Treatment for high blood pressure and satisfaction with sex can go hand in hand — if you're open about the problem and work closely with your doctor. High blood pressure often has no signs or symptoms. But the impact on your sex life may be obvious. Although sexual activity is unlikely to pose an immediate threat to your health — such as a heart attack — high blood pressure can affect your overall satisfaction with sex. A link between high blood pressure and sexual problems is proved in men.
Ekman E, Backstrom M. Kratom for opioid withdrawal L-arginine: Does it lower blood pressure? One of five cases of erectile dysfunction is due to adverse drug events. Special caution is required in cases of testosterone deficiency especially in the elderly imhibitors, the discovery of drug-induced erectile dysfunction, and the recognition that a Erevtyle component is frequently uncovered in patients with vasculogenic erectile dysfunction, especially in patients with chronic pain, depression, and anxiety. If the address matches an existing account Erectyle dysfunction ace inhibitors will receive an email with instructions to retrieve your username.
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Factors affecting the increased prevalence of erectile dysfunction in greek hypertensive compared with normotensive subjects. PDE-5 inhibitors are not initiators of erection but require sexual stimulation in order to facilitate erection. Therapeutic options for ED easily available and with good efficacy. Erectile dysfunction is a very Eastside adult day bellevue wa disorder. Table 1. Several studies showed that more than a half of ED men leave offices with prescription of PDE5 inhibitor but without correct information about its posology [ 83 ]. JOEL J. Anatomy, physiology, and pathophysiology of erectile Erectyle dysfunction ace inhibitors. No prob' ; but he's my boyfriend, not husband, though we are working towards tying the knot though. No new national policies or guidelines acw 1 October Low self-esteem. Ydsfunction erectile dysfunction in hypertension: the effects of a continuous training programme on biomarker of dysvunction. Ensure that the man is aware that they are not initiators of erection but require sexual stimulation in order to Erectyle dysfunction ace inhibitors erection. The association of ED and vascular risk factors including hypertension raises the hypothesis that endothelial dysfunction is the common link between erectile dysfunction and cardiovascular disease. Association between erectile dysfunction and Erfctyle artery disease.
To describe spontaneously reported cases of erectile dysfunction ED in association with angiotensin II type I blockers ARB and other antihypertensive drugs.
- A more recent article on erectile dysfunction is available.
- This CKS topic does not cover the management of sexual dysfunction in women.
- My boyfriend has to take meds for high blood pressure, but it is causing him to have erectile dysfunction.
- Erectile dysfunction ED is a common complaint in hypertensive men and can represent a systemic vascular disease, an adverse effect of antihypertensive medication or a frequent concern that may impair drug compliance.
Use the link below to share a full-text version of this article with your friends and colleagues. Learn more. The pharmacologic management of hypertension has long been implicated in the genesis of erectile dysfunction; the latter is considered the main reason of nonadherence to antihypertensive therapy.
Preliminary data with the latest drugs angiotensin receptor blockers point to a beneficial effect on erectile function. Erectile dysfunction is currently considered a disease of vascular origin in many patients. Atherosclerotic lesions in penile arteries as found with increasing age and in patients with diabetes, hypertension, or cardiovascular disease may affect penile blood flow and impair erectile function.
Thus, erectile dysfunction is more common in patients with manifestations of cardiovascular atherosclerotic disease. Erectile dysfunction is more frequent in patients with essential hypertension compared with normotensive subjects. However, a question has been raised as to whether the higher prevalence of erectile dysfunction in hypertensive patients is the result of hypertension per se, of antihypertensive treatment, or of a combination of both.
In addition, whether erectile dysfunction results from the reduction of blood pressure and the subsequent decrease in penile blood flow or from specific effects of the various antihypertensive drugs on erectile function remains to be clarified. One of five cases of erectile dysfunction is due to adverse drug events. In several studies, a common cause for treatment discontinuation was erectile dysfunction. Epidemiologic data suggest that a sedentary lifestyle represents a risk factor for erectile dysfunction; thus, it seems logical to assume that lifestyle modification will be of benefit.
However, only minimal data are available to support this assumption. Thus, this review will focus on the effects of these drug classes on erectile function. Angiotensin II is known to play a significant role in the pathogenesis of erectile dysfunction. Angiotensin II injected intracavernously terminates spontaneous erection, while the intracavernosal injection of losartan has the opposite effect.
Two large studies have confirmed the beneficial effects of ARBs on sexual function. Della Chiesa and colleagues 13 studied hypertensive patients and reported an increase of sexual intercourse per week with valsartan.
In an even larger study of hypertensive patients either on treatment or untreated , valsartan was found to improve all aspects of sexual function and, particularly, erectile function. Thus, although available data indicate that ARBs may benefit erectile function, large randomized studies are needed to confirm these findings.
ACE inhibitors, apart from reducing angiotensin II production, attenuate the degradation of bradykinin, which is known to activate nitric oxide release and results in subsequent corpus cavernosum relaxation. Twenty years ago, Croog and associates 19 examined the quality of life of patients on antihypertensive therapy and reported that patients taking captopril had less sexual dysfunction than those taking propranolol and methyldopa.
It can be stated that, although available data are not quantitatively and qualitatively adequate, ACE inhibitors have neutral effects on erectile function in hypertensive patients.
This statement, if confirmed by appropriate studies, suggests that ACE inhibitors are inferior to ARBs with respect to erectile function, possibly due to incomplete blockade of angiotensin II production. Existing data regarding the effect of calcium antagonists on erectile function are far from conclusive. Experimental data indicate that calcium antagonists do not exert the beneficial effects of ARBs on penile structure.
Kroner and colleagues 20 studied hypertensive patients and reported that nifedipine and diltiazem showed a trend toward improved sexual function; verapamil, lisinopril, and furosemide had no effect on sexual function; and hydrochlorothiazide was associated with decreased orgasmic ability.
Although evidence seems striking, several methodologic problems are worthy of discussion. However, impotence was found in However, methods assessing impotence in these studies were not of adequate quality according to current standards. Atenolol significantly reduced the number of intercourse events per month from 7. On the contrary, preliminary results indicate that nebivolol may exert beneficial effects on erectile function. The significance of the placebo effect has recently been emphasized by an Italian study of 96 hypertensive patients.
Thiazide diuretics have been the most implicated class of antihypertensives with respect to erectile function. More than 30 years ago, Bulpitt and Dollery 31 drew the attention of the scientific community to the negative effects of antihypertensives regarding erectile function. Thiazide diuretics exert negative effects on sexual function even when used as adjunct therapy. Two rather large randomized studies conducted in the United States confirmed the negative effects of diuretics on erectile function.
Of interest is the fact that weight reduction ameliorated the negative effect of chlorthalidone on sexual function. In the Treatment of Mild Hypertension Study TOMHS , 33 participants randomized to chlorthalidone reported a significantly higher incidence of erection problems at 2 years than participants randomized to placebo However, the difference between the two groups was not statistically significant at 4 years chlorthalidone Acebutolol, amlodipine, and enalapril exhibited effects similar to placebo, while doxazosin affected erectile function positively both in patients with and without sexual problems at baseline.
In contrast with the TAIM results, wight loss did not ameliorate the negative effect of chlorthalidone on sexual function. Although we have to keep in mind that all of these studies were inadequately assessing erectile dysfunction, without specifically and extensively addressing this issue, the vast majority of available data points to a negative effect of diuretics on erectile function.
According to management recommendations of the Second Princeton Consensus Conference 35 regarding sexual dysfunction and cardiac risk:. There is little objective clinical evidence that blood pressure control will reverse erectile dysfunction.
A change in class of antihypertensive medication rarely results in the restoration of sexual function. Although scientific data support the first three statements, the fourth and fifth merit discussion.
He reported that men with erectile dysfunction while on various antihypertensive drugs exhibit a marked improvement of erectile function when treated with valsartan. Although the study is limited by its open design and the absence of a placebo arm, it represents the conditions found in everyday clinical practice.
Although available data support most of the fifth statement, the first part needs clarification i. However, available data cannot be characterized as of high quality since they are mostly derived either from open studies or by using inappropriate assessment methods. Proposed algorithm for the management of erectile dysfunction ED in hypertensive patients who take antihypertensive drugs.
Most of the time health care professionals respond to patients rather inadequately, possibly because the extent of this problem is not appreciated and knowledge of the underlying pathophysiology and current treatment options is still poor.
Thus, general practitioners, internists, cardiologists, nephrologists, and other hypertension specialists need to be appropriately educated in recognizing and managing erectile dysfunction in patients. Physicians are reluctant to incorporate sexual health into their practice, partly due to a lack of familiarity with the subject and partly due to time constraints.
Thus, we believe that appropriate education of physicians and nurses is urgently needed to overcome this issue. Finally, erectile dysfunction should be considered an early sign of vascular disease even the earliest window and ought to be the subject of extensive inquiry in all patients with essential hypertension.
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N Engl J Med. The external review process is an essential part of CKS topic development. One of the first studies to ask about sexual function among hypertensives was the classic TOMHS The Treatment of Mild Hypertension Study [ 34 ] and its results contributed to the false belief that ED was rare in this population since they found only They found that vasodilation of the brachial artery by both mechanisms, endothelium-dependent and independent, was significantly compromised in the group suffering from ED, which illustrates that vascular alterations involved in ED are a generalized process [ 67 ]. Reprints are not available from the author.
Erectyle dysfunction ace inhibitors. Prevalence
No account yet? Start here. This review aims to highlight the importance of recognizing erectile dysfunction in patients with hypertension and cardiovascular disease and to provide practical information about the management of erectile dysfunction in treated and untreated hypertensive patients.
Blood pressure elevation per se is associated with an increased occurrence of erectile dysfunction, while successful blood pressure control is associated with erectile function benefits. Accumulating data indicate that antihypertensive drug therapy is associated with erectile dysfunction. Antihypertensive drugs have detrimental diuretics, beta-blockers, centrally acting agents , neutral calcium antagonists, ACE inhibitors or potentially beneficial angiotensin receptor blockers, nebivolol effects on erectile function.
Arterial hypertension is a major cardiovascular risk factor and represents a significant public health problem that affects more than one billion adults and is presumed responsible for almost 7 million deaths each year worldwide . The advent of antihypertensive therapy rendered more than antihypertensive drugs available on the market for the effective management of arterial hypertension. Each therapeutic class targets a specific mechanism involved in the pathogenesis of hypertension and has its own advantages and disadvantages, indications and contraindications.
Scientific advances in recent decades have resulted in the effective management of many diseases, have significantly prolonged the life expectancy of humankind, and uncovered the importance of quality of life as a significant aspect in the management of any patient. Sexuality is an inherent characteristic of human beings and represents a cardinal component of quality of life.
Erectile function is highly appreciated by the majority of males, even at older ages, and erectile dysfunction exerts a major burden on the quality of life not only of patients but also of their sexual partners . Erectile dysfunction is frequently encountered in hypertensive men, and the co-existence of arterial hypertension and erectile dysfunction increases with age.
There are several clinically meaningful questions that need to be answered regarding the association between arterial hypertension and erectile dysfunction: a is hypertension per se related to erectile dysfunction? This review aims to highlight the importance of recognizing erectile dysfunction in patients with hypertension and cardiovascular disease, to provide practical information about the management of erectile dysfunction in treated and untreated hypertensive patients, and to summarize the efficacy and safety of PDE5 inhibitors in cardiovascular disease.
The importance of searching for and recognizing erectile dysfunction in patients with hypertension lies in four major parameters: a its frequency, b the negative impact on quality of life, c the tendency towards poor adherence to therapy or even treatment withdrawal, and d its utility as an early diagnostic window for identifying asymptomatic coronary artery disease. Erectile dysfunction is found almost twice as frequently in hypertensive patients compared to normotensive individuals [3,4].
Moreover, erectile dysfunction is highly prevalent in patients with other concomitant cardiovascular risk factors diabetes mellitus, obesity, metabolic syndrome, dyslipidemia or overt cardiovascular disease coronary artery disease, heart failure. Overall, more than half of patients with hypertension suffer from erectile dysfunction and the prevalence of the latter increases with advancing age, the severity and the duration of hypertension, and the presence of other cardiovascular risk factors.
Erectile dysfunction exerts a major impact on the quality of life of patients and their sexual partners. It has to been seen that hypertension is mainly an asymptomatic disease. It is therefore not surprising that patients experiencing sexual problems induced by antihypertensive drugs are more likely to withdraw or not adhere to antihypertensive therapy than patients free of sexual problems.
Finally, erectile dysfunction is of vasculogenic origin, in the vast majority of cases due to atherosclerotic lesions in the penile arteries. Due to the smaller diameter of penile arteries as compared to coronary arteries, sexual problems tend to appear earlier than symptoms from the heart. Indeed, erectile dysfunction is usually experienced 3 to 5 years before the appearance of symptomatic coronary artery disease.
Therefore, erectile dysfunction can be used as an early diagnostic sign of otherwise asymptomatic coronary artery disease. However, despite the importance of the timely recognition and appropriate management of erectile dysfunction, the latter remains remarkably under-reported, under-recognized, and under-treated . Several patient-related and physician-related factors are responsible for this unpleasant reality.
Physicians are also reluctant to initiate a discussion about sexual problems due to lack of familiarity with this issue, mainly due to lack of appropriate training on this topic.
In order to address this issue, in , the European Society of Hypertension formed a Working Group on arterial hypertension and sexual dysfunction, aiming to sensitize physicians about the magnitude of this problem, and educate cardiologists, internists, primary care physicians, and other doctors regarding how to approach patients about sexuality, how to recognize erectile dysfunction, and how to manage these patients. Along with the position statement of the Working Group published in the Journal of Hypertension  and a relevant newsletter , several other actions have already taken place: educational lectures at the ESH annual meetings and hypertension congresses in many European countries, regional meetings Balkan region, Baltic region , and multinational protocols evaluating factors that contribute to erectile dysfunction in hypertensive patients and the impact of combination antihypertensive therapy on erectile function.
The first step in the management of erectile dysfunction is to recognize its existence, and then to identify whether it is vasculogenic or caused by other factors. Therefore, specifically structured questionnaires are used in everyday clinical practice to identify erectile dysfunction.
The International Index of Erectile Function complete and short version is widely used and represents a validated, reproducible, easy to perform, and accurate tool for the identification of erectile dysfunction. Several disease conditions are associated with erectile dysfunction and a detailed medical history combined with a meticulous clinical examination is required to exclude urological, neurological, psychological, endocrine, and iatrogenic causes of erectile dysfunction. Special caution is required in cases of testosterone deficiency especially in the elderly , the discovery of drug-induced erectile dysfunction, and the recognition that a psychologic component is frequently uncovered in patients with vasculogenic erectile dysfunction, especially in patients with chronic pain, depression, and anxiety.
Erectile dysfunction is highly prevalent in hypertensive patients. Several lines of evidence from experimental and clinical studies suggest that blood pressure elevation is associated with structural and functional alterations of the penile arteries which contribute to erectile dysfunction . Despite fears that blood pressure reduction might compromise penile blood supply and worsen erectile function, available data point towards a beneficial effect of blood pressure control on erectile function .
Accumulating data indicate that erectile dysfunction is more prevalent in treated than in untreated hypertensive patients and that antihypertensive drugs are associated with the occurrence of erectile dysfunction . However, not all antihypertensive drug classes share the same effects on erectile function. Many experimental and clinical studies observational, small and large studies have strongly indicated that older antihypertensive drugs exert detrimental effects on erectile function while newer agents exert either neutral or even beneficial effects .
Finally, data from open studies point towards benefits in erectile function when antihypertensive therapy is changed from a drug with detrimental effects to a drug without such effects on erectile function . The management of erectile function in untreated and treated hypertensive patients has some differences [12,13] which are summarized below. Once the diagnosis of vasculogenic erectile dysfunction has been established after careful exclusion of other causes as described above , the first step in the management of erectile dysfunction is to encourage lifestyle modification .
Lifestyle modification includes weight reduction, salt restriction, smoking cessation, alcohol moderation, and regular exercise, and is strongly recommended in patients with essential hypertension Class I, level A recommendation .
Likewise, several studies have shown that lifestyle modification is associated with significant improvements in erectile function . Antihypertensive drug therapy is required in patients with mild-moderate hypertension and low cardiovascular risk who fail to achieve blood pressure control after a reasonable time period of implementing lifestyle modification or immediately in patients with severe hypertension or high cardiovascular risk . According to the European guidelines, the choice of antihypertensive therapy follows an individualized approach and is mainly based on the presence and type of target organ damage, the presence and type of overt cardiovascular disease, special conditions, comorbidities, and concomitant therapy .
Therefore, in patients with an active sexual life that is highly appreciated, the choice of antihypertensive therapy has to take into account this important parameter. Older antihypertensive drugs diuretics and beta-blockers are not ideal candidates for these patients due to their detrimental effects on erectile function, and should be used only if they are absolutely indicated.
In cases where beta-blockers are chosen for an individual patient, the choice of nebivolol should be considered. Moreover, in case more than one class is indicated for an individual patient, the choice of an ARB should be considered.
Four important factors need to be considered in hypertensive patients with erectile dysfunction before any therapeutic changes: a the time sequence of drug administration and erectile dysfunction, b exclusion of other conditions or drugs causing erectile dysfunction, c future consequences on adherence to antihypertensive therapy, and d implementation of lifestyle modification. The first question that needs to be answered is whether sexual difficulties appeared or deteriorated after antihypertensive therapy initiation or were pre-existing.
Although erectile dysfunction may appear at any time after antihypertensive therapy initiation, it usually appears early, within the first months of therapy. When erectile dysfunction appears years after therapy administration, it is more likely to be the effect of progressive atherosclerosis and less likely to be the effect of antihypertensive therapy.
The second question regards the presence of concomitant diseases or drugs other than antihypertensive agents that might contribute, at least in part, to erectile dysfunction. The recognition and appropriate management of such comorbidities as well as the replacement of culprit drugs if possible need to be addressed before further therapeutic decisions.
The third question regards the impact of erectile dysfunction on adherence to drug therapy. It is known that the occurrence of sexual problems is associated with drug discontinuation or poor adherence to drug therapy. Therefore, these problems should be discussed in detail with the patient in order to minimize future poor adherence to therapy or even the discontinuation of antihypertensive drugs.
The final question is whether the patient has already implemented lifestyle modification. In case the patient has not followed one or more pieces of advice regarding lifestyle modification, treating physicians need to reinforce relevant advice and persuade the patient about the benefits of lifestyle changes.
After all these factors have been appropriately addressed and erectile dysfunction in the given patient seems to be related to an antihypertensive drug, known to exert negative effects on erectile function, then the therapeutic strategy offers two choices: a switching to another drug with beneficial effects on erectile function, or b the addition of PDE5 inhibitors on top of antihypertensive therapy.
Previous consensus statements negated any benefits from a change in therapeutic class of antihypertensive drugs.
However, data from open studies point towards significant benefits when older drugs diuretics, beta-blockers are replaced by newer agents angiotensin receptor blockers, nebivolol [10,11]. The change of antihypertensive drugs, however, needs to be handled with caution. First, in case a concomitant disease dictates the use of a specific drug category for example, beta-blockers for coronary artery disease and heart failure, diuretics for heart failure , then drug switching does not seem wise, although potential alternatives might be considered deltiazem for post-myocardial infarction, nebivolol for heart failure for patients experiencing a significant impact of erectile dysfunction on their quality of life, because these patients might withdraw from essential therapy.
Second, switching to another class does not guarantee either the restoration or the improvement of erectile function. This has to be carefully explained to the patient in advance, in order to avoid unreasonable expectations and future disappointments. PDE5 inhibitors represent the cornerstone of the management of erectile dysfunction.
PDE5 inhibitors block the breakdown of cGMP and subsequently result in increased nitric oxide bioavailability in the penile tissue and the systemic circulation, thus leading to an adequate erection and, in parallel, systemic vasodilatation. The vasodilatory effect of PDE5 inhibitors is usually modest, resulting in a blood pressure reduction of mmHg on average. Of note, the blood pressure reduction is not dose-dependent and usually occurs even at low doses.
Moreover, the blood pressure reduction might be significant in a small minority of patients and might result in symptomatic hypotension in a few patients. Four PDE5 inhibitors are currently available on the market sildenafil, vardenafil, tadalafil, and avanafil with different pharmacokinetic and pharmacodynamic characteristics mainly onset of action and half-life , which allow the tailoring of therapy according to the needs and preferences of the individual patient.
The cardiovascular safety of PDE5 inhibitors has been extensively evaluated . Sildenafil was not found to be associated with an increased cardiovascular risk in a large review of clinical trials and post-marketing safety data. Moreover, a recent systematic review and meta-analysis reported similar rates of serious adverse events between sildenafil and placebo.
Of note, sildenafil use was found safe not only in men free of cardiovascular disease but also in men with either confirmed cardiovascular disease or in the presence of cardiovascular risk factors. Up to now, an overall good safety profile has been shown with the other members of this drug category as well.
It has to be noted, however, that there exist no reliable data regarding the use of PDE5 inhibitors in the immediate post-MI and stroke phase, as well as in patients with hypotension. Therefore, PDE5 inhibitors should not be used in these patient populations unless relevant data become available. The co-administration of nitrates and PDE5 inhibitors is contraindicated due to the risk of clinically significant hypotension.
The time period for the safe use of nitrates following the ingestion of PDE5 inhibitors depends on the half-life of the latter. In general, nitrates can be used with safety 24 hrs after sildenafil or vardenafil intake, and 48 hrs after tadalafil intake.
In case of significant hypotension due to concomitant use within this timeframe, general supportive measures should be used to ensure the hemodynamic stability of the patient intravenous fluids, Trendelenburg position, inotropic agents if necessary and not contraindicated.
Although PDE5 inhibitors can usually be co-administered safely with almost all antihypertensive drugs, some precautions need to be taken when prescribed with alpha-blockers due to the risk of significant hypotension. Several maneuvers used in everyday clinical practice may minimize the hypotensive risk, including the use of uroselective alpha-blockers, a 6-hr dose separation, and the initiation of therapy with low doses and careful up-titration after prior stabilization of therapy .
In summary, available data from experimental and clinical studies suggest that blood pressure elevation per se is associated with an increased occurrence of erectile dysfunction, while successful blood pressure control is associated with erectile function benefits.
In addition, accumulating data indicate that antihypertensive drug therapy is associated with erectile dysfunction, that antihypertensive drugs have divergent effects on erectile function which is either detrimental diuretics, beta-blockers, centrally acting agents , neutral calcium antagonists, ACE inhibitors or potentially beneficial angiotensin receptor blockers, nebivolol , and that switching from a drug with negative to a drug with positive effects on erectile function seems to be beneficial in hypertensive patients with erectile dysfunction.
Michael Doumas 2 , MD. Author for correspondence:. E-mail: margus. Our mission: To reduce the burden of cardiovascular disease. All rights reserved. Did you know that your browser is out of date? To get the best experience using our website we recommend that you upgrade to a newer version.