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 [16]. 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 [17]. 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. Help centre. 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.
Learn more. Show navigation Hide navigation. Sub menu. Arterial hypertension and erectile dysfunction: an under-recognized duo Vol. Michael Doumas. Chrysoula Boutari. Topic s : Hypertension. Introduction 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 [1].
Searching for erectile dysfunction in hypertension: why? Basic principles of the management of erectile dysfunction 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. Management of erectile dysfunction in hypertensive patients Erectile dysfunction is highly prevalent in hypertensive patients. Untreated patients 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 [14].
Treated patients 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.
Switching antihypertensive therapy Previous consensus statements negated any benefits from a change in therapeutic class of antihypertensive drugs. PDE5 inhibitors: efficacy and safety PDE5 inhibitors represent the cornerstone of the management of erectile dysfunction.
Contraindications and precautions with PDE5 inhibitors The co-administration of nitrates and PDE5 inhibitors is contraindicated due to the risk of clinically significant hypotension. Conclusions 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.
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To encourage satisfying sex, initiate sex when you and your partner are feeling relaxed. Explore various ways to be physically intimate, such as massage or warm soaks in the tub. Share with each other the types of sexual activity you enjoy most. You may find that open communication is the best way to achieve sexual satisfaction. And studies have shown that a healthy, pleasurable sex life is good for the heart.
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This content does not have an Arabic version. See more conditions. High blood pressure and sex: Overcome the challenges. Products and services. High blood pressure and sex: Overcome the challenges You can be treated for high blood pressure and still enjoy a satisfying sex life — if you discuss any problems and work closely with your doctor.
By Mayo Clinic Staff. Thank you for Subscribing Our Housecall e-newsletter will keep you up-to-date on the latest health information. Please try again. Something went wrong on our side, please try again. Show references How high blood pressure can affect your sex life. American Heart Association. Accessed Feb. Sauer WH, et al. Sexual activity in patients with cardiovascular disease. Sidawy AN, et al. Erectile dysfunction. Philadelphia, Pa. PLOS One. Raheem OA, et al.
The association of erectile dysfunction and cardiovascular disease: A systematic critical review. American Journal of Men's Health. Foy CG, et al. Journal of Sexual Medicine. Shifren JL, et al.
Overview of sexual dysfunction in women: Epidemiology, risk factors, and evaluation. Rakel RE, et al. Human sexuality. In: Textbook of Family Medicine. Imprialos KP, et al.
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