Evaluation of Sexual Function in Hypertensive Men Receiving Treatment: A Review of Current Guidelines Recommendation

Journal of Sexual Medicine

Volumn 8, Issue 9, 2011, Pages 2405-2414

  Karavitakis, Markos ^a   Komninos, Christos ^a   Theodorakis, Pavlos N ^b   Politis, Vasilios ^a   Lefakis, Georgios ^a   Mitsios, Kostas ^a   Koritsiadis, Sotirios ^a   Doumanis, Grigorios ^a  

^a GENERAL HOSPITAL OF NIKEA   (Greece)

^b Organization for Health and Social Solidarity   (Greece)

Author keywords

Clinical Practice Guideline; Erectile Dysfunction; Hypertension; Sexual Dysfunction

Indexed keywords

ANGIOTENSIN RECEPTOR ANTAGONIST; ANTIHYPERTENSIVE AGENT; CALCIUM CHANNEL BLOCKING AGENT; DIPEPTIDYL CARBOXYPEPTIDASE INHIBITOR; NITRATE; PHOSPHODIESTERASE V INHIBITOR; THIAZIDE DIURETIC AGENT;

ADVERSE OUTCOME; ANTIHYPERTENSIVE THERAPY; CLINICAL EVALUATION; CLINICAL PRACTICE; DRUG INDUCED DISEASE; ERECTILE DYSFUNCTION; HEALTH SURVEY; HUMAN; HYPERTENSION; MEDICAL SOCIETY; OUTCOME ASSESSMENT; PRACTICE GUIDELINE; PRIORITY JOURNAL; QUESTIONNAIRE; REVIEW; SEXUAL BEHAVIOR; SEXUAL FUNCTION;

EID: 80052483252     PISSN: 17436095     EISSN: 17436109     Source Type: Journal    
DOI: 10.1111/j.1743-6109.2011.02342.x     Document Type: Review

References (84)

1. Feldman HA, Goldstein I, Hatzichristou DG, Krane RJ, McKinlay JB. Impotence and its medical and psychosocial correlates: Results of the Massachusetts Male Aging Study. J Urol 1994;151:54-61.
2. Lewis RW, Fugl-Meyer KS, Corona G, Hayes RD, Laumann EO, Moreira ED Jr, Rellini AH, Segraves T. Definitions/epidemiology/risk factors for sexual dysfunction. J Sex Med 2010;7:1598-607.
3. Melman A, Gingell JC. The epidemiology and pathophysiology of erectile dysfunction. J Urol 1999;161:5-11.
4. Corona G, Petrone L, Mannucci E, Magini A, Lotti F, Ricca V, Chiarini V, Forti G, Maggi M. Assessment of the relational factor in male patients consulting for sexual dysfunction: The concept of couple sexual dysfunction. J Androl 2006;27:795-801.
5. Corona G, Mannucci E, Lotti F, Boddi V, Jannini EA, Fisher AD, Monami M, Sforza A, Forti G, Maggi M. Impairment of couple relationship in male patients with sexual dysfunction is associated with overt hypogonadism. J Sex Med 2009;6:2591-600.
6. Keene LC, Davies PH. Drug-related erectile dysfunction. Adverse Drug React Toxicol Rev 1999;18:5-24.
7. Morley JE. Impotence. Am J Med 1986;80:897-905.
8. Chew KK, Earle CM, Stuckey BG, Jamrozik K, Keogh EJ. Erectile dysfunction in general medicine practice: Prevalence and clinical correlates. Int J Impot Res 2000;12:41-5.
9. Slag MF, Morley JE, Elson MK, Trence DL, Nelson CJ, Nelson AE, Kinlaw WB, Beyer HS, Nuttall FQ, Shafer RB. Impotence in medical clinic outpatients. JAMA 1983;249:1736-40.
10. Spark RF, White RA, Connolly PB. Impotence is not always psychogenic. Newer insights into hypothalamic-pituitary-gonadal dysfunction. JAMA 1980;243:750-5.
11. Montague DK, James RE Jr, deWolfe VG, Martin LM. Diagnostic evaluation, classification, and treatment of men with sexual dysfunction. Urology 1979;14:545-8.
12. Legros J, Mormont C, Servais J. A psycho-endocrinological study of erectile "psychogenic impotence": A comparison between normal patients and patients with abnormal reaction to glucose tolerance test. Carenza L, Pansheri P, Zichella L, eds. Clin psychoneuroendocrinology in reproduction. New York: Academic Press; 1978:301-19.
13. Collins WE, McKendry JB, Silverman M, Krul LE, Collins JP, Irvine AH. Multidisciplinary survey of erectile impotence. Can Med Assoc J 1983;128:1393-9.
14. Bortolotti A, Parazzini F, Colli E, Landoni M. The epidemiology of erectile dysfunction and its risk factors. Int J Androl 1997;20:323-34.
15. Horowitz JD, Goble AJ. Drugs and impaired male sexual function. Drugs 1979;18:206-17.
16. Wassertheil-Smoller S, Blaufox MD, Oberman A, Davis BR, Swencionis C, Knerr MO, Hawkins CM, Langford HG. Effect of antihypertensives on sexual function and quality of life: The TAIM Study. Ann Intern Med 1991;114:613-20.
17. Ko DT, Hebert PR, Coffey CS, Sedrakyan A, Curtis JP, Krumholz HM. Beta-blocker therapy and symptoms of depression, fatigue, and sexual dysfunction. JAMA 2002;288:351-7.
18. Doumas M, Douma S. The effect of antihypertensive drugs on erectile function: A proposed management algorithm. J Clin Hypertens (Greenwich) 2006;8:359-64.
19. Llisterri JL, Lozano Vidal JV, Aznar Vicente J, Argaya Roca M, Pol Bravo C, Sanchez Zamorano MA, Ferrario CM. Sexual dysfunction in hypertensive patients treated with losartan. Am J Med Sci 2001;321:336-41.
20. Della Chiesa A, Pfiffner D, Meier B, Hess OM. Sexual activity in hypertensive men. J Hum Hypertens 2003;17:515-21.
21. Dusing R. Effect of the angiotensin II antagonist valsartan on sexual function in hypertensive men. Blood Press Suppl 2003;2:29-34.
22. Fogari R, Zoppi A, Poletti L, Marasi G, Mugellini A, Corradi L. Sexual activity in hypertensive men treated with valsartan or carvedilol: A crossover study. Am J Hypertens 2001;14:27-31.
23. Medical Research Council Working Party on Mild to Moderate Hypertension. Adverse reactions to bendrofluazide and propranolol for the treatment of mild hypertension. Lancet 1981;2:539-43.
24. Rutchik SD, Baudiere M, Wade M, Sullivan G, Rayford W, Goodman J. Practice patterns in the diagnosis and treatment of erectile dysfunction among family practice physicians. Urology 2001;57:146-50.
25. al Khaja KA, Sequeira RP, al Damanhori AH, Mathur VS. Antihypertensive drug-associated sexual dysfunction: A prescription analysis-based study. Pharmacoepidemiol Drug Saf 2003;12:203-12.
26. Humphery S, Nazareth I. GPs' views on their management of sexual dysfunction. Fam Pract 2001;18:516-8.
27. NIH Consensus Development Panel on Impotence. NIH consensus conference: Impotence. JAMA 1993;270:83-90.
28. Jassim Al Khaja KA, Sequeira RP, Mathur VS. Patterns of utilization of antihypertensive drug combinations in BahraDo they conform with international guidelines? Int J Clin Pharmacol Ther 2000;38:568-80.
29. U.S. Department of Health and Human Services, National Heart Lung and Blood Institute, National Institute of Health. The seventh report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure-Complete report. 2004. Available at: (accessed September 13, 2010).
30. Williams B, Poulter NR, Brown MJ, Davis M, McInnes GT, Potter JF, Sever PS, McG Thom S, British Hypertension Society. Guidelines for management of hypertension: Report of the fourth working party of the British Hypertension Society, 2004-BHS IV. J Hum Hypertens 2004;18:139-85.
31. Khan NA, Hemmelgarn B, Herman RJ, Bell CM, Mahon JL, Leiter LA, Rabkin SW, Hill MD, Padwal R, Touyz RM, Larochelle P, Feldman RD, Schiffrin EL, Campbell NR, Moe G, Prasad R, Arnold MO, Campbell TS, Milot A, Stone JA, Jones C, Ogilvie RI, Hamet P, Fodor G, Carruthers G, Burns KD, Ruzicka M, DeChamplain J, Pylypchuk G, Petrella R, Boulanger JM, Trudeau L, Hegele RA, Woo V, McFarlane P, Vallee M, Howlett J, Bacon SL, Lindsay P, Gilbert RE, Lewanczuk RZ, Tobe S, Canadian Hypertension Education Program. The 2009 Canadian Hypertension Education Program recommendations for the management of hypertension: Part 2-Therapy. Can J Cardiol 2009;25:287-98.
32. Heart Foundation. Guide to management of hypertension 2008. Assessing and managing raised blood pressure in adults. 2009. Available at: (accessed September 13, 2010).
33. Japanese Society of Hypertension. Japanese Society of Hypertension guidelines for the management of hypertension (JSH 2004). Hypertens Res 2006;29(suppl 1s):S1-105.
34. Sanchez RA, Ayala M, Baglivo H, Velazquez C, Burlando G, Kohlmann O, Jimenez J, Jaramillo PL, Brandao A, Valdes G, Alcocer L, Bendersky M, Ramirez AJ, Zanchetti A, Latin America Expert Group. Latin American guidelines on hypertension. Latin American Expert Group. J Hypertens 2009;27:905-22.
35. National Institute for Health and Clinical Excellence. Hypertension. Management in adults in primary care: Pharmacological update. 2006. Available at: (accessed September 13, 2010).
36. Saudi Hypertension Management Society. Saudi hypertension management guidelines 2007. 2006. Available at: (accessed September 14, 2010).
37. IV Brazilian Guidelines in Arterial Hypertension Work Groups. IV Brazilian guidelines in arterial hypertension. Arq Bras Cardiol 2004;82(4 suppl):7-22.
38. Seedat YK, Croasdale MA, Milne FJ, Opie LH, Pinkney-Atkinson VJ, Rayner BL, Veriava Y, Guideline Committee, Southern African Hypertension Society, Directorate: Chronic Diseases, Disabilities and Geriatrics, National Department of Health. South African hypertension guideline 2006. S Afr Med J 2006;96:337-62.
39. Mancia G, De Backer G, Dominiczak A, Cifkova R, Fagard R, Germano G, Grassi G, Heagerty AM, Kjeldsen SE, Laurent S, Narkiewicz K, Ruilope L, Rynkiewicz A, Schmieder RE, Struijker Boudier HA, Zanchetti A, Vahanian A, Camm J, De Caterina R, Dean V, Dickstein K, Filippatos G, Funck-Brentano C, Hellemans I, Kristensen SD, McGregor K, Sechtem U, Silber S, Tendera M, Widimsky P, Zamorano JL, Kjeldsen SE, Erdine S, Narkiewicz K, Kiowski W, Agabiti-Rosei E, Ambrosioni E, Cifkova R, Dominiczak A, Fagard R, Heagerty AM, Laurent S, Lindholm LH, Mancia G, Manolis A, Nilsson PM, Redon J, Schmieder RE, Struijker-Boudier HA, Viigimaa M, Filippatos G, Adamopoulos S, Agabiti-Rosei E, Ambrosioni E, Bertomeu V, Clement D, Erdine S, Farsang C, Gaita D, Kiowski W, Lip G, Mallion JM, Manolis AJ, Nilsson PM, O'Brien E, Ponikowski P, Redon J, Ruschitzka F, Tamargo J, van Zwieten P, Viigimaa M, Waeber B, Williams B, Zamorano JL. The Task Force for the Management of Arterial Hypertension of the European Society of Hypertension, The Task Force for the Management of Arterial Hypertension of the European Society of Cardiology. 2007 Guidelines for the management of arterial hypertension: The Task Force for the Management of Arterial Hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). Eur Heart J 2007;28:1462-536.
40. World Health Organization. 2003 World Health Organization (WHO)/International Society of Hypertension (ISH) statement on management of hypertension. 2003. Available at: (accessed September 13, 2010).
41. Chun J, Carson CC 3rd. Physician-patient dialogue and clinical evaluation of erectile dysfunction. Urol Clin North Am 2001;28:249-58.
42. Doumas M, Tsakiris A, Douma S, Grigorakis A, Papadopoulos A, Hounta A, Tsiodras S, Dimitriou D, Giamarellou H. Factors affecting the increased prevalence of erectile dysfunction in Greek hypertensive compared with normotensive subjects. J Androl 2006;27:469-77.
43. Giuliano FA, Leriche A, Jaudinot EO, de Gendre AS. Prevalence of erectile dysfunction among 7689 patients with diabetes or hypertension, or both. Urology 2004;64:1196-201.
44. Hackett G, Kell P, Ralph D, Dean J, Price D, Speakman M, Wylie K, British Society for Sexual Medicine. British Society for Sexual Medicine guidelines on the management of erectile dysfunction. J Sex Med 2008;5:1841-65.
45. Kloner RA. Erectile dysfunction as a predictor of cardiovascular disease. Int J Impot Res 2008;20:460-5.
46. Jensen J, Lendorf A, Stimpel H, Frost J, Ibsen H, Rosenkilde P. The prevalence and etiology of impotence in 101 male hypertensive outpatients. Am J Hypertens 1999;12:271-5.
47. Fogari R, Preti P, Derosa G, Marasi G, Zoppi A, Rinaldi A, Mugellini A. Effect of antihypertensive treatment with valsartan or atenolol on sexual activity and plasma testosterone in hypertensive men. Eur J Clin Pharmacol 2002;58:177-80.
48. Lue TF. Erectile dysfunction. N Engl J Med 2000;342:1802-13.
49. Dusing R. Sexual dysfunction in male patients with hypertension: Influence of antihypertensive drugs. Drugs 2005;65:773-86.
50. Lindholm LH, Persson M, Alaupovic P, Carlberg B, Svensson A, Samuelsson O. Metabolic outcome during 1 year in newly detected hypertensives: Results of the Antihypertensive Treatment and Lipid Profile in a North of Sweden Efficacy Evaluation (ALPINE study). J Hypertens 2003;21:1563-74.
51. Grimm RH Jr, Grandits GA, Prineas RJ, McDonald RH, Lewis CE, Flack JM, Yunis C, Svendsen K, Liebson PR, Elmer PJ. Long-term effects on sexual function of five antihypertensive drugs and nutritional hygienic treatment in hypertensive men and women. Treatment of Mild Hypertension Study (TOMHS). Hypertension 1997;29:8-14.
52. Fogari R, Zoppi A, Corradi L, Mugellini A, Poletti L, Lusardi P. Sexual function in hypertensive males treated with lisinopril or atenolol: A cross-over study. Am J Hypertens 1998;11:1244-7.
53. Materson BJ, Reda DJ, Cushman WC, Massie BM, Freis ED, Kochar MS, Hamburger RJ, Fye C, Lakshman R, Gottdiener J. Single-drug therapy for hypertension in men. A comparison of six antihypertensive agents with placebo. The Department of Veterans Affairs Cooperative Study Group on Antihypertensive Agents. N Engl J Med 1993;328:914-21.
54. Silvestri A, Galetta P, Cerquetani E, Marazzi G, Patrizi R, Fini M, Rosano GM. Report of erectile dysfunction after therapy with beta-blockers is related to patient knowledge of side effects and is reversed by placebo. Eur Heart J 2003;24:1928-32.
55. Egan BM, Basile J, Chilton RJ, Cohen JD. Cardioprotection: The role of beta-blocker therapy. J Clin Hypertens (Greenwich) 2005;7:409-16.
56. Cheng JW. Nebivolol: A third-generation beta-blocker for hypertension. Clin Ther 2009;31:447-62.
57. Doumas M, Tsakiris A, Douma S, Grigorakis A, Papadopoulos A, Hounta A, Tsiodras S, Dimitriou D, Giamarellou H. Beneficial effects of switching from beta-blockers to nebivolol on the erectile function of hypertensive patients. Asian J Androl 2006;8:177-82.
58. Dahlof B, Lindholm LH, Carney S, Pentikainen PJ, Ostergren J. Main results of the losartan versus amlodipine (LOA) study on drug tolerability and psychological general well-being. LOA Study Group. J Hypertens 1997;15:1327-35.
59. Park JK, Kim SZ, Kim SH, Park YK, Cho KW. Renin angiotensin system in rabbit corpus cavernosum: Functional characterization of angiotensin II receptors. J Urol 1997;158:653-8.
60. Toblli JE, Stella I, Mazza ON, Ferder L, Inserra F. Candesartan cilexetil protects cavernous tissue in spontaneously hypertensive rats. Int J Impot Res 2004;16:305-12.
61. Becker AJ, Uckert S, Stief CG, Scheller F, Knapp WH, Hartmann U, Jonas U. Plasma levels of angiotensin II during different penile conditions in the cavernous and systemic blood of healthy men and patients with erectile dysfunction. Urology 2001;58:805-10.
62. Miura S, Ideishi M, Sakai T, Motoyama M, Kinoshita A, Sasaguri M, Tanaka H, Shindo M, Arakawa K. Angiotensin II formation by an alternative pathway during exercise in humans. J Hypertens 1994;12:1177-81.
63. Jackson G, Boon N, Eardley I, Kirby M, Dean J, Hackett G, Montorsi P, Montorsi F, Vlachopoulos C, Kloner R, Sharlip I, Miner M. Erectile dysfunction and coronary artery disease prediction: Evidence-based guidance and consensus. Int J Clin Pract 2010;64:848-57.
64. Kostis JB, Jackson G, Rosen R, Barrett-Connor E, Billups K, Burnett AL, Carson C 3rd, Cheitlin M, Debusk R, Fonseca V, Ganz P, Goldstein I, Guay A, Hatzichristou D, Hollander JE, Hutter A, Katz S, Kloner RA, Mittleman M, Montorsi F, Montorsi P, Nehra A, Sadovsky R, Shabsigh R. Sexual dysfunction and cardiac risk (the Second Princeton Consensus Conference). Am J Cardiol 2005;96:85M-93M.
65. Kloner RA, Brown M, Prisant LM, Collins M. Effect of sildenafil in patients with erectile dysfunction taking antihypertensive therapy. Sildenafil Study Group. Am J Hypertens 2001;14:70-3.
66. Bohm M, Burkart M, Baumann G. Sildenafil is well tolerated by erectile dysfunction patients taking antihypertensive medications, including those on multidrug regimens. Curr Drug Saf 2007;2:5-8.
67. Webb DJ, Freestone S, Allen MJ, Muirhead GJ. Sildenafil citrate and blood-pressure-lowering drugs: Results of drug interaction studies with an organic nitrate and a calcium antagonist. Am J Cardiol 1999;83:21C-8C.
68. Hatzimouratidis K, Amar E, Eardley I, Giuliano F, Hatzichristou D, Montorsi F, Vardi Y, Wespes E. Guidelines on male sexual dysfunction: Erectile dysfunction and premature ejaculation. Eur Urol 2010;57:804-14.
69. Wespes E, Amar E, Hatzichristou D, Hatzimouratidis K, Montorsi F, Pryor J, Vardi Y, EAU. EAU guidelines on erectile dysfunction: An update. Eur Urol 2006;49:806-15.
70. Oliver JJ, Dear JW, Webb DJ. Clinical potential of combined organic nitrate and phosphodiesterase type 5 inhibitor in treatment-resistant hypertension. Hypertension 2010;56:62-7.
71. Corona G, Razzoli E, Forti G, Maggi M. The use of phosphodiesterase 5 inhibitors with concomitant medications. J Endocrinol Invest 2008;31:799-808.
72. Toblli JE, Cao G, Lombrana A, Rivero M. Functional and morphological improvement in erectile tissue of hypertensive rats by long-term combined therapy with phosphodiesterase type 5 inhibitor and losartan. J Sex Med 2007;4:1291-303.
73. Pickering TG, Shepherd AM, Puddey I, Glasser DB, Orazem J, Sherman N, Mancia G. Sildenafil citrate for erectile dysfunction in men receiving multiple antihypertensive agents: A randomized controlled trial. Am J Hypertens 2004;17:1135-42.
74. Mikhailidis DP, Khan MA, Milionis HJ, Morgan RJ. The treatment of hypertension in patients with erectile dysfunction. Curr Med Res Opin 2000;16(1 suppl):s31-6.
75. Hatzichristou D, Gambla M, Rubio-Aurioles E, Buvat J, Brock GB, Spera G, Rose L, Lording D, Liang S. Efficacy of tadalafil once daily in men with diabetes mellitus and erectile dysfunction. Diabet Med 2008;25:138-46.
76. Porst H, Giuliano F, Glina S, Ralph D, Casabe AR, Elion-Mboussa A, Shen W, Whitaker JS. Evaluation of the efficacy and safety of once-a-day dosing of tadalafil 5mg and 10mg in the treatment of erectile dysfunction: Results of a multicenter, randomized, double-blind, placebo-controlled trial. Eur Urol 2006;50:351-9.
77. Rajfer J, Aliotta PJ, Steidle CP, Fitch WP 3rd, Zhao Y, Yu A. Tadalafil dosed once a day in men with erectile dysfunction: A randomized, double-blind, placebo-controlled study in the US. Int J Impot Res 2007;19:95-103.
78. Athanasiadis L, Papaharitou S, Salpiggidis G, Tsimtsiou Z, Nakopoulou E, Kirana PS, Moisidis K, Hatzichristou D. Educating physicians to treat erectile dysfunction patients: Development and evaluation of a course on communication and management strategies. J Sex Med 2006;3:47-55.
79. Shabsigh R, Sadovsky R, Rosen RC, Carson CC 3rd, Seftel AD, Noursalehi M. Impact of an educational initiative on applied knowledge and attitudes of physicians who treat sexual dysfunction. Int J Impot Res 2009;21:74-81.
80. Foley S, Wittmann D, Balon R. A multidisciplinary approach to sexual dysfunction in medical education. Acad Psychiatry 2010;34:386-9.
81. Parish SJ, Clayton AH. Sexual medicine education: Review and commentary. J Sex Med 2007;4:259-67.
82. Berg M. Problems and promises of the protocol. Soc Sci Med 1997;44:1081-8.
83. Grimshaw JM, Russell IT. Effect of clinical guidelines on medical practice: A systematic review of rigorous evaluations. Lancet 1993;342:1317-22.
84. Esposito K, Ciotola M, Giugliano F, Maiorino MI, Autorino R, De Sio M, Gugliano G, Nicoletti G, D' Andrea F, Gugliano D. Effects of intensive lifestyle changes on erectile dysfunction in men. J Sex Med 2009;6:243-50.