Hypertension and erectile dysfunction

Erectile dysfunction (ED) is frequently reported by hypertensive patients. The prevalence increases from 30% at the age of 50 years to 50% or more in patients aged over 70 years, i.e. 2-fold higher than that observed in normotensive subjects of the same age. The conventional view holds that ED is an adverse effect of the antihypertensive treatment, but the results of several controlled trials addressing this issue indicate that the incidence of ED is essentially similar in treated and untreated hypertensive patients, suggesting that ED is due to the elevation in blood pressure rather than to its pharmacological reduction. A number of psychological, hormonal and vascular alterations associated with hypertension justify the findings of these observational studies and explain why ED should, at present, be considered as an early marker of cardiovascular risk. However, it is still possible that in specific cases some antihypertensive agents (namely the diuretics and the sympatholytic agents) may contribute to ED, but the more modern drugs such as the calcium antagonists and the antagonists of the renin-angiotensin system are neutral with respect to ED; actually, some recent studies carried out with the sartans suggest that these compounds may ameliorate ED. Finally, there is no evidence that antihypertensive treatment increases the adverse effects of the phosphodiesterase inhibitors recently introduced for the treatment of ED; thus, the use of these drugs is not contraindicated in hypertensive patients.