Sexual Dysfunction in Patients with Hypertension: Implications for Therapy

Carlos M. Ferrario, MD, Pavel Levy, MD

In This Article

Prevalence of Sexual Dysfunction in Hypertensive Patients

Several reports collectively spanning more than three decades indicate that 2.4%-58% of hypertensive males experience one or more symptoms of sexual dysfunction of varying degrees of severity during antihypertensive drug therapy.[9,11,15,16,17,19,22,23] It is also true, however, that hypertensive patients also experience sexual dysfunction prior to taking medication, when compared to normotensive subjects. This finding, while quite consistent with the physiologic changes noted in hypertensive individuals, is often neglected in the overall assessment of subjects and in the formulation of a therapeutic scheme. The large variations in the prevalence of sexual problems reported in the literature most likely reflect differences in study methodology (lack of control subjects), types of antihypertensive medications taken, the presence of confounding medications, age differences of study populations, and cultural and socioeconomic factors. In the clinical practice setting, the prevalence of sexual dysfunction is likely to be even higher than that reported in clinical trials because the personal nature of this problem often leads to an unwillingness of many patients and/or physicians to openly discuss this issue.

Although most research on sexual dysfunction has focused almost exclusively on men,[24] women with hypertension are also at risk of developing sexual dysfunction. According to a 1994 survey, sexually active women aged 60-80 years who were receiving antihypertensive medications (atenolol, enalapril, or isradipine) experienced sexual dysfunction, as manifested as a difficulty achieving orgasm, inadequacy of vaginal lubrication, and diminished libido.[10] However, in the absence of a control group of hypertensive women who were not receiving antihypertensive therapy, it is difficult to accurately assess the effect of antihypertensive medication on sexual functioning.