Lowering blood pressure in patients without affecting quality of life

Sexual dysfunction in patients with hypertension: implications for therapy

Sexual dysfunction associated with hypertension or antihypertensive therapies may impact the ability of patients to stay on therapy and lead to deterioration in patients' quality of life. Therefore, it is important for practitioners to become familiar with the wide variation in sexual side effects produced by antihypertensive agents and to discuss the potential occurrence of these side effects with their patients. In many cases, a change in the patient's drug regimen may help patients overcome specific sexual side effects experienced with certain treatments. Practitioners should consider selecting an antihypertensive therapy that is highly effective in lowering blood pressure but preserves patients quality of life. The effect of medications on sexual function remains controversial. Some blinded trials report little difference between placebo and specific medications, whereas other studies indicate that antihypertensive medications increase sexual dysfunction, which has an impact on quality of life. Recent evidence suggests that losartan, an angiotensin II antagonist, is not typically associated with development of sexual dysfunction and may actually positively impact several indices of sexual function (erectile function, sexual satisfaction, and frequency of sexual activity) as well as perceived quality of life. Thus, angiotensin II antagonists may offer a therapeutic option to prevent or correct erectile dysfunction in patients with hypertension. The favorable effects of these agents on sexual function may be related, in part, to their ability to block angiotensin II, which has recently become recognized as an important mediator of detumescence and possibly erectile dysfunction.

Understanding the effects of a myocardial infarction on sexual functioning: a basis for sexual counseling

Sexual counseling is an integral component of the rehabilitative process for clients who have experienced a myocardial infarction (MI). This article describes myths and fears concerning the dangers of resuming sexual intercourse after a heart attack, positions for intercourse, and the effects of intercourse on arrhythmias, angina, and blood pressure. The purpose is to provide the results of empirical research to dispel myths and fears and to consider the causes of sexual dysfunction, the changes MI brings about in sexual activity for men and women, and the effects of age, exercise, and antihypertensive drugs on the resumption of sexual activity. Guidelines are provided for conducting a sexual/cardiac history as part of the counseling model with specific information for the post-MI client.