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Patoulias D, Katsimardou A, Imprialos K, Doumas M. Exercise, Erectile Dysfunction and Co-Morbidities: "The Good, the Bad and the Ugly". Rev Cardiovasc Med 2022; 23:304. [PMID: 39077699 PMCID: PMC11262406 DOI: 10.31083/j.rcm2309304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Revised: 07/24/2022] [Accepted: 08/17/2022] [Indexed: 07/31/2024] Open
Abstract
Erectile dysfunction (ED), defined as the inability to attain or maintain sufficient penile erection for sexual intercourse, is a growing health problem, which unfortunately remains underreported, underdiagnosed and undertreated. Growing evidence suggests that ED is a promising cardiovascular risk marker, as it is associated with major co-morbidities increasing cardiovascular disease burden, while it is an independent predictor of cardiovascular morbidity and mortality. The role of exercise as a non-pharmacological therapeutic intervention in ED has been widely investigated during the last two decades, both in observational studies and in randomized controlled trials, enrolling different patients' populations. In the present narrative review, we summarize relevant evidence concerning the effect of exercise on vascular ED and the pathophysiologic background, underscoring the importance of enhanced physical activity as a recommendation in all subjects with vascular ED.
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Affiliation(s)
- Dimitris Patoulias
- Second Propedeutic Department of Internal Medicine, Aristotle University of Thessaloniki, 54642 Thessaloniki, Greece
| | - Alexandra Katsimardou
- Second Propedeutic Department of Internal Medicine, Aristotle University of Thessaloniki, 54642 Thessaloniki, Greece
| | - Konstantinos Imprialos
- Second Propedeutic Department of Internal Medicine, Aristotle University of Thessaloniki, 54642 Thessaloniki, Greece
| | - Michael Doumas
- Second Propedeutic Department of Internal Medicine, Aristotle University of Thessaloniki, 54642 Thessaloniki, Greece
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Aguilera-Alvarez VH, Mohammed BK, Fatima A, Patel A, Patel A, Gyabaah FN, John J, Iqbal A, Naz S, Munir A, Haffar A, Irfan M, Hanif M. The Role and Efficacy of Coenzyme Q10 in the Management of Erectile Dysfunction in a Hypertensive Male: An Interventional Study. Cureus 2021; 13:e17937. [PMID: 34660127 PMCID: PMC8513668 DOI: 10.7759/cureus.17937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/13/2021] [Indexed: 11/20/2022] Open
Abstract
Introduction Erectile dysfunction (ED) is a prevalent medical condition that affects millions of men globally. A number of pharmacological and complementary options are used in the management of ED, including Coenzyme Q10 (CoQ10). Oxidative stress has been linked to the progression of ED, and Co Q10 protects against oxidative damages and improves erectile function as well as the activity of antioxidant enzymes. This study aimed to determine the efficacy of CoQ10 in the treatment of erectile dysfunction in hypertensive males. Method An open-labeled parallel arm interventional study was conducted in the cardiology unit of Hayatabad Medical Complex Hospital, Peshawar, Pakistan, from March 2020 to March 2021. Hypertensive male patients (n = 230) were randomly allocated to either receiving 200-gram CoQ10 daily along with their current antihypertensive therapy (n=104) or anti‐hypertensive treatment only (n=105). The patient’s erectile function was assessed at baseline and three months using the International Index of Erectile Function Test (IIEF-5) during the study period. Result Of the total 230, 209 (90.87%) patients were included in the final analysis. There were no significant differences in demographics, history of illness, co-morbid conditions, and current medication of both groups. After three months, 21 (20.1%) participants scored more than 17 in the IIEF-5 and no longer had ED. Overall, no significant difference was found in the mean IIEF-5 score between the study group and control group (14.41 ± 4.49 Vs. 15.61 ± 4.82; p=0.06). However, in subgroup analysis, significant improvement in the study group was seen in participants with mild ED (p=0.03). Conclusion With the demonstration of its efficacy in hypertensive patients with mild ED, co-enzyme Q10 supplementation can be proposed as a potential candidate in patients with long-term hypertension and can play a role in erectile dysfunction.
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Affiliation(s)
| | | | - Aqsa Fatima
- Internal Medicine, Allama Iqbal Medical College, Lahore, PAK
| | - Ankit Patel
- Internal Medicine, Spartan Health Science University School of Medicine, St. Lucia, USA
| | - Avaniben Patel
- Internal Medicine, Spartan Health Science University School of Medicine, St. Lucia, USA
| | | | - Jobby John
- Internal Medicine, Dr. Somervell Memorial CSI Medical College and Hospital, Kerala, IND
| | - Abbas Iqbal
- Pediatrics, Ayub Teaching Hospital, Abbottabad, PAK
| | - Sidra Naz
- Internal Medicine, University of Health Sciences (UHS), Lahore, PAK
| | - Affan Munir
- Internal Medicine, Jersey City Medical Center, Jersey City, USA
| | - Ammer Haffar
- Internal Medicine, Jersey City Medical Center, Jersey City, USA
| | - Muhammad Irfan
- Internal Medicine, Hayatabad Medical Complex, Peshawar, PAK
| | - Muhammad Hanif
- Internal Medicine, Khyber Medical College Peshawar, Hayatabad Medical Complex, Peshawar, PAK
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Getie Mekonnen E, Yeshita HY, Bishaw Geremew A. Sexual dysfunction among men with diabetes mellitus attending chronic out-patient department at the three hospitals of Northwest Amhara region, Ethiopia: Prevalence and associated factors. PLoS One 2021; 16:e0256015. [PMID: 34379695 PMCID: PMC8357135 DOI: 10.1371/journal.pone.0256015] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Accepted: 07/28/2021] [Indexed: 01/23/2023] Open
Abstract
Background Sexual dysfunction is the commonest reproductive health problem observed among men with diabetes mellitus affecting their quality of life. Previous studies conducted in this area were concentrated on the specific domains of sexual dysfunction, and factors were not well-addressed. Therefore, this study was aimed to determine the prevalence of all forms of sexual dysfunction and to identify its associated factors among diabetic men patients attending at the three hospitals of the Amhara region, Ethiopia. Method An institutional-based cross-sectional study was conducted involving 462 men diabetic patients at the three hospitals of the northwest Amhara region. A systemic random sampling technique was employed. A face-to-face interviewer-administered change in the sexual functioning questionnaire was used to collect the required data from the 20th of February to the 15th of April 2020. The binary logistic regression was employed and a multivariable logistic regressions model was used to control the effect of confounders. Variables that had an independent correlation with the sexual dysfunction were identified based on a p-value≤ 0.05. Likewise, the direction and strength of association were interpreted using Adjusted Odds Ratio (AOR) with its corresponding 95% CI. Results The prevalence of sexual dysfunction was found to be 69.5% (95%CI: (65.1–73.9)). The magnitude of sexual dysfunction was prevalently observed among participants who were older (> 50 years) (AOR = 8.7, 95%CI: (3.3–23.1)). Likewise, the odds of sexual dysfunction was significantly higher among men who have lived with diabetes for a longer duration (AOR = 10.8, 95%CI: (5.3–21.9)), with poor metabolic control (AOR = 3.57, 95%CI: (1.81–7.05)), with comorbid illnesses (AOR = 5.07, 95%CI: (2.16–11.9)), and diabetic-related complications (AOR = 3.01, 95%CI: 1.31–6.92). On the other hand, participants who were physically active (AOR = 0.41, 95%CI: (0.12–0.7)) and satisfied with their relationship (AOR = 0.15, 95%CI: (0.03–0.7)) showed a lesser risk of experiencing sexual dysfunction. Conclusion Well over two-thirds of men with diabetes mellitus have experienced sexual dysfunction, implying a public health pressing problem. Older age, lack of physical activity, living longer duration with diabetes, having diabetic complications, experiencing co-morbid illnesses, being unsatisfied with couple relationship, and poor metabolic control increased the risk of developing SD. Therefore, promoting physical exercise, preventing co-morbid illnesses, and couples counseling to build up a good couple relationship are recommended to promote the sexual and reproductive health of men with diabetes.
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Affiliation(s)
- Eskedar Getie Mekonnen
- Department of Reproductive and Child Health, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
- * E-mail:
| | - Hedija Yenus Yeshita
- Department of Reproductive and Child Health, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Alehegn Bishaw Geremew
- Department of Reproductive and Child Health, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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Imprialos K, Koutsampasopoulos K, Manolis A, Doumas M. Erectile Dysfunction as a Cardiovascular Risk Factor: Time to Step Up? Curr Vasc Pharmacol 2021; 19:301-312. [PMID: 32286949 DOI: 10.2174/1570161118666200414102556] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Revised: 03/10/2020] [Accepted: 03/12/2020] [Indexed: 01/01/2023]
Abstract
BACKGROUND Erectile dysfunction (ED) is a major health problem that affects a significant proportion of the general population, and its prevalence is even higher in patients with CV risk factors and/or disease. ED and cardiovascular (CV) disease share several common pathophysiological mechanisms, and thus, the potential role of ED as a predictor of CV events has emerged as a significant research aspect. OBJECTIVE The purpose of this review is to present and critically discuss data assessing the relation between ED and CV disease and the potential predictive value of ED for CV events. METHODS A comprehensive review of the literature has been performed to identify studies evaluating the association between ED and CV disease. RESULTS Several cross-sectional and prospective studies have examined the association between ED and CV disease and found an increased prevalence of ED in patients with CV disease. ED was shown to independently predict future CV events. Importantly, ED was found to precede the development of overt coronary artery disease (CAD) by 3 to 5 years, offering a "time window" to properly manage these patients before the clinical manifestation of CAD. Phosphodiesterase type 5 inhibitors are the first-line treatment option for ED and were shown to be safe in terms of CV events in patients with and without CV disease. CONCLUSION Accumulating evidence supports a strong predictive role of ED for CV events. Early identification of ED could allow for the optimal management of these patients to reduce the risk for a CV event to occur.
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Affiliation(s)
- Konstantinos Imprialos
- Second Propaedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, Hippokration Hospital, Thessaloniki, Greece
| | - Konstantinos Koutsampasopoulos
- Second Propaedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, Hippokration Hospital, Thessaloniki, Greece
| | | | - Michael Doumas
- Second Propaedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, Hippokration Hospital, Thessaloniki, Greece
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Abstract
: Sexual health is an integral part of overall health, and an active and healthy sexual life is an essential aspect of a good life quality. Cardiovascular disease and sexual health share common risk factors (arterial hypertension, diabetes mellitus, dyslipidemia, obesity, and smoking) and common mediating mechanisms (endothelial dysfunction, subclinical inflammation, and atherosclerosis). This generated a shift of thinking about the pathophysiology and subsequently the management of sexual dysfunction. The introduction of phosphodiesterase type 5 inhibitors revolutionized the management of sexual dysfunction in men. This article will focus on erectile dysfunction and its association with arterial hypertension. This update of the position paper was created by the Working Group on Sexual Dysfunction and Arterial Hypertension of the European Society of Hypertension. This working group has been very active during the last years in promoting the familiarization of hypertension specialists and related physicians with erectile dysfunction, through numerous lectures in national and international meetings, a position paper, newsletters, guidelines, and a book specifically addressing erectile dysfunction in hypertensive patients. It was noted that erectile dysfunction precedes the development of coronary artery disease. The artery size hypothesis has been proposed as a potential explanation for this observation. This hypothesis seeks to explain the differing manifestation of the same vascular condition, based on the size of the vessels. Clinical presentations of the atherosclerotic and/or endothelium disease in the penile arteries might precede the corresponding manifestations from larger arteries. Treated hypertensive patients are more likely to have sexual dysfunction compared with untreated ones, suggesting a detrimental role of antihypertensive treatment on erectile function. The occurrence of erectile dysfunction seems to be related to undesirable effects of antihypertensive drugs on the penile tissue. Available information points toward divergent effects of antihypertensive drugs on erectile function, with diuretics and beta-blockers possessing the worst profile and angiotensin receptor blockers and nebivolol the best profile.
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Kretchy IA, Boima V, Agyabeng K, Koduah A, Appiah B. Psycho-behavioural factors associated with medication adherence among male out-patients with hypertension in a Ghanaian hospital. PLoS One 2020; 15:e0227874. [PMID: 31995606 PMCID: PMC6988959 DOI: 10.1371/journal.pone.0227874] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Accepted: 01/01/2020] [Indexed: 11/18/2022] Open
Abstract
Medication adherence is a key health outcome that reflects the health and general well-being of patients with hypertension. Challenges with adherence are common and associated with clinical, behavioural and psychosocial factors. This study sought to provide data on the extent of medication adherence among male patients with hypertension and their biopsychosocial predictors. Patient and clinical characteristics, psychological distress, insomnia and sexual dysfunction were hypothesized to predict outcomes of medication adherence. Utilizing quantitative data from a hospital-based cross-sectional study from 358 male out-patients with hypertension attending a tertiary hospital in Ghana, medication adherence was associated with age, marital status, educational level, income, duration of diagnosis, number of medications taken and sexual dysfunction. These findings support the need for biopsychosocial interventions aiming at promoting adherence while taking these factors into consideration for the benefit of improving the health and general well-being of male patients with hypertension.
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Affiliation(s)
- Irene A. Kretchy
- Department of Pharmacy Practice and Clinical Pharmacy, School of Pharmacy, College of Health Sciences, University of Ghana, Legon, Ghana
| | - Vincent Boima
- Department of Medicine and Therapeutics, University of Ghana Medical School, College of Health Sciences, University of Ghana, Korle-Bu, Ghana
- * E-mail: ,
| | - Kofi Agyabeng
- Department of Biostatistics, School of Public Health, College of Health Sciences, University of Ghana, Legon, Ghana
| | - Augustina Koduah
- Department of Pharmacy Practice and Clinical Pharmacy, School of Pharmacy, College of Health Sciences, University of Ghana, Legon, Ghana
| | - Bernard Appiah
- Department of Environmental and Occupational Health, School of Public Health, Texas A&M Health Science Center, TAMU, College Station, Texas, United States of America
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ALTUNÖREN O, ERKEN E, GÜNGÖR Ö, YAVUZ YC. Hipertansiyon ve Erektil Disfonksiyon. KAHRAMANMARAŞ SÜTÇÜ İMAM ÜNIVERSITESI TIP FAKÜLTESI DERGISI 2019. [DOI: 10.17517/ksutfd.477511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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Bouhanick B, Blacher J, Huyghe E, Colson MH, Boivin JM, Mounier-Vehier C, Denolle T, Fauvel JP. [Sexual dysfunction and antihypertensive treatment: Involvement of the different therapeutic classes and what to do about the treatment of hypertension]. Presse Med 2019; 48:1222-1228. [PMID: 31303372 DOI: 10.1016/j.lpm.2019.05.029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Accepted: 05/27/2019] [Indexed: 11/19/2022] Open
Abstract
Erectile dysfunction (ED) is not routinely discussed with patients in cardiology practices whereas it may impact the ability of patients to stay on therapy. Most of the studies about ED and antihypertensive therapies have several methodological limitations. Diuretics and beta-blockers have been shown to have a deleterious effect on ED. ISRA inhibitors, calcium antagonists, vasodilator beta-blockers and alpha-blockers have been shown to have a neutral impact on ED. Angiotensin 2 inhibitors, nebivolol and alpha-blockers use has sometimes beneficial effect on ED. In case of ED due to antihypertensive treatment, drugs can be switched each other but careful attention in patients with a high cardiovascular risk is required.
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Affiliation(s)
- Béatrice Bouhanick
- CHU Rangueil, université Toulouse 3, service d'hypertension artérielle et thérapeutique, UMR1027, TSA 50032, 1, avenue J. Poulhes, 31059 Toulouse cedex 9 France.
| | - Jacques Blacher
- AP-HP, université Paris-Descartes, Hôtel-Dieu, Centre de diagnostic et de thérapeutique, 75004 Paris, France
| | - Eric Huyghe
- CHU Toulouse, EA 3694 human fertility research group, Paule de Viguier, reproductive medicine department, 31059 Toulouse, France
| | | | - Jean-Marc Boivin
- CHU de Nancy, université de Lorraine, institut Lorrain du Cœur et des Vaisseaux Louis Mathieu, CIC-P Pierre Drouin, Inserm, 54000 Vandoeuvre-lès-Nancy, France
| | | | - Thierry Denolle
- Centre d'Excellence Européen en HTA Rennes-Dinard, 35800 Dinard, France
| | - Jean-Pierre Fauvel
- Université C Bernard Lyon 1, hospices civils de Lyon, 69000 Lyon, France
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Choy CL, Sidi H, Koon CS, Ming OS, Mohamed IN, Guan NC, Alfonso CA. Systematic Review and Meta-Analysis for Sexual Dysfunction in Women With Hypertension. J Sex Med 2019; 16:1029-1048. [PMID: 31113742 DOI: 10.1016/j.jsxm.2019.04.007] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Revised: 02/17/2019] [Accepted: 04/04/2019] [Indexed: 10/26/2022]
Abstract
INTRODUCTION Sexual dysfunction in hypertensive women is an often-neglected subject despite a reported prevalence of 42.1%. Although few reviews exist, a definitive relationship between hypertension and sexual dysfunction in women has not been clearly established. AIM To review the existing literature to definitively examine sexual dysfunction in women with hypertension, in both treated and untreated subjects. METHODS We performed a systematic search for published literature of 3 electronic databases (Scopus, EBSCOhost Medline Complete, and Cochrane Library) in August 2018. The search terms with relevant truncation and Boolean were developed according to a population exposure-comparator-outcome model combining pilot searches. The quality of included studies was assessed with the McMaster Critical Review Form for Quantitative Studies. Initial search, limited to the English language, included a total of 2,198 studies. 31 studies (18,260 subjects) met our inclusion criteria and were included in the review. Sexual dysfunction in these studies was measured using different tools. We extracted information of study setting, country, number of subjects, participants' age and blood pressure, comparators, and outcome. We ran a meta-analysis on the presence of sexual dysfunction as an outcome from the following comparisons: (i) hypertensive vs normotensive (ii) treated vs untreated hypertension, and (iii) exposure vs absence of specific class of anti-hypertensive drug. MAIN OUTCOME MEASURES Women with sexual dysfunction and hypertension were included. RESULTS We found significant sexual dysfunction in women with hypertension compared with the normotensive group (pooled odds ratio [OR] = 2.789, 95% CI = 1.452-5.357, P = .002). However, there was no statistical difference of sexual dysfunction in women with treated or untreated hypertension (OR = 1.229, 95% CI = 0.675-2.236, P = .5). Treatment with alpha-/beta-blockers, angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, calcium channel blockers, and diuretics resulted in no statistical difference in sexual dysfunction in hypertensive women. CLINICAL IMPLICATIONS Because sexual dysfunction is prevalent in women with hypertension, it is imperative to address the underlying medical condition to manage this important clinical problem. STRENGTH & LIMITATIONS Many studies had to be excluded from the meta-analysis, due to unavailability and incompleteness of data. Nevertheless, results of the review are useful to derive recommendations for alerting physicians of the need to routinely assess the sexual functioning of women with hypertension. CONCLUSION We conclude that women with hypertension are at increased risk for sexual dysfunction, and our findings imply that evaluation for sexual dysfunction needs to be part of the clinical management guidelines for women with hypertension. Choy CL, Sidi H, Koon CS, et al. Systematic Review and Meta-Analysis for Sexual Dysfunction in Women With Hypertension. J Sex Med 2019;16:1029-1048.
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Affiliation(s)
- Chia Lip Choy
- Department of Psychiatry, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia
| | - Hatta Sidi
- Department of Psychiatry, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia.
| | - Chong Siew Koon
- Department of Psychiatry, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia
| | - Ooi Soon Ming
- Department of Psychiatry, Hospital Sri Aman, Sri Aman, Sarawak, Malaysia
| | - Isa Naina Mohamed
- Department of Pharmacology, Universiti Kebangsaan Malaysia Medical Centre, Cheras, Kuala Lumpur, Malaysia
| | - Ng Chong Guan
- Department of Psychological Medicine, University Malaya Medical Centre, Kuala Lumpur, Malaysia
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Erectile Dysfunction. Sex Med 2019. [DOI: 10.1007/978-981-13-1226-7_3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
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Heikkilä A, Kaipia A, Venermo M, Kautiainen H, Korhonen P. Relationship of Blood Pressure and Erectile Dysfunction in Men Without Previously Diagnosed Hypertension. J Sex Med 2017; 14:1336-1341. [PMID: 28993149 DOI: 10.1016/j.jsxm.2017.09.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2017] [Revised: 09/04/2017] [Accepted: 09/10/2017] [Indexed: 11/28/2022]
Abstract
BACKGROUND Erectile dysfunction (ED) is the most common male sexual disorder that affects all age groups and has a close association with essential hypertension. AIM To characterize the relation of blood pressure and ED in detail. METHODS A cross-sectional population-based study of 45- to 70-year-old men without previously diagnosed hypertension, cardiovascular diseases, renal disease, or diabetes was conducted from 2005 to 2007 in southwestern Finland. A total of 665 men with at least one cardiovascular risk factor were studied. ED was defined by the five-item International Index of Erectile Function. OUTCOMES We found a U-shaped association between diastolic blood pressure (DBP) and prevalence of ED. RESULTS The average age of the study subjects was 56 ± 6 years and 52% had ED. After adjustment for age, cohabitation status, education, fasting plasma glucose level, waist circumference, and prevalence of depressive symptoms, the curve relating DBP to the prevalence of ED was U-shaped with a nadir of DBP 90 mm Hg. CLINICAL IMPLICATIONS Our findings emphasize the importance of blood pressure measurement in the physical examination of men with ED. STRENGTHS AND LIMITATIONS This was a cross-sectional study, which prevents the evaluation of causality between ED and hypertension. However, this community-based study population is well defined and the anthropologic measurements were made by trained medical staff. CONCLUSION We found a U-shaped correlation between ED and DBP, which confirms the link between ED and hypertension. Heikkilä A, Kaipia A, Venermo M, et al. Relationship of Blood Pressure and Erectile Dysfunction in Men Without Previously Diagnosed Hypertension. J Sex Med 2017;14:1336-1341.
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Affiliation(s)
- Arto Heikkilä
- Department of General Practice, Turku University and Turku University Hospital, Turku University, Turku, Finland.
| | - Antti Kaipia
- Department of Surgery, Satakunta Hospital District, Pori, Finland
| | - Maarit Venermo
- Department of Vascular Surgery, Helsinki University Central Hospital, Helsinki, Finland
| | - Hannu Kautiainen
- Unit of Primary Health Care, Kuopio University Hospital, Kuopio, Finland; Folkhälsan Research Centre, Helsinki, University of Helsinki, Helsinki, Finland
| | - Päivi Korhonen
- Department of General Practice, Turku University and Turku University Hospital, Turku University, Turku, Finland; Central Satakunta Health Federation of Municipalities, Harjavalta, Finland
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Kaufman KR, Coluccio M, Sivaraaman K, Campeas M. Lamotrigine-induced sexual dysfunction and non-adherence: case analysis with literature review. BJPsych Open 2017; 3:249-253. [PMID: 29034101 PMCID: PMC5627137 DOI: 10.1192/bjpo.bp.117.005538] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2017] [Revised: 08/07/2017] [Accepted: 08/23/2017] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Optimal anti-epileptic drug (AED) treatment maximises therapeutic response and minimises adverse effects (AEs). Key to therapeutic AED treatment is adherence. Non-adherence is often related to severity of AEs. Frequently, patients do not spontaneously report, and clinicians do not specifically query, critical AEs that lead to non-adherence, including sexual dysfunction. Sexual dysfunction prevalence in patients with epilepsy ranges from 40 to 70%, often related to AEDs, epilepsy or mood states. This case reports lamotrigine-induced sexual dysfunction leading to periodic non-adherence. AIMS To report lamotrigine-induced sexual dysfunction leading to periodic lamotrigine non-adherence in the context of multiple comorbidities and concurrent antidepressant and antihypertensive pharmacotherapy. METHOD Case analysis with PubMed literature review. RESULTS A 56-year-old male patient with major depression, panic disorder without agoraphobia and post-traumatic stress disorder was well-controlled with escitalopram 20 mg bid, mirtazapine 22.5 mg qhs and alprazolam 1 mg tid prn. Comorbid conditions included complex partial seizures, psychogenic non-epileptic seizures (PNES), hypertension, gastroesophageal reflux disease and hydrocephalus with patent ventriculoperitoneal shunt that were effectively treated with lamotrigine 100 mg tid, enalapril 20 mg qam and lansoprazole 30 mg qam. He acknowledged non-adherence with lamotrigine secondary to sexual dysfunction. With lamotrigine 300 mg total daily dose, he described no libido with impotence/anejaculation/anorgasmia. When off lamotrigine for 48 h, he described becoming libidinous with decreased erectile dysfunction but persistent anejaculation/anorgasmia. When off lamotrigine for 72 h to maximise sexual functioning, he developed auras. Family confirmed patient's consistent monthly non-adherence for 2-3 days during the past year. CONCLUSIONS Sexual dysfunction is a key AE leading to AED non-adherence. This case describes dose-dependent lamotrigine-induced sexual dysfunction with episodic non-adherence for 12 months. Patient/clinician education regarding AED-induced sexual dysfunction is warranted as are routine sexual histories to ensure adherence. DECLARATION OF INTEREST No financial interests. K.R.K. is Editor of BJPsych Open; he took no part in the peer-review of this work. COPYRIGHT AND USAGE © The Royal College of Psychiatrists 2017. This is an open access article distributed under the terms of the Creative Commons Non-Commercial, No Derivatives (CC BY-NC-ND) license.
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Affiliation(s)
- Kenneth R Kaufman
- , MD, FRCPsych, DLFAPA, FAES, Departments of Psychiatry, Neurology and Anesthesiology, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA
| | - Melissa Coluccio
- , BS, Department of Psychiatry, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA
| | - Kartik Sivaraaman
- , MD, Department of Neurology, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA
| | - Miriam Campeas
- , BA, Department of Psychiatry, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA
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Shimizu S, Tsounapi P, Honda M, Dimitriadis F, Taniuchi K, Shimizu T, Inoue K, Saito M. Effect of an angiotensin II receptor blocker and a calcium channel blocker on hypertension associated penile dysfunction in a rat model. Biomed Res 2015; 35:215-21. [PMID: 24942861 DOI: 10.2220/biomedres.35.215] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Possible effect of olmesartan, an angiotensin II receptor blocker (ARB), or nifedipine, an L-type calcium channel blocker, on penile dysfunction in the spontaneously hypertensive rat (SHR) was investigated in this study. Twelve-week-old male SHRs were treated with olmesartan (1 or 3 mg/kg, per orally (p.o.)) or nifedipine (30 mg/kg, p.o.) once a day for 6 weeks. Wistar rats and SHRs with vehicle treatment were used as controls. Penile cGMP and malondialdehyde concentrations, and mRNA levels of endothelial and neuronal NO synthase (eNOS and nNOS) were measured. Penile function was evaluated by organ bath studies with norepinephrine-induced contractions and acetylcholine-induced relaxations. The SHR showed significantly increased blood pressure, decreased cGMP concentrations, increased malondialdehyde concentrations, decreased eNOS and nNOS mRNA levels, norepinephrine-induced hyper-contractions, and acetylcholine-induced hypo-relaxations in the penile tissue compared to the Wistar rat. Both nifedipine and olmesartan significantly decreased blood pressure, increased cGMP and normalized the hyper-contractions and hypo-relaxations observed in the SHR group. However, not nifedipine but olmesartan improved the malondialdehyde concentrations and increased mRNA levels of eNOS and nNOS in the penis. Our results indicate that the hypertension-associated penile dysfunction might be treated with ARBs such as olmesartan better than calcium channel blockers, such as nifedipine.
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Affiliation(s)
- Shogo Shimizu
- Department of Pharmacology, Kochi Medical School, Kochi University, Nankoku, Japan
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Leoni LAB, Fukushima AR, Rocha LY, Maifrino LBMM, Rodrigues B. Physical activity on endothelial and erectile dysfunction: a literature review. Aging Male 2014; 17:125-30. [PMID: 24894579 DOI: 10.3109/13685538.2014.923836] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Physical inactivity, diabetes, hypertension, dyslipidemia, smoking and obesity were associated with imbalance in oxidative stress, leading to endothelial dysfunction. Such dysfunction is present in both cardiovascular disease (CVD) and erectile dysfunction (ED). ED is the persistent inability to achieve or sustain an erection sufficient for satisfactory sexual performance and is one of the first manifestations of endothelial damage in men with CVD risk factors. The purpose of this article is to review the results of studies involving physical activity, CVD, endothelial dysfunction and ED in order to verify its applicability for improving the health and quality of life of men with such disorders. There is consistent evidence that endothelial damage is intimately linked to ED, and this manifestation seems to be associated with the appearance CVDs. On the other hand, physical activity has been pointed out as an important clinical strategy in the prevention and treatment of CVDs and ED mainly associated with improvement of endothelial function. However, further experimental and clinical prospective investigations are needed to test the role of physical exercises in the modulation of endothelial function and their implications on erectile function and the appearance of CVDs.
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Affiliation(s)
- Luís Antônio B Leoni
- Human Movement Laboratory, São Judas Tadeu University (USJT) , São Paulo , Brazil
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Shadman Z, Akhoundan M, Poorsoltan N, Larijani B, Arzaghi SM, Khoshniat M. Factors associated with sexual function in Iranian women with type 2 diabetes mellitus: partner relationship as the most important predictor. IRANIAN RED CRESCENT MEDICAL JOURNAL 2014; 16:e14941. [PMID: 24829778 PMCID: PMC4005440 DOI: 10.5812/ircmj.14941] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/19/2013] [Revised: 10/30/2013] [Accepted: 12/07/2013] [Indexed: 11/23/2022]
Abstract
Background: No comprehensive study has been conducted on risk factors of sexual dysfunction in women with diabetes mellitus. Objectives: The aim of this study was to consider all possible influencing variables including hormonal, physical and, psychological status, socioeconomic status, and dietary intake to get more accurate and reliable results. Patients and Methods: Sexual function was assessed by Iranian validated female sexual function index (FSFI).The variables of the study were demographic and diabetes-related factors, stress-depression, physical activity, blood pressure, anthropometric measurements, lipid profile, cortisol, sex and thyroid hormones, 25-hydroxy vitamin D, and dietary intake. Results: Among all investigated variables, partner relationship showed a strong positive association with FSFI (β = 1.93 ± 0.41, P < 0.0001). In addition, not considering partner relationship, FSFI showed a significant negative association with age (β = -0.19 ± 0.20, P = 0.04), stress-depression score (β = -0.08 ± 0.04, P = 0.04), DD (β = -0.03 ± 0.01, P = 0.04), and systolic blood pressure (β = -0.14 ± 0.06, P = 0.03). Significant associations between FSFI and serum sex hormones and other biochemical were found in neither postmenopausal nor non-menopausal women. The means of SFSI in postmenopausal women were greater than non-menopausal (P = 0.02). Conclusions: It seems that in our population, female sexual function was much more than just a hormonal or physical problem and psychological factors, especially partner relationship and stress-depression, are the most determinants. In addition, age, duration of challenging with disease, and the lack of controlling systolic blood pressure were common factors that decreased sexual function.
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Affiliation(s)
- Zhaleh Shadman
- Endocrinology and Metabolism Research Center, Tehran University of Medical Sciences, Tehran, IR Iran
| | - Mahdieh Akhoundan
- Endocrinology and Metabolism Research Center, Tehran University of Medical Sciences, Tehran, IR Iran
| | - Nooshin Poorsoltan
- Endocrinology and Metabolism Research Center, Tehran University of Medical Sciences, Tehran, IR Iran
| | - Bagher Larijani
- Endocrinology and Metabolism Research Center, Tehran University of Medical Sciences, Tehran, IR Iran
| | - Seyed Masoud Arzaghi
- Endocrinology and Metabolism Research Center, Tehran University of Medical Sciences, Tehran, IR Iran
| | - Mohsen Khoshniat
- Endocrinology and Metabolism Research Center, Tehran University of Medical Sciences, Tehran, IR Iran
- Corresponding Author: Mohsen Khoshniat, Endocrinology and Metabolism Research Center, Tehran University of Medical Sciences, Tehran, IR Iran. Tel/Fax: +98-2184902477, E-mail:
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Kakkavas A, Tsioufis C, Tsiachris D, Thomopoulos C, Dimitriadis K, Milkas A, Alexopoulos D, Kallikazaros I, Stefanadis C. Erectile dysfunction and target organ damage in the early stages of hypertension. J Clin Hypertens (Greenwich) 2013; 15:644-9. [PMID: 24034657 PMCID: PMC8033829 DOI: 10.1111/jch.12159] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2013] [Revised: 05/17/2013] [Accepted: 05/21/2013] [Indexed: 11/27/2022]
Abstract
The authors investigated whether erectile dysfunction (ED) in the early stages of hypertension is associated with heightened end-organ damage. A total of 174 consecutive men with untreated, newly diagnosed essential hypertension (aged 50.3 years, office blood pressure [BP] 150/98 mm Hg) were studied. All participants underwent 24-hour ambulatory BP monitoring, blood examination, albumin-creatinine ratio, carotid-femoral pulse-wave velocity assessment, and echocardiography for estimation of left ventricular mass index and diastolic function. Hypertensive men with ED (n=43, 24.7%) compared with those without ED were older (by 6.4 years, P<.05), had greater 24-hour pulse pressure (by 4.3 mm Hg, P=.011) and a greater prevalence of nondipping status (72.2% vs 46.7%, P=.008), while the two groups did not differ in plasma glucose, lipid, creatinine, and albumin/creatinine ratio levels. Regarding cardiac adaptations, hypertensive men with ED exhibited only significantly lower tissue Doppler imaging-derived Em (by 1.6 cm/s, adjusted P=.035), while no difference in left ventricular mass index or pulse wave velocity were detected. ED in the setting of untreated newly diagnosed essential hypertension does not have an unfavorable impact on traditional markers of target organ damage. This finding suggests that ED assessment might not refine the traditional risk stratification procedure at least in the early stages of hypertensive disease.
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Affiliation(s)
| | - Costas Tsioufis
- First Cardiology ClinicHippocration HospitalUniversity of Athens Medical SchoolAthensGreece
| | - Dimitris Tsiachris
- First Cardiology ClinicHippocration HospitalUniversity of Athens Medical SchoolAthensGreece
| | - Costas Thomopoulos
- First Cardiology ClinicHippocration HospitalUniversity of Athens Medical SchoolAthensGreece
| | - Kyriakos Dimitriadis
- First Cardiology ClinicHippocration HospitalUniversity of Athens Medical SchoolAthensGreece
| | - Anastasios Milkas
- First Cardiology ClinicHippocration HospitalUniversity of Athens Medical SchoolAthensGreece
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Anyfanti P, Pyrpasopoulou A, Triantafyllou A, Doumas M, Gavriilaki E, Triantafyllou G, Gkaliagkousi E, Chatzimichailidou S, Petidis K, Avagianou PA, Zamboulis C, Aslanidis S, Douma S. The impact of frequently encountered cardiovascular risk factors on sexual dysfunction in rheumatic disorders. Andrology 2013; 1:556-62. [DOI: 10.1111/j.2047-2927.2013.00094.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2012] [Revised: 03/28/2013] [Accepted: 04/02/2013] [Indexed: 01/23/2023]
Affiliation(s)
- P. Anyfanti
- 2nd Prop. Department of Internal Medicine; Aristotle University; Thessaloniki; Greece
| | - A. Pyrpasopoulou
- Department of Rheumatology - 2nd Prop. Department of Internal Medicine; Aristotle University; Thessaloniki; Greece
| | - A. Triantafyllou
- 2nd Prop. Department of Internal Medicine; Aristotle University; Thessaloniki; Greece
| | - M. Doumas
- 2nd Prop. Department of Internal Medicine; Aristotle University; Thessaloniki; Greece
| | - E. Gavriilaki
- 2nd Prop. Department of Internal Medicine; Aristotle University; Thessaloniki; Greece
| | - G. Triantafyllou
- 2nd Prop. Department of Internal Medicine; Aristotle University; Thessaloniki; Greece
| | - E. Gkaliagkousi
- 2nd Prop. Department of Internal Medicine; Aristotle University; Thessaloniki; Greece
| | - S. Chatzimichailidou
- Department of Rheumatology - 2nd Prop. Department of Internal Medicine; Aristotle University; Thessaloniki; Greece
| | - K. Petidis
- 2nd Prop. Department of Internal Medicine; Aristotle University; Thessaloniki; Greece
| | - P.-A. Avagianou
- Laboratory of Developmental Psychology and Psychopathology; Preschool Education Department; University of Thessaly; Thessaly; Greece
| | - C. Zamboulis
- 2nd Prop. Department of Internal Medicine; Aristotle University; Thessaloniki; Greece
| | - S. Aslanidis
- Department of Rheumatology - 2nd Prop. Department of Internal Medicine; Aristotle University; Thessaloniki; Greece
| | - S. Douma
- 2nd Prop. Department of Internal Medicine; Aristotle University; Thessaloniki; Greece
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Abdul Latif R, Muhamad R, Kanagasundram S, Sidi H, Nik Jaafar NR, Midin M, Das S, Ng CG. Risk and associated factors of female sexual orgasmic disorder in women with hypertension in Malaysia. Asia Pac Psychiatry 2013; 5 Suppl 1:21-6. [PMID: 23857833 DOI: 10.1111/appy.12039] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
INTRODUCTION The objective of this study was to examine the risk of female sexual orgasmic disorder among a group of women with hypertension in Malaysia. The associated factors were also examined. METHODS This cross-sectional study involved 348 hypertensive women attending the primary care or hypertension clinic in a teaching hospital in Malaysia. Female sexual orgasmic disorder was assessed using the Orgasmic subscale of the Malay Version of the Female Sexual Function Index (MVFSFI). Basic socio-demographic data of the subjects was collected using a predesigned questionnaire. Medical records were reviewed to gather patients' medical information. RESULTS The risk of female sexual orgasmic disorder among hypertensive women was 14.1%. Univariate analysis found that older age, longer duration of marriage, lower educational level, and menopause were associated with higher risk of female sexual orgasmic disorder. These factors were not significant in multivariate analysis. DISCUSSION The risk of female sexual orgasmic disorder was relatively low in Malaysian women with hypertension. No risk factors were associated with female sexual orgasmic disorder in the current study.
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Affiliation(s)
- Rozimah Abdul Latif
- Department of Family Medicine, School of Medical Science, Universiti Sains Malaysia, Kelantan, Malaysia
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Holt E, Joyce C, Dornelles A, Morisky D, Webber LS, Muntner P, Krousel-Wood M. Sex differences in barriers to antihypertensive medication adherence: findings from the cohort study of medication adherence among older adults. J Am Geriatr Soc 2013; 61:558-64. [PMID: 23528003 DOI: 10.1111/jgs.12171] [Citation(s) in RCA: 82] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
OBJECTIVES To determine whether sociodemographic, clinical, healthcare system, psychosocial, and behavioral factors are differentially associated with low antihypertensive medication adherence scores in older men and women. DESIGN Cross-sectional analysis of baseline data. SETTING Cohort Study of Medication Adherence in Older Adults (N = 2,194). MEASUREMENTS Low antihypertensive medication adherence was defined as a score less than 6 on the 8-item Morisky Medication Adherence Scale. Information on risk factors for low adherence was collected using telephone surveys and administrative databases. RESULTS The prevalence of low medication adherence scores did not differ according to sex (women, 15.0%; men 13.1%; P = .21). In sex-specific multivariable models, having problems with medication cost and practicing fewer lifestyle modifications for blood pressure control were associated with low adherence scores in men and women. Factors associated with low adherence scores in men but not women were poor sexual functioning (odds ratio (OR) = 2.03, 95% confidence interval (CI) = 1.31-3.16 for men and OR = 1.28, 95% CI = 0.90-1.82 for women), and body mass index of 25.0 kg/m(2) or more (OR = 3.23, 95% CI = 1.59-6.59 for men; OR = 1.23, 95% CI = 0.82-1.85 for women). Factors associated with low adherence scores in women but not men included dissatisfaction with communication with their healthcare provider (OR = 1.75, 95% CI = 1.16-2.65 for women; OR = 1.16, 95% CI = 0.57-2.34 for men) and depressive symptoms (OR = 2.29, 95% CI = 1.55-3.38 for women; OR = 0.93, 95% CI = 0.48-1.80 for men). CONCLUSION Factors associated with low antihypertensive medication adherence scores differed according to sex. Interventions designed to improve adherence in older adults should be customized to account for the sex of the target population.
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Affiliation(s)
- Elizabeth Holt
- Center for Health Research, Ochsner Clinic Foundation, New Orleans, LA 70121, USA
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Doumas M, Viigimaa M, Papademetriou V. Combined Antihypertensive Therapy and Sexual Dysfunction: Terra Incognita. Cardiology 2013; 125:232-4. [DOI: 10.1159/000351696] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2013] [Accepted: 04/24/2013] [Indexed: 11/19/2022]
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Abstract
Sexual dysfunction is frequently encountered in hypertensive patients. Available data indicates that sexual dysfunction is more frequent in treated than in untreated patients, generating the hypothesis that antihypertensive therapy might be associated with sexual dysfunction. Several lines of evidence suggest that differences between antihypertensive drugs exist regarding their effects on sexual function. Older antihypertensive drugs (diuretics, beta blockers) exert detrimental effects on erectile function whereas newer drugs (nebivolol, angiotensin receptor blockers) have neutral or even beneficial effects. Phosphodiesterase (PDE)-5 inhibitors are effective in hypertensive patients and can be safely administered even when multidrug regimes are used. Precautions need to be taken with alpha blockers or patients with uncontrolled high-risk hypertension, while co-administration with nitrates is contraindicated.
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Affiliation(s)
- Athanasios Manolis
- Cardiology Department, Asclepeion General Hospital, 41, Thassou Street, 16672, Athens, Greece.
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Shaeer O, Shaeer K, Shaeer E. The Global Online Sexuality Survey (GOSS): Female Sexual Dysfunction among Internet Users in the Reproductive Age Group in the Middle East. J Sex Med 2012; 9:411-24. [DOI: 10.1111/j.1743-6109.2011.02552.x] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Javaroni V, Queiroz-Miguez M, Abreu-Casanova M, Oigman W, Neves MF. Brachial Flow-mediated Dilation Correlates With Vardenafil Response in Hypertensive Men With Vasculogenic Erectile Dysfunction. Urology 2011; 78:368-74. [DOI: 10.1016/j.urology.2011.02.070] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2010] [Revised: 02/25/2011] [Accepted: 02/25/2011] [Indexed: 01/22/2023]
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Allahdadi KJ, Hannan JL, Tostes RC, Webb RC. Endothelin-1 induces contraction of female rat internal pudendal and clitoral arteries through ET(A) receptor and rho-kinase activation. J Sex Med 2010; 7:2096-2103. [PMID: 20412427 PMCID: PMC3061306 DOI: 10.1111/j.1743-6109.2010.01816.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
INTRODUCTION Endothelin-1 (ET-1), a potent vasoconstrictor peptide, acts mainly through the Gprotein-coupled ET(A) receptor (ET(A)R). Increased vascular ET-1 production and constrictor sensitivity have been observed in various cardiovascular diseases, including hypertension, as well as erectile dysfunction. The internal pudendal artery (IPA) supplies blood to the vagina and clitoris. Inadequate blood flow through the IPA may lead to insufficient vaginal engorgement and clitoral tumescence. AIM Characterize the effects of ET-1 on the IPA and clitoral artery (CA). METHODS IPA and CA from female Sprague Dawley rats (225-250 g) were mounted in myograph chambers. Arterial segments were submitted to increasing concentrations of ET-1 (10-10-10-6 M). Segments were incubated with the ET(A)R antagonist, atrasentan (10-8 M) or the Rho-kinase inhibitor, Y-27632 (10-6 M) 30 minutes prior to agonist exposure. All E(max) values are expressed as % KCl-induced maximal contraction. ET(A)R, RhoA, and Rho-kinase expression from IPA was evaluated by Western blot. mRNA of preproET-1, ET(A)R, ET(B)R, RhoA, and Rho-kinase were measured by real time PCR. MAIN OUTCOME MEASURES ET-1 constrictor sensitivity in IPA and CA, protein expression and messenger RNA levels of ET-1-mediated constriction components. RESULTS ET-1 concentration-dependently contracted IPA (% Contraction and pD2, respectively: 156 ± 18, 8.2 ± 0.1) and CA (163 ± 12, 8.8 ± 0.08), while ET(A)R antagonism reduced ET-1-mediated contraction (IPA: 104 ± 23, 6.4 ± 0.2; CA: 112 ± 17, 6.6 ± 0.08). Pretreatment with Y-27632 significantly shifted ET-1 pD2 in IPA (108 ± 24, 7.9 ± 0.1) and CA (147 ± 58 and 8.0 ± 0.25). Protein expression of ET(A)R, ET(B)R, RhoA, and Rho-kinase were detected in IPA. IPA and CA contained preproET-1, ET(A)R, ET(B)R, RhoA, and Rho-kinase message. CONCLUSION We observed that the IPA and CA are sensitive to ET-1, signaling through the ET(A)R and Rho-kinase pathway. These data indicate that ET-1 may play a role in vaginal and clitoral blood flow and may be important in pathologies where ET-1 levels are elevated.
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Affiliation(s)
| | | | - Rita C Tostes
- Medical College of Georgia-Physiology, Augusta, GA, USA; University of Sao Paulo-Pharmacology, Sao Paulo, Brazil
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Sexual dysfunction: the 'prima ballerina' of hypertension-related quality-of-life complications. J Hypertens 2008; 26:2074-84. [PMID: 18854743 DOI: 10.1097/hjh.0b013e32830dd0c6] [Citation(s) in RCA: 97] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Sexual dysfunction is currently considered a serious quality-of-life-related health problem, exerting a major impact on patients' and their sexual partners' life. Available data indicate that essential hypertension is a risk factor for sexual dysfunction, as male and female sexual dysfunction is more prevalent in hypertensive patients than normotensive individuals. Several mechanisms have been implicated in the pathogenesis of sexual dysfunction in hypertensive patients, and major determinants include severity and duration of hypertension, age, and antihypertensive therapy. Female sexual dysfunction, although more frequent than its male counterpart, remains largely under-recognized. Older antihypertensive drugs (diuretics, beta-blockers, centrally acting) exert negative results, whereas newer drugs have either neutral (calcium antagonists, angiotensin-converting enzyme inhibitors) or beneficial effects (angiotensin receptor blockers). Erectile dysfunction is related to ischemic heart disease and might be an 'early therapeutic window' of asymptomatic coronary artery disease. It seems of utmost importance for every physician treating hypertensive patients to become familiar with sexual dysfunction (through better education and specific seminars) for the proper management of these patients.
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Doumas M, Tsiodras S, Tsakiris A, Douma S, Chounta A, Papadopoulos A, Kanellakopoulou K, Giamarellou H. Female sexual dysfunction in essential hypertension: a common problem being uncovered. J Hypertens 2006; 24:2387-92. [PMID: 17082720 DOI: 10.1097/01.hjh.0000251898.40002.5b] [Citation(s) in RCA: 109] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
OBJECTIVES Female sexual dysfunction (FSD) is increasingly attracting more scientific and public interest, and represents a poorly investigated issue in patients with essential hypertension. We evaluated the prevalence of sexual dysfunction in hypertensive women compared with normotensive women according to age, hypertension severity, hypertension duration, and antihypertensive treatment. METHODS The study population consisted of consecutive, sexually active women attending an outpatient hypertension clinic. The Female Sexual Function Index (FSFI questionnaire) was used to evaluate FSD. Univariate and multivariate analyses were used to evaluate predictors of FSD. RESULTS Four hundred and seventeen women were studied. From them, 216 women had arterial hypertension (136 treated, 80 untreated) and 201 were normotensive. Sexual dysfunction was found in 42.1% of hypertensive women compared with 19.4% of normotensive women (odds ratio, 3.2; 95% confidence interval, 1.9-4.7; P < 0.001). Systolic blood pressure levels were significantly related to FSFI score (r = -0.67, P < 0.001). Successful control of hypertension was related to lower prevalence of FSD. Increasing age (beta = -0.187, P = 0.001), increasing systolic blood pressure (beta = -0.687, P < 0.001), and beta-blocker administration (beta = -0.162, P = 0.001) were significant predictors of sexual dysfunction in this patient population. CONCLUSIONS FSD is more prevalent in women with essential hypertension compared with women with normal blood pressure, and its prevalence declines with adequate blood pressure control. Adequate control of hypertension with medication not affecting sexual function can have a great impact on the quality of life of hypertensive patients. Physicians should recognize and properly manage FSD in hypertensive women.
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Affiliation(s)
- Michael Doumas
- Hypertension Outpatient Clinic, 4th Department of Internal Medicine, University of Athens, Attikon Hospital, Greece.
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