Antihypertensive Medications and Sexual Function

Medication-Specific Effects

Beta-blockers can cause sexual dysfunction by decreasing peripheral vasodilation and reducing cardiac output in patients with hypertension, as noted by the JNC-7 guidelines and the American College of Cardiology 1, 2, 3
Thiazide diuretics, such as hydrochlorothiazide and chlorthalidone, have a high association with erectile dysfunction, possibly due to reduced blood volume and effects on vascular smooth muscle, according to the American Heart Association and the TOMHS study 1, 2, 3
ACE inhibitors and ARBs have fewer sexual side effects, making them a suitable alternative for patients experiencing sexual dysfunction with other antihypertensive medications, as stated by the 2017 ACC/AHA guidelines and research published in Diabetes/Metabolism Research and Reviews 2, 3, 4
Other medications, such as 5-alpha reductase inhibitors, GnRH analogues and antagonists, and tranquilizers, can also cause erectile dysfunction, as reported by the European Urology association and Diabetes/Metabolism Research and Reviews 4, 5

If sexual dysfunction or low testosterone appears after starting antihypertensive therapy, the JNC-7 guidelines and the American College of Cardiology recommend discontinuing the offending agent and restarting treatment with another agent, such as ACE inhibitors or ARBs, to minimize sexual side effects 1, 2, 3
Phosphodiesterase-5 inhibitors, such as sildenafil, tadalafil, vardenafil, and avanafil, can be safely coadministered with most antihypertensive medications and have additive BP-lowering effects, as suggested by the American College of Cardiology and the 2017 ACC/AHA guidelines 2, 3
Medication switching, such as using ACE inhibitors or ARBs for hypertension, or bupropion, mirtazapine, or other antidepressants with lower sexual side effect profiles for depression, can be considered to minimize erectile dysfunction risk, as recommended by the European Urology association and the American College of Cardiology 5, 2, 3

Erectile dysfunction can be an early marker of cardiovascular disease, especially in patients with hypertension, as reported by the American College of Cardiology and the Journal of the American College of Cardiology 2, 3
Drug-induced erectile dysfunction is typically dose-related and reversible upon discontinuation, highlighting the importance of proper management strategies, as noted by the American Heart Association 1