What treatment options are available for a 53-year-old male with hypertension (HTN) on losartan, experiencing erectile dysfunction (ED)?

From the Guidelines

For a 53-year-old male with hypertension on losartan who is experiencing erectile dysfunction, the most effective treatment option is to initiate therapy with a phosphodiesterase type 5 (PDE5) inhibitor, such as sildenafil, tadalafil, vardenafil, or avanafil, as recommended by the American College of Physicians 1. The choice of a specific PDE5 inhibitor should be based on individual preferences, including ease of use, cost of medication, and adverse effects profile 1. It's also important to note that losartan is one of the preferred antihypertensive medications for patients with ED, as it has fewer sexual side effects compared to other classes like beta-blockers or thiazide diuretics. Some key points to consider when treating ED include:

• First-line treatment: PDE5 inhibitors such as sildenafil (Viagra) 50-100mg taken 1 hour before sexual activity, tadalafil (Cialis) 10-20mg taken as needed or 2.5-5mg daily, vardenafil (Levitra) 10-20mg, or avanafil (Stendra) 100-200mg.
• Second-line options: vacuum erection devices, intracavernosal injections (such as alprostadil 5-40mcg), or intraurethral suppositories.
• Lifestyle modifications: weight loss, increased physical activity, reduced alcohol consumption, and smoking cessation can also improve erectile function.
• Evaluation for underlying causes: diabetes, low testosterone, or cardiovascular disease. A discussion with the patient's healthcare provider is essential to determine the most appropriate treatment based on his specific health profile and preferences 1.

From the FDA Drug Label

Tadalafil tablets are not right for everyone. Only your healthcare provider and you can decide if tadalafil tablets are right for you Before taking tadalafil tablets, tell your healthcare provider about all your medical problems, including if you: • have heart problems such as angina, heart failure, irregular heartbeats, or have had a heart attack. • have high blood pressure that is not controlled • have had a stroke • have liver problems • have kidney problems or require dialysis Can Other Medicines Affect Tadalafil Tablets? Tell your healthcare provider about all the medicines you take including prescription and non-prescription medicines, vitamins, and herbal supplements Tadalafil tablets and other medicines may affect each other. Especially tell your healthcare provider if you take any of the following*: • medicines called nitrates • medicines called guanylate cyclase stimulators, such as riociguat (Adempas®) • medicines called alpha blockers • other medicines to treat high blood pressure (hypertension) • medicines called HIV protease inhibitors, such as ritonavir (Norvir®, Kaletra®) • some types of oral antifungals such as ketoconazole (Nizoral®) • some types of antibiotics such as clarithromycin (Biaxin®)

For a 53-year-old male with hypertension (HTN) on losartan, experiencing erectile dysfunction (ED), tadalafil may be considered as a treatment option. However, it is essential to discuss the potential risks and benefits with a healthcare provider, especially considering the patient's high blood pressure and losartan use.

• The patient should inform their healthcare provider about all their medical problems, including heart problems, high blood pressure, stroke, liver problems, and kidney problems.
• The healthcare provider should also be informed about all the medicines the patient takes, including nitrates, guanylate cyclase stimulators, alpha blockers, other medicines to treat high blood pressure, HIV protease inhibitors, oral antifungals, and antibiotics.
• The patient's healthcare provider will decide if tadalafil is right for them and prescribe the appropriate dose.
• It is crucial to follow the healthcare provider's instructions and take tadalafil exactly as prescribed.
• The patient should not take tadalafil with certain alpha blockers, as this can cause a sudden drop in blood pressure, leading to dizziness or fainting.
• The patient should not drink too much alcohol when taking tadalafil, as this can increase the risk of getting a headache, dizziness, or low blood pressure.
• The patient should seek medical attention immediately if they experience any severe side effects, such as a sudden decrease or loss of hearing, or an erection that lasts more than 4 hours. 2

From the Research

Treatment Options for Erectile Dysfunction

The patient, a 53-year-old male with hypertension (HTN) on losartan, experiencing erectile dysfunction (ED), has several treatment options available.

• Lifestyle modifications such as tobacco cessation, regular exercise, weight loss, and improved control of diabetes, hypertension, and hyperlipidemia are recommended initial interventions 3.
• Oral phosphodiesterase-5 inhibitors are the first-line treatments for ED, with medications like sildenafil, tadalafil, vardenafil, and avanafil showing success in 60-65% of men with ED, including those with hypertension and diabetes mellitus 4.
• Second-line treatments include alprostadil and vacuum devices, which can be effective for men who fail to respond to oral pharmacological agents 3, 4.
• Surgical treatment of ED with multicomponent inflatable penile implants is associated with high satisfaction rates, although penile arterial revascularisation and venous ligation surgery have relatively poor outcome results in men with penile atherosclerotic disease or corporal veno-occlusive dysfunction 4.

Importance of Addressing Erectile Dysfunction

It is essential to address ED, as it is associated with an increased risk of cardiovascular disease, particularly in men with metabolic syndrome 5, 6, 7.

• ED can be an early sign of forthcoming cardiovascular disease, and its presence should prompt screening for comorbidities to improve overall health 5, 6, 7.
• The relationship between ED and cardiovascular disease is not coincidental, and understanding this connection can provide physicians with a unique opportunity to assess their patients' future cardiovascular health 6.