Original Articles
Sexual Dysfunction in Hypertensive Patients Treated with Losartan

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ABSTRACT

Background

Impaired erectile function in men is a component of the dysmetabolic syndrome of high blood pressure as well as a sequela of antihypertensive therapy. This prospective interventional study in men with uncontrolled hypertension (blood pressure ≥ 140/90 mm Hg) used a survey instrument to assay sexual dysfunction before and after therapy with losartan.

Methods

We evaluated the influence of a 12-week therapy with losartan in 82 hypertensive subjects with (n = 82) and without (n = 82) a diagnosis of erectile dysfunction using a self-administered questionnaire validated in another 60 subjects with hypertension. Results: From an initial sample of 323 hypertensive men and women, 82 men, aged 30 to 65 years, with sexual dysfunction underwent a 12-week regimen of losartan therapy (50–100 mg/day). Losartan treatment improved sexual satisfaction from an initial 7.3 to 58.5% (χ2; P = 0.001). Subjects reporting a high frequency of sexual activity improved from 40.5% initially to 62.3% after drug treatment, whereas the number of patients with low or very low frequency of sexual activity decreased significantly (χ2; P = 0.001). At the completion of the 12-week losartan regimen, only 11.8% of the treated subjects reported in improvement in sexual function. Improvement on quality of life was demonstrated in 73.7% of subjects medicated with losartan, 25.5% reported no changes, and only 0.8% felt worse. In the group without sexual dysfunction, losartan had a non-significant effect on sexual function.

Conclusions

Our data suggest that losartan improved erectile function and both satisfaction and frequency of sexual activity. Because side effects are one of the most influential factors in the management of hypertension, an added benefit of losartan therapy may be its positive impact on quality of life.

Section snippets

Study Design and Patient Population

Three hundred twenty-three patients with uncontrolled hypertension (blood pressure ≥ 140/90 mm Hg) (197 men, 126 women) attending primary care clinics were screened for sexual dysfunction using a self-administered questionnaire (“symptom-finding” questionnaire) validated in a pilot study conducted in another 64 subjects (see below). From the pool of 197 male subjects, 82 male subjects were diagnosed as suffering from sexual dysfunction (prevalence, 42.3%; 95% confidence interval, 35.3–49.3). Of

Sample Characteristics

General characteristics of both intervention and control subjects completing the study are given in Table 1. The control and interventional groups were comparable with regard to age, marital status, educational level, and duration of hypertension treatment. Group systolic and diastolic blood pressures at the initiation of the study averaged 153 ± 13/89 ± 8 mm Hg (mean ± 1SD) and 155 ± 12/89 ± 8 mm Hg in subjects reporting negative and positive histories of sexual dysfunction, respectively (P > 0.05).

Before

Discussion

A man’s sexual response reflects a dynamic balance between excitatory and inhibitory forces. Any physiological or organic disturbance in the network of peripheral and central mechanisms regulating erection and detumescence has a clear effect on sexual function.21 Both high blood pressure and antihypertensive medications are among the various disorders associated with sexual dysfunction.6., 7., 18. In keeping with these observations, the prevalence of sexual dysfunction attributed to the use of

Acknowledgments

We are grateful for the careful assistance provided by Carla Yunis, M.D., M.P.H., for her valuable comments regarding data analysis and interpretation of findings. This study was supported in part by Merck Sharpe and Dohme de Espana SA who provided drugs used and paid for statistical analysis.

References (34)

  • B.J. Bailey et al.

    Hypertension treatment compliance: what do patients want to know about their medications?

    Prog Cardiovasc Nurs

    (1997)
  • R.W.S. Fisher

    Compliance in the treatment of hypertension: a need for action

    Am J Hypertens

    (1995)
  • S.H. Croog et al.

    Sexual symptoms in hypertensive patients. A clinical trial of antihypertensive medications

    Arch Intern Med

    (1988)
  • S.R. Leiblum et al.

    The sexual functioning of elderly hypertensive women

    J Sex Marital Ther

    (1994)
  • A. Jaffe et al.

    Erectile dysfunction in hypertensive subjects. Assessment of potential determinants

    Hypertension

    (1996)
  • R.C. Rosen et al.

    Sexual sequelae of antihypertensive drugs: treatment effects on self-report and physiological measures in middle-aged male hypertensives

    Arch Sex Behav

    (1994)
  • B.A. Kroner et al.

    Effect of frequently prescribed cardiovascular medications on sexual function: a pilot study

    Ann Pharmacother

    (1993)
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