Long-term Effects on Sexual Function of Five Antihypertensive Drugs and Nutritional Hygienic Treatment in Hypertensive Men and Women

Abstract

Problems with sexual function have been a long-standing concern in the treatment of hypertension and may influence the choice of treatment regimens and decisions to discontinue drugs. The Treatment of Mild Hypertension Study (TOMHS) provides an excellent opportunity for examination of sexual function and effects of treatment on sexual function in men and women with stage I diastolic hypertension because of the number of drug classes studied, the double-blind study design, and the long-term follow-up. TOMHS was a double-blind, randomized controlled trial of 902 hypertensive individuals (557 men, 345 women), aged 45 to 69 years, treated with placebo or one of five active drugs (acebutolol, amlodipine maleate, chlorthalidone, doxazosin maleate, or enalapril maleate). All participants received intensive lifestyle counseling regarding weight loss, dietary sodium reduction, alcohol reduction (for current drinkers), and increased physical activity. Sexual function was ascertained by physician interviews at baseline and annually during follow-up. At baseline, 14.4% of men and 4.9% of women reported a problems with sexual function. In men, 12.2% had problems obtaining and/or maintaining an erection; 2.0% of women reported a problem having an orgasm. Erection problems in men at baseline were positively related to age, systolic pressure, and previous antihypertensive drug use. The incidences of erection dysfunction during follow-up in men were 9.5% and 14.7% through 24 and 48 months, respectively, and were related to type of antihypertensive therapy. Participants randomized to chlorthalidone reported a significantly higher incidence of erection problems through 24 months than participants randomized to placebo (17.1% versus 8.1%, P = .025). Incidence rates through 48 months were more similar among treatment groups than at 24 months, with nonsignificant differences between the chlorthalidone and placebo groups. Incidence was lowest in the doxazosin group but was not significantly different from the placebo group. Incidence for acebutolol, amlodipine, and enalapril groups was similar to that in the placebo group. In many cases, erection dysfunction did not require withdrawal of medication. Disappearance of erection problems among men with problems at baseline was common in all groups but greatest in the doxazosin group. Incidence of reported sexual problems in women was low in all treatment groups. In conclusion, long-term incidence of erection problems in treated hypertensive men is relatively low but is higher with chlorthalidone treatment. Effects of erection dysfunction with chlorthalidone appear relatively early and are often tolerable, and new occurrences after 2 years are unlikely. The rate of reported sexual problems in hypertensive women is low and does not appear to differ by type of drug. Similar incidence rates of erection dysfunction in placebo and most active drug groups caution against routine attribution of erection problems to antihypertensive medication.

Effect of irbesartan on erectile function in patients with hypertension and metabolic syndrome

“…3,21 Treatment of hypertension and diabetes is alleged to contribute to an impairment of erectile function. 3,22,23 The present data indicate an association of a decrease in erectile function with current use of diuretics, calcium-channel blockers, antidiabetics and statins. These results are consistent with prior findings, which demonstrated a decrease in erectile function in patients treated with the calcium channel blocker nifedipine and the diuretic chlorthalidone, but not in patients who received b-receptor blockers.…”

“…23 Surprisingly, the improvement in erectile function as well as the change of prevalence of ED was comparable in patients irrespective of the addition of the diuretic HCTZ to the treatment regime. On the one hand, beneficial effects of irbesartan are likely to exceed the supposed adverse effect of diuretics on erectile function.…”

“…These results are consistent with prior findings, which demonstrated a decrease in erectile function in patients treated with the calcium channel blocker nifedipine and the diuretic chlorthalidone, but not in patients who received b-receptor blockers. 20,[23][24][25][26] The adverse influence of treatment with statins on erectile function is somewhat surprising, taking into account the pleiotropic effects of statins, as for instance the improvement of endothelial function due to an upregulation of the endothelial nitric oxide synthase. 27,28 Recently the hydroxymethylglutaryl (HMG) coenzyme A reductase inhibitor rosuvastatin has been shown to exert beneficial effects on erectile function in diabetic mice.…”

“…On the other hand, a previous study which highlighted an impairment of erectile function by treatment with diuretics detected this effect in the first 12 months of treatment only, whereas after treatment for 24 months, erectile function was found not to be impaired anymore. 23 Thus, in the course of treatment, blood pressure reduction is likely to overcome the questionable negative effect of diuretics. Indeed, this suggestion is in conflict with the present results in univariate analysis of cardiovascular drugs affecting erectile function.…”

Erectile dysfunction and heart failure: the role of phosphodiesterase type 5 inhibitors

“…Thiazide diuretics, digoxin, aldosterone and traditional b-blockers have been linked to ED. [18][19][20][21] However some third generation b-blockers and angiotensin receptor blockers have been associated with improvement of ED due to their protective effects on penile tissue and endothelial function. [22][23][24][25] In summary, causes of ED in HF patients are decreased exercise capacity, depression, endothelial dysfunction and standard HF medications.…”