Erectile Dysfunction in High‐Risk Hypertensive Patients Treated with Beta‐Blockade Agents

Abstract

Background: Erectile dysfunction (ED) is a multifactorial disease related to age, vascular disease, psychological disorders, or medical treatments. Beta‐blockade agents are the recommended treatment for hypertensive patients with some specific organ damage but have been outlined as one of leading causes of drug‐related ED, although differences between beta‐blockade agents have not been assessed. Methods: Cross‐sectional and observational study of hypertensive male subjects treated with any beta‐blockade agent for at least 6 months. ED dysfunction was assessed by the International Index of Erectile Dysfunction (IIEF). Results: 1.007 patients, mean age 57.9 (10.59) years, were included. The prevalence of any category of ED was 71.0% (38.1% mild ED; 16.8% moderate ED; 16.1% severe ED). Patients with ED had longer time since the diagnosis of hypertension and higher prevalence of risk factors and comorbidities. The prevalence of ED increased linearly with age. ED patients received more medications and were more frequently treated with carvedilol and less frequently with nebivolol. Patients treated with nebivolol obtained higher scores in every parameter of the IIEF questionnaire. The multivariate analysis identified independent associations between ED and coronary heart disease (OR: 1.57), depression (OR: 2.25), diabetes (OR: 2.27), atrial fibrillation (OR: 2.59), and dyhidopiridines calcium channel blockers (OR: 1.76); treatment with nebivolol was associated to lower prevalence of ED (OR: 0.27). Conclusion: ED is highly prevalent in hypertensive patients treated with beta‐blockade agents. The presence of ED is associated with more extended organ damage and not to cardiovascular treatments, except for the lower prevalence in nebivolol‐treated patients.

Efficacy and tolerability of nebivolol: does age matter? A retrospective analysis of three randomized, placebo-controlled trials in stage I–II hypertension

“…For example, older age is also associated with an increased prevalence of comorbidities and polypharmacy, whereas younger age is a key determinant of poor therapy adherence [Briesacher et al 2008;Fischer et al 2010]. In addition, antihypertensive medication itself is independently associated with a higher risk of adverse events (AEs) such as erectile dysfunction (ED) [Cordero et al 2010;Düsing, 2005;Ko et al 2002;Shiri et al 2007] and orthostatic hypotension (OH) [Cleophas and van Marum, 2003], which may affect quality of life and lead to treatment discontinuation in both younger and older patients [Fogari and Zoppi, 2004]. Therefore, patient age should be carefully taken into consideration when selecting antihypertensive therapy [Carlberg and Nilsson, 2010].…”

Differential Effect of β‐Blockers for Heart Rate Control in Coronary Artery Disease

“…21 In a recent report from a registry of hypertensive patients treated with a BB, we demonstrated that the use of different BBs differs if heart failure or CAD are present. 19 We did not find differences in BB doses between patients with RHR below or above 70 bpm, although the absence of dose equivalence should be addressed. Nevertheless, parameters like selectivity or vasodilator activity can be highly dosedependent, as different patients may exhibit widely variable pharmacodynamic responsiveness to the same dose of an individual drug.…”

“…18 In the DELTHA registry (DisfunciónErectiL en pacientes con HTA [Erectile Dysfunction in Hypertensive patients]), nebivolol was independently associated with lower prevalence of erectile dysfunction. 19 The largely debated meta-analysis by Lindholm et al 16 showed that BB treatment for hypertension was associated with lower or no cardiovascular protection compared to angiotensin-converting enzyme, angiotensinreceptor blockers, diuretics, or CCBs, but this effect was largely attributable to the results obtained in clinical trials with atenolol. More recently, another meta-analysis 37 addressed the negative effect of RHR reduction with BBs in patients with hypertension, especially driven by the effect of atenolol.…”

Erectile Function in Cardiovascular Disease and Hypertension: the Role of Nebivolol

“…A large, cross-sectional study of more than a thousand middle-aged and older high-risk hypertensive patients reported the effects of betablockers on erectile function [50]. Erectile dysfunction was highly prevalent (71%) among users of beta blockers for at least 6 months and the dysfunction was of relatively high severity (16.1% severe; 16.8% moderate; and 38.1% mild).…”