Which antihypertensive (blood pressure lowering) medications improve erectile dysfunction (ED)?

From the Guidelines

Angiotensin receptor blockers (ARBs) and nebivolol are the antihypertensive medications most likely to improve erectile dysfunction, as they have a favorable effect on endothelial function and nitric oxide availability, which enhances blood flow to the penis. For ARBs, consider telmisartan 40-80 mg daily or losartan 50-100 mg daily, as these medications have been shown to improve erectile function in patients with hypertension 1. For nebivolol, the typical dose is 5-10 mg daily, and it is a beta-blocker that has vasodilatory properties, which can benefit erectile function. When prescribing these medications, inform patients that it may take several weeks to see improvements in erectile function, and encourage them to continue their medication even if they don't notice immediate benefits. Some key points to consider when prescribing these medications include:

• Starting at a lower dose and titrating up as needed for blood pressure control
• Informing patients about the potential benefits and risks of the medication
• Monitoring patients for any adverse effects or interactions with other medications
• Considering alternative medications if the patient experiences any adverse effects or if the medication is not effective in improving erectile function. In contrast, some antihypertensives like thiazide diuretics and older beta-blockers may worsen erectile dysfunction and should be avoided if erectile function is a concern. It's also important to note that PDE-5 inhibitors, such as sildenafil, have been shown to be effective in improving erectile function in patients with specific medical conditions, including diabetes, depression, and cardiovascular disease 1. However, the use of these medications should be carefully considered and monitored, as they may interact with other medications or have adverse effects. Overall, the choice of antihypertensive medication should be based on the individual patient's needs and medical history, and should take into account the potential effects on erectile function.

From the FDA Drug Label

Sildenafil tablets, phosphodiesterase-5 (PDE-5) inhibitor, is the citrate salt of sildenafil, a selective inhibitor of cyclic guanosine monophosphate (cGMP)-specific phosphodiesterase type-5 (PDE-5). Sildenafil is also marketed as sildenafil citrate tablets, 25 mg, 50 mg and 100 mg for erectile dysfunction

The medication that improves erectile dysfunction (ED) is sildenafil, a phosphodiesterase-5 (PDE-5) inhibitor. However, it is not an antihypertensive medication.

• Key points:
  • Sildenafil is used to treat erectile dysfunction (ED)
  • It is not primarily used as an antihypertensive medication
  • The question asks for antihypertensive medications that improve ED 2

From the Research

Antihypertensive Medications and Erectile Dysfunction

• The relationship between antihypertensive medications and erectile dysfunction (ED) is complex, with some medications exacerbating ED and others having a positive effect 3, 4, 5, 6, 7.
• Certain antihypertensive drugs, such as thiazide type diuretics, aldosterone receptor blockers, and β-adrenergic receptor blockers, are associated with an increased risk of ED 3.
• In contrast, some studies suggest that certain antihypertensive medications, including:
  • Doxazosin: may have a positive effect on erectile function 4.
  • Losartan: an angiotensin II receptor blocker, may positively impact erectile function and is not typically associated with sexual dysfunction 4, 6, 7.
  • Angiotensin-receptor blockers and angiotensin-converting enzyme inhibitors: may be beneficial for patients with hypertension and ED 5.
  • Calcium channel blockers: may be a suitable option for patients with hypertension and ED, although careful consideration of potential adverse effects on sexual function is necessary 5.

Mechanisms and Considerations

• The pathophysiological mechanism of ED is multifactorial and involves various comorbid conditions, including hypertension, coronary artery disease, heart failure, and diabetes mellitus 3, 5.
• The treatment of hypertension and ED requires careful consideration of the potential effects of antihypertensive medications on sexual function, as well as the use of phosphodiesterase 5 inhibitors, which may be contraindicated with certain antihypertensive agents 3, 5.
• The selection of antihypertensive therapy should prioritize medications that are effective in lowering blood pressure while preserving patients' quality of life, including sexual function 7.