Sexual Dysfunction in Patients with Hypertension: Implications for Therapy

Carlos M. Ferrario, MD, Pavel Levy, MD

In This Article

Effects of Sexual Dysfunction on Quality of Life and Compliance With Therapy

Sexual dysfunction associated with antihypertensive agents may impact the ability of patients to stay on therapy and lead to an impaired quality of life.[6,7,8] Sexual dysfunction is an important reason that patients discontinue antihypertensive medications, as exemplified by the findings of the Medical Research Council (MRC) trial in 17,354 hypertensive patients studied over 5.5 years.[25] In this study, premature withdrawal due to impotence occurred at a significantly higher rate in patients receiving either a thiazide diuretic (p<0.001) or blocker (p<0.001) than in placebo-treated patients (12.6% and 6.3% vs. 1.3% per 1000 patient-years, respectively). However, it must be pointed out that the MRC study was of single-blind design, and thus the findings should be interpreted with caution.

Sexual dysfunction associated with antihypertensive therapies may also impact the quality of life of hypertensive patients, especially as reported in instruments that address sexual functioning or distress.[4,26] As early as 1982, Jachuck and colleagues[27] reported an association of sexual dysfunction with impairment of quality of life in hypertensive patients treated primarily with diuretics, blockers, or methyldopa (the last, of course, is no longer commonly used in antihypertensive therapy because of its high association with side effects). Approximately 78% of patients who had severe quality of life impairment (according to spouses' ratings) had a reduction in or no sexual interest. In contrast, only 38% of patients with mild impairment of quality of life had reduced sexual function. It must be noted, however, that not all studies have reported a relation between antihypertensive therapy and sexual dysfunction, and in one review of six randomized trials, short-term exposure to antihypertensive drugs was associated with a prevalence of self-reported impotence that was similar to that in placebo-treated patients.[23] Further, in the Trial of Antihypertensive Interventions and Management (TAIM),[28] a multicenter, randomized, placebo-controlled trial in patients with mild hypertension, low-dose antihypertensive drug therapy (with chlorthalidone or atenolol) actually improved, rather than impaired, quality of life.