Frequency of Iatrogenic Sexual Dysfunction Associated with Antihypertensive Compounds

Abstract

Iatrogenic sexual dysfunction (SD) caused by antihypertensive (AH) compounds, provoking sexual desire, orgasm or arousal dysfunction, is a common clinical adverse event. Unfortunately, it is often underestimated and underreported by clinicians and prescribers in clinical practice, deteriorating the adherence and patient quality of life. The objective of this study was to investigate the frequency of SD in patients treated with different antihypertensive compounds; a real-life naturalistic and cross-sectional study in patients receiving AH treatment was carried out. Method: A total of 256 patients were included in the study (188 males and 68 females who met the inclusion and exclusion criteria). The validated Psychotropic-Related Sexual Dysfunction Questionnaire (PRSexDQ-SALSEX) was transversally applied once at least every two months following the onset of the treatment in order to measure possible AH-related SD. Although the spontaneous reporting of SD was very low (6.81% females/24.8% males), 66.40% of the patients reported impaired sexual function through the SALSEX questionnaire after the treatment onset, as follows: decreased desire (55.8% females/54.2% males), delayed orgasm (42.6%/45.7%), anorgasmia (42.6%/43.6%) and arousal difficulties (53%/59.6%). The average frequency of moderate to severe iatrogenic SD was 66.4% with AH in monotherapy as follows: angiotensin II receptor antagonists (ARBs), 29.8%; calcium antagonists, 40%; diuretics, 42.9%; beta blockers, 43.8%; and angiotensin-converting enzyme (ACE) inhibitors, 77.8%. Combined treatments showed a higher percentage of main SD (70.3%): diuretic + ACE inhibitor, 42.3%; ARB + calcium antagonist, 55.6%; diuretic + calcium antagonist, 68.8%; and diuretic + ARB, 74.2%. The greatest risk factors associated with SD were poor general health, age over 60 with a comorbid coronary or musculoskeletal disease, mood disorder and diuretic +ARB combined therapy. Conclusion: SD is common in patients treated with antihypertensive drugs, and it is still underreported. The most harmful treatment deteriorating sexual function was the combination of diuretic +ARB, while the least harmful was monotherapy with ARBs. More research is needed on the clinical management of this problem to preserve the quality of life of patients and their partners.

Erectile dysfunction predictors in hypertensives at a primary care clinic in Southern Nigeria

“… 3 In medical practice, physicians frequently attribute sexual problems to antihypertensive drugs and modify or discontinue medication regimens to address this concern. 4 However, scientific evidence that links antihypertensive drugs to sexual dysfunction in a placebo-controlled trial is limited. 4 …”

“… 4 However, scientific evidence that links antihypertensive drugs to sexual dysfunction in a placebo-controlled trial is limited. 4 …”

“… 6 Recent analyses suggest that about 67% – 68% of men with hypertension have some degree of ED. 4 In the United States, ED related to hypertension was found to be more severe in nature than ED in the general population. 5 Apart from the negative effects of ED, more worrisome is the link between ED and hypertension.…”

Drug-Induced Sexual Dysfunction in Individuals with Epilepsy: Beyond Antiepileptic Compounds

“…These drugs are known to cause SD, including erectile dysfunction, ejaculation disorders and reduced sexual desire. Angiotensin II receptor antagonists exert the most severe effect on sexual function, especially when combined with diuretics, which impair sexuality through different and still not well-known mechanisms, including lowering of blood volume and flow and decreasing electrolytes [ 21 ]. Beta blockers, except nebivolol, determine SD through their action on the adrenergic system, whose balance with the cholinergic pathway is fundamental for a vasogenic erection to exist [ 8 ].…”

“…Beta blockers, except nebivolol, determine SD through their action on the adrenergic system, whose balance with the cholinergic pathway is fundamental for a vasogenic erection to exist [ 8 ]. Calcium channel blockers and ACE inhibitors appear to have the best profiles, leading to fewer sexual side-effects than other antihypertensive drugs [ 21 ].…”