients with and without cardiovascular disease. Modified with permission from Vlachopoulos et al. [53]. *Low-risk patients include those with complete revascularization (e.g. via coronary artery bypass grafting, stenting, or angioplasty), patients with asymptomatic controlled hypertension, those with mild valvular disease, and patients with left ventricular dysfunction/heart failure (NYHA classes I and II) who achieved five metabolic equivalents of the task (METS) without ischemia on recent exercise testing. **Indeterminate risk patients include diabetic patients, those with mild or moderate stable angina pectoris, past myocardial infarction (2–8 weeks) without intervention awaiting exercise electrocardiography, congestive heart failure (NYHA class III), and noncardiac sequelae of atherosclerotic disease (e.g. peripheral artery disease and a history of stroke or transient ischemic attack); this patient with erectile dysfunction may require assessment for additional vascular disease using carotid intima-media thickness or ankle-brachial index and subsequent reclassification to low or high risk. ***High-risk patients include those with unstable or refractory angina pectoris, uncontrolled hypertension, congestive heart failure (NYHA class IV), recent myocardial infarction without intervention (2 weeks), high-risk arrhythmia (exercise-induced ventricular tachycardia, implanted internal cardioverter defibrillator with frequent shocks, and poorly controlled atrial fibrillation), obstructive hypertrophic cardiomyopathy with severe symptoms, and moderate-to-severe valve disease, particularly aortic stenosis. Where appropriate CVD, cardiovascular disease; FRS, Framingham risk score; NYHA, New York Heart Association; PDE5i, phosphodiesterase type 5 inhibitors; RF, risk factor; Tth, testosterone therapy.
 

madman

Super Moderator
so metoprolol and Lisinopril will help erections. Please advise Madman

Beta blockers and diuretics can cause the most sexual side effects. In contrast, sexual side effects less commonly occur with ACE inhibitors, angiotensin-receptor blockers, and calcium-channel blockers.

All beta-blockers (except selective β₁ receptor blocker nebivolol) can have a negative effect on erectile function and this includes the selective β₁ receptor blocker metoprolol.

ACE inhibitors can have a neutral/positive effect on erectile function and this includes lisinopril.
 

madman

Super Moderator
I just posted the full paper.



Antihypertensive treatment

Drug effects

Treated patients with hypertension are more likely to have sexual dysfunction compared with untreated ones, suggesting a detrimental role of antihypertensive treatment on erectile function [43,105–109]. The occurrence of erectile dysfunction seems to be related to undesirable effects of antihypertensive drugs on the penile tissue. It remains to be clarified whether the lower blood pressure levels impair the blood supply towards the penile vasculature, thus resulting to erectile dysfunction. It should be highlighted that treated patients with hypertension usually suffer from more severe forms of the disease and target-organ damage of greater extent. Subsequently, the high prevalence of erectile dysfunction comes with no surprise [110]. The one-million-dollar question for the practicing physician is whether all antihypertensive drugs exert detrimental effects on erectile function or differences exist between the various drug categories. Accumulating evidence strongly indicates divergent effects of the various antihypertensive drugs on erectile function, pointing towards not only between-class differences but also within-class differences. Available data come from experimental, observational, and clinical studies. Collectively, available information points toward divergent effects of antihypertensive drugs on erectile function, with diuretics and beta-blockers possessing the worst profile and angiotensin receptor blockers (ARBs) and nebivolol the best profile (Table 2). Therefore, a more detailed description about the effects of ARBs and nebivolol on erectile function is provided.
 
Last edited:

Fernando Almaguer

Active Member
Beta blockers and diuretics can cause the most sexual side effects. In contrast, sexual side effects less commonly occur with ACE inhibitors, angiotensin-receptor blockers, and calcium-channel blockers.

All beta-blockers (except selective β₁ receptor blocker nebivolol) can have a negative effect on erectile function and this includes the selective β₁ receptor blocker metoprolol.

ACE inhibitors can have a neutral/positive effect on erectile function and this includes lisinopril.
THANKS so looks like I'm good with metoprolol since its a selective b-1. Am I understanding you correctly?
 

Golfboy307

Active Member
Madman, I wanted to give you a big thanks for posting this study. I have been on a Lisinopril 20mg/HCTZ 12.5mg (diuretic) combo for over 5 years. It does a great job keeping me at 120/80 or below. However, based on other health progress I have made, my Body Logic doctor has been urging me to consider dropping the diuretic (prescribed by my old doc). Well, after reading this article, I have finally made that change as of 3 weeks ago. The good news: my erections have been the strongest they have been in several years. Eye popping results really, very noticeable about 3 days after I stopped the HCTZ. The diuretic was definitely a negative factor sexually. Not as good news: my BP is back to averaging 125-135/75. Fine for now, but I may need to tweak my Lisinopril dosage a bit. As I move forward, I am going to use this study as a guide with my doctor.

(For reference, age 52, active runner/fitness athlete. Good diet. Hypertension in both parents. Currently on successful TRT regimen)
 

Mark Saur

Active Member
I just started 60mg ER Propranolol and find it better for heart rate control. I have not checked by BP yet. I had been on Metoprolol and felt it was not working anymore.
 

Nelson Vergel

Founder, ExcelMale.com
I still strongly believe that using non-MRA diuretics like amiloride is the best way to deal with TRT or anabolic-induced water retention without affecting erectile function on insulin sensitivity. Amiloride plus losartan or telmisartan would also work if blood pressure is an issue.

Diuretics ED water retention TRT.jpg
 
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