Effects of Antihypertensive Drugs on Sexual Function

 Tiejun Tang

Hypertension is common conditions that affect millions of people worldwide. Antihypertensive drugs are the mainstay of treatment for these conditions, and they are highly effective in controlling blood pressure. However, these drugs may have unwanted side effects on sexual function, which can significantly impact quality of life. Sexual dysfunction can lead to reduced self-esteem, anxiety, and depression, which can exacerbate the underlying conditions. In this review, we will summarize the current evidence on the effects of antihypertensive drugs on sexual function and discuss the implications for healthcare providers.

Effects of Antihypertensive Drugs on Sexual Function: Beta-blockers, calcium channel blockers, and diuretics are the most commonly used antihypertensive drugs. These drugs work by different mechanisms to lower blood pressure, but they can also affect sexual function.

Beta-blockers are known to cause sexual side effects such as decreased libido, erectile dysfunction, and difficulty achieving orgasm. A systematic review and meta-analysis of randomized controlled trials found that beta-blockers were associated with a higher risk of sexual dysfunction compared to placebo^[1]. Another study found that the sexual side effects of beta-blockers were dose-dependent, with higher doses associated with greater risk of sexual dysfunction ^[2].

Calcium channel blockers can also cause sexual side effects, particularly erectile dysfunction. A randomized controlled trial of hypertensive patients found that treatment with amlodipine, a commonly used calcium channel blocker, was associated with a higher risk of erectile dysfunction compared to treatment with irbesartan, an angiotensin receptor blocker ^[3].

Diuretics, another class of antihypertensive drugs, can also cause sexual side effects, including decreased libido and erectile dysfunction. A study of hypertensive men found that treatment with hydrochlorothiazide, a commonly used diuretic, was associated with a higher risk of erectile dysfunction compared to treatment with an angiotensin receptor blocker ^[4].

If patients experience sexual side effects, healthcare providers may need to adjust the medication or recommend alternative treatments. Chinese herbal medicine is a good choice in this condition.

Chinese herbal medicine (CHM) has been used for centuries for the prevention and treatment of hypertension in China. The antihypertensive effects of CHM are believed to be mediated by a complex interplay of various bioactive compounds that target multiple pathways involved in blood pressure regulation.

One of the main mechanisms of CHM in lowering blood pressure is by promoting vasodilation through the release of nitric oxide (NO) and/or inhibition of vasoconstrictor agents such as angiotensin II (Ang II) and endothelin-1 (ET-1) ^[5]. For example, some CHM such as Radix Salviae Miltiorrhizae (Danshen) and Ginkgo biloba have been shown to increase NO production, leading to relaxation of vascular smooth muscle cells and consequent vasodilation ^[6,7]. Other CHM such as Rhizoma Chuanxiong and Ligusticum wallichii have been shown to inhibit the production and release of ET-1, a potent vasoconstrictor, by blocking the activation of its signaling pathways ^{[8, 9]}.

Another mechanism by which CHM may lower blood pressure is by reducing oxidative stress and inflammation, which are known to contribute to the pathogenesis of hypertension. CHM such as Radix Astragali (Huangqi) and Radix Rehmanniae (Dihuang) have been shown to possess potent antioxidant and anti-inflammatory properties, which can protect endothelial cells from damage and improve vascular function ^{[10, 11].}

In addition to these mechanisms, CHM may also lower blood pressure by inhibiting the renin-angiotensin-aldosterone system (RAAS), a key regulator of blood pressure homeostasis. CHM such as Radix Polygoni Multiflori (Heshouwu) and Radix Bupleuri (Chaihu) have been shown to block the activation of the RAAS by inhibiting the production and release of renin and Ang II, two important mediators of the system ^{[12, 13].}

Overall, the antihypertensive effects of CHM are likely due to the synergistic actions of multiple bioactive compounds targeting multiple pathways involved in blood pressure regulation.

Use natural herbal medicine to replace the chemical drugs, the side effects can be avoided.

References:

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