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It is unclear whether high blood pressure per se or antihypertensive drug use causes erectile dysfunction (ED). The aim of this study was to investigate the effect of cardiovascular diseases and their concomitant medications use on the incidence of ED. The target population consisted of men aged 55, 65 or 75 years old residing in the study area in...
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... men with incomplete follow-up were on average 4 years Cardiovascular drug use and the incidence of ED R Shiri et al older and reported a higher prevalence of heart disease, diabetes, ED and heart drug use than those with complete follow-up. Compared with men free of cardiovascular dis- eases and concomitant medications use (Table 2), the risk of ED was higher in men with untreated heart disease, treated hypertension, treated heart disease and in those with both treated hypertension and heart disease. The incidence of ED was also higher in men using cardiovascular medication for conditions other than hypertension and heart dis- ease. ...
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Erectile dysfunction (ED) impacts over 100 million men worldwide and occurs at a higher incidence in men with hypertension. Beta blockers are one of several antihypertensive drug classes associated with ED. Nebivolol is a beta blocker with vasodilating properties mediated through endothelial release of nitric oxide which facilitates penile erection...
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... Erectile dysfunction is present in 10-38% of males with CHD, which is more than twice as high as in males without CHD. The use of cardiac medication, such as beta-blockers or ACE inhibitors, is associated with erectile dysfunction, but the data are inconsistent [21,25,27,28]. Fears related to cardiac events before or during sexual intercourse are more common in men with CHD compared to unaffected men (10%) [21,26]. ...
Introduction:
Due to the improved survival in individuals with Congenital Heart Disease (CHD), considering their reproductive health has become more important. Currently, this topic is still underexplored.
Areas covered:
We discuss fertility, sexuality, Assisted Reproductive Technology (ART) and contraception in adults with CHD.
Expert opinion:
Timely counseling regarding fertility, sexuality, pregnancy and contraception is necessary, preferably during teenage years. Due to a lack of data, whether or not to perform ART in adults with CHD is almost always based on expert opinion and follow-up in an expert center is recommended. Future research is necessary to fill the gaps in knowledge on the risks and frequency of complications of ART in adults with CHD, but also to be able to differentiate the relative risks in the different types of CHD. Only then will we be able to counsel adults with CHD correctly and not unjustly deprive someone of a chance of pregnancy.
... ED was found to be high. However, no correlation could be found between organic nitrates, ACE inhibitors and selective beta-blockers and ED (11). In our study, age was found to be significantly higher in the group using betablockers. ...
Objective:Sexual dysfunction after acute coronary syndrome (ACS), is a frequently encountered problem in clinical practice. The aim of our study is to determine the time it takes for patients to switch to a healthy sexual life, which is one of the basic elements of a healthy social life, after a cardiovascular event in Turkish society and investigation of the effect of drugs related to ACS on sexual activity.Method:In our study, volunteer women and men who had a cardiovascular event at least 3 months before and were sexually active before the ACS between January 2017-December 2019 were evaluated using a closed questionnaire. The demographic characteristics of the patients, their comorbidities and medications, and their sexual activity levels before and after the ACS were compared.Results:After ACS, sexual dysfunction developed in 36% (n=117) of the patients. In the group with sexual dysfunction, heart failure [21% (n=25) - 9% (n=18) - p=0.001], chronic renal failure [9% (n=11) - 0% (n=0) p
... Furthermore, throughout their effect on luteinizing hormone, β-blockers might induce a depression of Leydig cell activity leading a reduction in testosterone levels, which have been demonstrated to be necessary for maintenance of intra-penile NO synthase levels [19]. In addition, β-blockers can adversely affect sexual performance by increasing the latency to initial erection and reducing the number of erectile reflexes [20]. Last, β-blocker therapy may cause sleepiness or worsen a depression status thereby decreasing sexual function and libido [21] (Fig. 3). ...
... [77][78][79] On the other hand, calcium channel blockers have been associated with a neutral effect on erectile function, and angiotensin-converting enzyme inhibitors and mostly angiotensin receptor blockers seem to even improve it given that they block the vasoconstrictive action of angiotensin-II. [80][81][82][83] Given the aforementioned data, clinicians should customise anti-hypertensive therapies, particularly in patients with DM, who are at high risk for ED, considering angiotensin receptor blockers as their first choice, followed by angiotensinconverting enzyme inhibitors and calcium channel blockers, with nebivolol as the preferred β-blocker therapy when needed. ...
Diabetes mellitus (DM), a chronic metabolic disease characterised by elevated levels of blood glucose, is among the most common chronic diseases. The incidence and prevalence of DM have been increasing over the years. The complications of DM represent a serious health problem. The long-term complications include macroangiopathy, microangiopathy and neuropathy as well as sexual dysfunction (SD) in both men and women. Erectile dysfunction (ED) has been considered the most important SD in men with DM. The prevalence of ED is approximately 3.5-fold higher in men with DM than in those without DM.
Common risk factors for the development of DM and its complications include sedentary lifestyle, overweight/obesity and increased caloric consumption. Although lifestyle changes may help improve sexual function, specific treatments are often needed.
This study aimed to review the definition and prevalence of DM and ED, the impact of DM complications and DM treatment on ED and current and emerging treatments and novel approaches for the treatment of ED in patients with DM.
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... The dysregulation of this mechanism in penile results in electrolyte disturbance, volume depletion, inadequate tissue perfusion and/or damage to smooth muscle cells (Wang et al., 2018). Clinical trials have revealed their depleting effects on sexual function in hypertensive patients according to Grimm et al. (1997) and Chang et al. (1991) in the MRC trial (MRC Working Party 1985) Calcium channel blockers (CCBs) reduces erectile function even more than beta blockers and diuretics in observed 1665 hypertensive patients (Shiri et al., 2007). Fig. 3 reveals the degree of effects of antihypertensive drugs in the advancement of ED. ...
A common observation with hypertensive patients is the depreciating ability to maintain an erection. The statistics in the occurrence of erectile dysfunction (ED) have recorded a spike owing to intake of anti-hypertensive drugs together with other contributing factors accompanying the development of ED amongst hypertensive patients. There are medication side-effects faced with high blood pressure (HBP) which promotes ED owing to prolonged intake of anti-hypertensive drugs. It is thus reasonable to state that new therapeutic drugs that addresses both ED, HBP and antihypertensive medication will be strategic interventions towards the decline of these conditions by targeting related enzymes and active proteins. Phytomedicinal plants are promising option in managing numerous diseases such as infertility, cardiovascular diseases, diabetes amongst others. Species variants of fig plants (Ficus species) also serve in the management of a wide range of diseases including hypertension and erectile dysfunction as a result of their aphrodisiacs, cardio-protective properties based on their high residual polyphenolic constituents. Hence, consumption of fig plants could possibly be beneficial in managing hypertension especially in patients suffering from erectile dysfunction.
... 12 Dit komt overeen met resultaten van het Finse cohortonderzoek waarin geen verhoogd risico op erectiele disfunctie werd gevonden voor thiazidediuretica (RR: 1,3; 95%-BI: 0,7-2,4). 10 Bij vrouwen die chloortalidon gebruikten werd evenmin een negatief effect op de seksuele functie waargenomen. 13 ...
... Hoewel men gunstige effecten van ARB's mocht verwachten, werd in het Finse cohortonderzoek juist een hoger risico op erectiele disfunctie gevonden bij gebruik van ARB's (RR: 2,2; 95%-BI: 1,0-4,7). 10 De auteurs geven hier geen verklaring voor. ...
... 8 One study found that non-selective beta-blockers had a relative risk of 2.0 on univariate analysis and 1.7 on multivariate analysis for causing ED, while selective betablockers had a relative risk of 1.0. 9 The same study also showed an increased risk of ED with calcium channel blockers (CCBs) and ACE inhibitors. ...
Erectile dysfunction (ED) affects about 50% of men in the USA and is primarily attributed to physiological (organic) and psychological causes. However, a substantial portion of men suffer from ED due to iatrogenic causes. Common medications such as antihypertensives, non-steroidal anti-inflammatory drugs and antacids may cause ED. Physicians should be aware of the various prescription medications that may cause ED to properly screen and counsel patients on an issue that many may feel too uncomfortable to discuss. In this review, we discuss the physiology, data and alternative therapies for the ED caused by medications.
... Так, общепринятым является мнение экспертов, которое подтверждено рядом экспериментальных и рандомизированных клинических наблюдений, что блокаторы рецепторов ангиотензина II и альфа-адреноблокаторы улучшают эректильную функцию, ингибиторы АПФ и антагонисты кальция не влияют на нее, а БАБ и диуретики ухудшают ее [126]. Однако в исследовании Shiri с соавторами [127] опрос 2837 мужчин показал, что на протяжении 5 лет приема различных АГП наиболее часто ЭД ассоциировалась с приемом БРА, неселективных БАБ и антагонистов кальция. В другом наблюдении монотерапия и БАБ, и тиазидным диуретиком гидрохлортиазидом вызывала меньше случаев ЭД, чем плацебо, антагонисты кальция и ингибитор АПФ [128]. ...
This article is the review of the literature data about the effectiveness and safety of beta-blockers in arterial hypertension treatment. There were analyzed the influence of beta-blockers on cardiovascular events, central blood pressure and arterial stiffness, glucose and lipid metabolism, target organ damage and quality of life in patients with arterial hypertension. There was concluded that adverse effect rate of beta-blockers is not high in clinical trials and is exaggerated by general practitioners. In patients with arterial hypertension and indications, the beta-blocker treatment is more useful than no treatment, including in patients with diabetes mellitus, metabolic syndrome, the elderly, persons with chronic obstructive pulmonary diseases. If there is a high risk of adverse reactions, the beta-blockers with vasodilation are more benefit. Special stress was done on positive influence of carvedilol.
... Les patients avaient un pharmaco-écho-doppler pénien pour suivre l'évolution du flux artériel à destinée caverneuse ainsi que les index de résistance avec deux groupes de population: IEC et placebo, mais aucune différence significative n'a été retrouvée entre ces deux groupes (38). De nombreux autres travaux n'ont également pas pu mettre en évidence d'effet bénéfique ou délétère des IEC sur la fonction érectile (39,40). ...
Objectif : Une nouvelle stratégie de dépistage ciblé en France a entrainé une augmentation de l’incidence des anévrismes de l’aorte abdominale (AAA), ainsi qu’un âge de diagnostic plus précoce. L’émergence des endoprothèses dans le traitement des AAA a permis d’enrichir l’arsenal thérapeutique cependant bien que les conséquences sexuelles d’une chirurgie anévrismale par laparotomie soient connues, l’impact de la chirurgie endovasculaire le reste beaucoup moins. L’objectif de notre travail était de comparer les conséquences sexuelles d’une chirurgie d’AAA en fonction de la voie d’abord choisie : laparotomie vs voie endovasculaire. Matériel et méthodes : Une étude de cohorte prospective mono centrique non randomisée observationnelle a été réalisée chez les patients opérés d’un AAA de manière programmée par laparotomie et par voie endovasculaire de novembre 2013 à janvier 2015, dans le service de chirurgie vasculaire du Centre Hospitalier Universitaire (CHU) de Rouen. L’impact sur la fonction érectile était évalué pour chaque patient en pré et post-opératoire à 3 mois de façon standardisée par les questionnaires « international index of erectile function » (IIEF-5) et « erectile quality scale » (EQS). Les symptômes du bas appareil urinaire étaient évalués via le score « International Prostate Symptom Score » (IPSS). Nous avons également analysé dans un second temps les facteurs pronostiques pré et per-opératoire de dysfonction érectile (DE) post-opératoire ainsi que l’apparition d’éjaculations rétrogrades. Résultats : L’analyse a porté sur 80 patients ayant eu une chirurgie d’AAA, 27 d’entre eux ont eu un traitement endovasculaire par endoprothèse aorto bi-iliaque, 53 un traitement par laparotomie médiane avec pour 34 patients un tube aorto-aortique et 19 un tube aorto bi-iliaque. Par laparotomie le score IIEF-5 moyen était altéré de 20,8% par rapport à sa valeur pré-opératoire contre ,5.3% dans le groupe endoprothèse. Le score EQS retrouvait une détérioration plus importante après une chirurgie par laparotomie (-19,1% contre - 8,4% pour le groupe endoprothèse). 7 éjaculations rétrogrades de novo ont été retrouvées après une chirurgie par laparotomie avec la mise en place d’une prothèse aorto-biiliaque. Un tabagisme entre 36 et 50 PA sevré était un facteur de risque de DE (OR : 6,64 (IC [1.51 ; 29.22]) tout comme un âge supérieur à 61 ans (61-65 ans: OR: 34,65; hommes > 65 ans: OR: 18,93). Les patients ayant une altération de leur fonction érectile en post opératoire avaient des pertes sanguines per-opératoires plus importantes (1077cc versus 625cc ; p<0,05) ; la durée de réanimation ainsi que la durée d’hospitalisation totale étaient également plus importantes chez les patients ayant une DE majorée en post-opératoire respectivement : 21 versus 54 heures ; 7 jours versus 9,3; p<0,05. En analyse univariée ajustée sur le score IIEF-5 pré-opératoire, la chirurgie par laparotomie est apparue comme un facteur de risque isolé d’aggravation de la DE avec un odds ratio à 52,18 (IC [10.30 ; 264]).L’analyse multivariée a également défini la laparotomie comme seul facteur de risque de DE avec un odds ratio ajusté à 35,5 (IC [5,75 ; 218,8] ; p=0,0001). Conclusion : Notre étude a montré l’intérêt d’une chirurgie endovasculaire pour la préservation de la fonction sexuelle. La laparotomie est apparue comme un facteur de risque majeur de DE avec un odds ratio à 35,5. Une évaluation pré-opératoire de la fonction érectile avant chirurgie d’un AAA apparaît nécessaire. La préservation de la fonction sexuelle et son impact sur la qualité de vie doivent être des critères à prendre en compte dans la thérapeutique proposée. Devant l’augmentation de l’incidence et l’âge de diagnostic précoce des AAA, la prise en charge des hommes jeunes et sexuellements actifs va constituer dans les années à venir un enjeu de santé majeur ; à terme une collaboration chirurgie vasculaire-urologie pour les patients demandeurs devrait se développer.
... However, differences in study designs and in the evaluation of ED [3] make comparison of cardiovascular drugs complex. Comparative analyses do exist [3,5,6], but the evaluation of ED is often based on unstandardized questionnaires [3]. In addition, the association between ED and use of cardiovascular drugs may be confounded by the underlying diseases, which cause prescribing of the drugs in question [3]. ...
... We found no associations with use of spironolactone despite the established anti-androgen effect [24]. The observed association with use of ACE inhibitors, although minor, contradicts that of a previous clinical trial [25] and observational studies [3,5,6]. The majority of studies on angiotensin receptor antagonists have suggested a beneficial effect towards ED [3], which is not in accordance with our finding. ...
... The majority of studies on angiotensin receptor antagonists have suggested a beneficial effect towards ED [3], which is not in accordance with our finding. Lastly, our finding of a negative association with the use of calcium channel blockers is confirmed by one study [6], but contradicts another [5]. The differences in study results may be caused by differences in composition of the study populations and differences in study designs e.g. ...
Erectile dysfunction is a common problem among patients with cardiovascular diseases and the influence of cardiovascular drugs is much debated. The aim of this study was to evaluate the short-term potential for different cardiovascular drugs to affect the risk of being prescribed a drug against erectile dysfunction.
We employed a symmetry analysis design and included all Danish male individuals born before 1950 who filled their first ever prescription for a cardiovascular drug and a 5-phospodiesterase inhibitor within a six-month interval during 2002-2012. If the cardiovascular drug induces erectile dysfunction, this would manifest as a non-symmetrical distribution of subjects being prescribed the cardiovascular drug first vs persons following the opposite pattern. Furthermore, we calculated the number of patients needed to treat for one additional patient to be treated for erectile dysfunction (NNTH).
We identified 20,072 males with a median age of 64 years (IQR: 60-70) who initiated a cardiovascular drug and a 5-phosphodiesterase inhibitor within a six-month interval. Sequence ratios showed minor asymmetry in prescription orders after adjustment for trends in prescribing. This asymmetry was most profound for thiazides (1.28; 95% CI 1.20-1.38), calcium channel blockers (1.29; 95% CI 1.21-1.38) and ACE inhibitors (1.29; 95% CI 1.21-1.37), suggesting a small liability of these drugs to provoke ED. NNTH values were generally large, in the range of 6,400-330, corresponding to small absolute effects.
Our study does not suggest that cardiovascular drugs strongly affect the risk of being prescribed a drug against erectile dysfunction on a short-term basis.
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