Author:
Corona G.,Vena W.,Pizzocaro A.,Salvio G.,Sparano C.,Sforza A.,Maggi M.
Abstract
Abstract
Purpose
Although anti-hypertensive medications, including thiazides and β-blockers (BBs) in particular, have been suggested to cause erectile dysfunction (ED) their real contribution is still conflicting. The aim of this paper is to summarize available evidence providing an evidence-based critical analysis of the topic.
Methods
An overall comprehensive narrative review was performed using Medline, Embase and Cochrane search. In addition, to better understand the impact of BBs on ED a specific systematic review was also performed.
Results
The negative role of centrally acting drugs, such as clonidine and α-methyldopa, is well documented althuogh limited controlled trials are available. Angiotensin-converting enzyme inhibitors (ACEis), angiotensin receptor blockers (ARBs), and calcium-channel-blockers (CCBs) have neutral (CCBs) or even positive (ACEis and ARBs) effects on erectile function. Despite some preliminary negative reports, more recent evidence does not confirm the negative impact of thiazides. BBs should be still considered the class of medications more often associated with ED, although better outcomes can be drawn with nebivolol.
Conclusion
Sexual function should be assessed in all patients with arterial hypertension, either at diagnosis or after the prescription of specific medications. A close related patient-physician interaction and discussion can overcome possible negative outcomes allowing a successful management of possible side effects.
Funder
Recovery and Resilience Plan, Investment PE8 – Project Age-It: “Ageing Well in an Ageing Society
Publisher
Springer Science and Business Media LLC
Reference100 articles.
1. NCD Risk Factor Collaboration (NCD-RisC), Worldwide trends in blood pressure from 1975 to 2015: a pooled analysis of 1479 population-based measurement studies with 19·1 million participants. Lancet 389(Jan 10064), 37–55 (2017)
2. B. Williams, G. Mancia, W. Spiering et al. 2018 Practice guidelines for the management of arterial hypertension of the European Society of Cardiology and the European Society of Hypertension. Blood Press 27(Dec 6), 314–340 (2018)
3. G. Corona, M. Monami, V. Boddi et al. Pulse pressure independently predicts major cardiovascular events in younger but not in older subjects with erectile dysfunction. J Sex Med 8(Jan 1), 247–254 (2011)
4. M. Brunström, B. Carlberg, Association of blood pressure lowering with mortality and cardiovascular disease across blood pressure levels: a systematic review and meta-analysis. JAMA Intern Med 178(Jan 1), 28–36 (2018)
5. I.T. Farmakis, N. Pyrgidis, I. Doundoulakis et al. Effects of major antihypertensive drug classes on erectile function: a network meta-analysis. Cardiovasc Drugs Ther 36(Oct 5), 903–914 (2022)