Sexual function in hypertensive patients receiving treatment

Figures & data

Table 1 Risk factors, conditions, and diseases associated with erectile dysfunction

Risk factor associated with atherosclerosis:

Smoking Diabetes mellitus Hypertension low levels of HDL cholesterol/high levels of LDL cholesterol/high level of total cholesterol sedentary lifestyle family history of atherosclerosis obesity

Neurological factors

neuropathy (diabetic, etc) spinal cord injury, cerebrovascular insult, multiple sclerosis, nerve damage due to prostate surgery etc.

Medical diseases

renal failure, dialysis, abnormal liver function, endocrine disorders (hypogonadism, hyperprolactenemia, hypo- and hyperthyroidism), sickle cell anemia

Drugs

antihypertensives, thiazide diuretics, spironolactone, digoxin, antidepressants, β-blockers, centrally acting antihypertensives, phenothiazines, carbamazepin, phenytoin, risperidone, fibrates, statins, Histamine-2-receptor antagonists, allopurinol, indomethacin, tranquilizer, disulfiram, levodopa, chemotherapeutics, etc. alcohol, others

Others

Peyroni's disease, priapism, trauma

Psychosocial causes

depression, anxiety disorder, problems or changes in relationship

Compiled according to Brock et al. 1993; NIH Consensus Development Panel on Impotence 1993; Benet et al. 1995; Greiner et al. 1996; Keene et al. 1999; Kloner et al. 1999; Kloner et al. 2002; Levine 2000; McVary et al. 2001; Nusbaum et al. 2002; Moulik et al. 2003; Nicolosi et al. 2003; Nurnberg et al. 2003, and Roth et al. 2003.

Table 2 Three risk groups of patients with cardiovascular disease according to the “Second Princeton Consensus Panel” (Kostis 2005; see also DeBusk 2000)

1. Low risk group

Patients with

Two or less atherogenic risk factors, asymtomatic Medically controlled hypertension with ≥1 antihypertensive drug mild, stable angina (consider exercise test in some cases) after successful coronary revascularization (without remaining ischemia) after uncomplicated myocardial infarction (>6–8 weeks) mild valvular disease Left ventricular dysfunction: New York Heart Association I

2. Intermediate or indetermined risk group

Patients with

Three or more atherogenic risk factors, asymptomatic moderate, stable angina myocardial infarction (2–6 weeks after the acute event) congestive heart failure: New York Heart Association II non-cardiac sequelae of atherosclerotic disease (stroke, transient ischemic attack, peripheral vascular disease)

3. High risk group

Patients with

unstable angina/refractory angina untreated, poorly controlled, accelerated, or malignant hypertension congestive heart failure (New York Heart Association III–IV) myocardial infarction (within the last 2 weeks) recent stroke moderate to severe valvular heart disease, particularly aortic stenosis or hypertrophic obstructive cardiomyopathy high risk arrhythmia

Table 3 Medical therapy, incidence of erectile dysfunction, and potential alternatives

Drug	Potential alternative	Comment
thiazide diuretics	loop diuretics	thiazide diuretics: higher incidence of erectile dysfunction than β-blockers
β-blockers	angiotensin converting enzyme inhibitors, angiotensin II receptor type-1 blockers, calcium channel blockers	prognostic benefit after myocardial infarction or in heart failure needs to be weighed against side effects
aldosterone receptor antagonists (spironolactone)	potassium sparing diuretics or eplerenone in the treatment of congestive heart failure	limited information
fibrates	statins	−
angiotensin-converting enzyme inhibitors	angiotensin II type-1 receptor blockers	angiotensin II receptor type-1 blockers may even improve sexual function

Notes: Some of the alternatives may not be applicable in individual patients

Compiled according to Langford et al. (1989), Carvajal et al. (1995), Llisterri et al. (2001), Ralph (2000), Rizvi et al. (2002), Schachter et al. (2000), and Bruckert et al. (1996).

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