Evaluation of Sexual Function in Hypertensive Men Receiving Treatment: A Review of Current Guidelines Recommendation

Abstract

Introduction It has been suggested that some classes of antihypertensive drugs may induce or exacerbate sexual and/or erectile dysfunction (ED) more than others. Sexually related side effects of antihypertensive treatment may compromise patient's and partner's quality of life. Often, these side effects can lead to withdrawal or poor compliance with therapy resulting in abnormal blood pressure and associated morbidity. Aim The aim of this study was to evaluate whether hypertension clinical practice guidelines (CPGs) address ED and/or other sexual issues as either an adverse outcome of chosen therapy or as a factor to consider in treatment decision. Methods Hypertension CPGs were identified by searching PubMed (from 2000 to current), the World Wide Web, bibliographies of retrieved guidelines, and official home pages of major medical societies. Main Outcome Measures The main outcome measures used for this study were guidelines assessment using a set of author-determined survey questions. Results Twelve CPGs were identified and analyzed. From these 12, only three emphasized the importance of assessing sexual function prior to initiation and/or follow-up of antihypertensive therapy; only five described potential sexual side effects associated with some drugs; only two provided specific management recommendations on commencing antihypertensive therapy in sexually active men or those with preexisting ED and address the timeline of the potential drug-induced impairment of sexual function. Conclusions Only a minority of CPGs for the treatment of hypertension consider ED or other sexual issues as either an adverse outcome or as a factor to consider in treatment. Sexual function is an important aspect of quality of life for both the individual and his partner. It is therefore imperative to select therapy with the least possible potential for causing sexual sequelae and enable the best achievable balance between therapeutic efficacy, quality of life, and therapeutic compliance. Based on these results, our proposed algorithm attempts to effectively apply available evidence to clinical practice.

A review of the positive and negative effects of cardiovascular drugs on sexual function: a proposed table for use in clinical practice

“…Furthermore, if patients present with sexual dysfunction during treatment with β-blockers, a switch to Nebivolol, a novel third-generation β-1 blocker with a greater degree of selectivity for β-1 adrenergic receptors, might be a solution. Nebivolol appears to have a very low risk of sexual side effects compared with other agents in its class [23–25]. In a study designed to compare the effects of metoprolol and nebivolol in erectile tissue (MR-NOED), nebivolol was even shown to significantly improve erectile function of hypertensive patients due to nitric oxide modulation [26].…”

Tolerability of Antihypertensive Medications in Older Adults

“…A report describes high-dose b-blockers being prescribed to the young while ACEIs and CCBs were underutilized, although the ACEIs and CCBs were known to have a lesser impact on sexual function [136]. Sexual dysfunction is currently considered a serious QOL health issue [137] warranting treatment considerations to achieve a balance between BP control and least possible adverse sequelae involving sexual function [138]. Furthermore, dose-dependent and combination therapy-related adverse effects on sexual function are unresolved issues [139].…”

Erectile Dysfunction and Hypertension: Impact on Cardiovascular Risk and Treatment

“…Although ED has a high prevalence in the hypertensive population, sexual questions are not frequently asked during general practitioners consultations [37]. Many hypertensive men do not recognize that they have ED and only a minority of GP considers ED or other sexual issues for the treatment of hypertension as either a possible adverse outcome or as a factor to consider in treatment decision [86]. …”