Update of the position paper on arterial hypertension and erectile dysfunction

Abstract

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.

Deterioration of Sexual Health in Cancer Survivors Five Years after Diagnosis: Data from the French National Prospective VICAN Survey

“…Although the deterioration of SH may be a direct consequence of cancer and its treatments, other comorbidities may have a major impact. In our study, there was an association between hypertension and SH deterioration, which has been previously described in the literature [ 40 , 41 ]. Diabetes has also been reported as an associated factor [ 42 ] but five-year data on diabetes was unavailable in our study sample.…”

Protective effects of irbesartan and benazepril against vaginal vascular remodeling and fibrosis in female spontaneously hypertensive rats

“…However, there is currently little evidence to support an effect of other RAS inhibitors, angiotensin converting enzyme inhibitors (ACEIs), on sexual function. 10 Sexual dysfunction has important effects on quality of life, and although women are less likely to talk about this issue, clinicians should pay attention to this problem when prescribing medications, to minimize sexual side effects and maximize the quality of life and compliance with therapy.…”

The effect of nebivolol on erectile function in the cases with coronary artery bypass surgery

“…[ 19 ] Nebivolol exhibits highly selective β1-AR blockade and has vasodilatory properties secondary to the enhancement of nitric oxide bioavailability. [ 20 ] Experimental data demonstrate that nebivolol results in increases in endothelial nitric oxide synthase activation and phosphorylation, and endothelium-dependent relaxation of the corpora cavernosa, [ 21 ] which exerts protective effects on erectile function against the disruptive effects of CPB in patients undergoing CABG.…”