The Effect of Combined Antihypertensive Treatment (Felodipine with Either Irbesartan or Metoprolol) on Erectile Function: A Randomized Controlled Trial

Abstract

Objectives: This study aimed to determine whether combining a calcium channel blocker with either an angiotensin II receptor blocker or a β-blocker would have similar effects on sexual function in men with hypertension. Methods: This prospective, randomized study (ClinicalTrials.gov: NCT01​238705) included 218 male participants with untreated hypertension. Patients were randomized to treatment with felodipine combined with irbesartan or metoprolol for 48 weeks. Sexual function was evaluated at baseline and after 48 weeks of therapy. The levels of serum sex hormones and markers of oxidative stress were measured at the same time. Results: There was no significant difference in the prevalence of erectile dysfunction before and after treatment in either group (p > 0.05). There were also no differences in the levels of serum testosterone, sex hormone-binding globulin or 4-hydroxynonenal before and after treatment in either group (p > 0.05). In the felodipine-irbesartan group, sexual desire scores rose after treatment (p = 0.022) and the concentrations of serum 8-hydroxy-2′-deoxyguanosine and malondialdehyde declined (p < 0.001 and p = 0.002, respectively). The between-group differences for 8-hydroxy-2′-deoxyguanosine and malondialdehyde were not significant (p > 0.05, respectively). Conclusion: The results suggest that felodipine-irbesartan may be more beneficial to the sexual desire of hypertensive male patients than felodipine-metoprolol. This effect was possibly relevant to irbesartan, which prevents oxidative stress to some extent.

Tolerability of Antihypertensive Medications in Older Adults

“…Prospective randomized study in 218 males, over 48 weeks Randomized to treatment with felodipine combined with metoprolol or irbesartan No significant difference in prevalence of ED before or after treatment in either group Felodipine-irbesartan was more beneficial to the sexual desire of hypertensive males [145] Sexual activity and function in middle-aged and older men and women with HT National Opinion Research Center sample of 4017 l community-dwelling adults, 57-85 years, of whom 75.5 % completed the interview No consistent associations between specific antihypertensive medication classes and sexual problems, suggesting the need for prospective studies [149] Risk of falls after initiation of antihypertensive drugs in the elderly Population-based self-controlled study of elderly aged 66 Several factors contribute to nonadherence to medications and resultant suboptimal control of hypertension; poor tolerability due to ADEs is only one contributory factor. Anxiety sensitivity is strongly associated with antihypertensive drug nonadherence, a situation that can be managed through the use of adaptive strategies for anxiety, with resultant better control of hypertension and lower cardiovascular risk [166].…”

“…An extensive review of several studies discussed the clinical impact of antihypertensives on sexual dysfunction: a table attributes largely neutral to negative impact for b-blockers (except nebivolol), diuretics, and ablockers; largely neutral or beneficial effects for ACEIs and ARBs; and neutral effects for CCBs [140]. The combination of a CCB (felodipine) with irbesartan appeared more beneficial to sexual desire in hypertensive males than the combination with metoprolol, perhaps attributed to the prevention of oxidative stress with irbesartan [145]. A Swedish study of 225 reports on antihypertensive drugs and ED suggested that all classes of drugs were implicated in ED, including ARBs, suggesting that ARBs had neither a positive nor any effect on ED [146].…”

Re: Efficacy and safety of mirodenafil for patients with erectile dysfunction: a meta-analysis of three multicenter, randomized, double-blind, placebo-controlled clinical trials

“…However, certain types of antihypertensive agents are likely to affect the efficacy of PDE5-Is in ED patients and even antihypertensive drug itself can impact some aspects of sexual function [6][7][8]. Angiotensin-converting enzyme inhibitors, angiotensin II receptor blockers, calcium channel blockers and alphablockers are less likely to cause ED while thiazide diuretics and some less selective beta-blockers (atenolol and carvedilol) may be detrimental to ED [9].…”

Combined Antihypertensive Therapy and Sexual Dysfunction: Terra Incognita

“…In this issue of Cardiology, Yang et al [8] evaluated the effects of antihypertensive therapy on erectile function, comparing two combinations in a prospective randomized study. They recruited 218 male hypertensive patients, naive to antihypertensive therapy, and examined the combination of felodipine with either irbesartan or metoprolol for a follow-up period of 48 weeks.…”

“…Moreover, the results of antihypertensive therapy remained consistent over time in the ONTARGET substudy [16], which was specifically designed to address this issue and is thus more reliable. Yang et al [8] followed their patients for 1 year, a period longer than the usual single-center studies but shorter than the typical multicenter trials in the hypertension field.…”