Anti-hypertensive medications and erectile dysfunction: focus on β-blockers

Although anti-hypertensive medications, including thiazides and β-blockers (BBs) in particular, have been suggested to cause erectile dysfunction (ED) their real contribution is still conflicting. The aim of this paper is to summarize available evidence providing an evidence-based critical analysis of the topic.

An overall comprehensive narrative review was performed using Medline, Embase and Cochrane search. In addition, to better understand the impact of BBs on ED a specific systematic review was also performed.

The negative role of centrally acting drugs, such as clonidine and α-methyldopa, is well documented althuogh limited controlled trials are available. Angiotensin-converting enzyme inhibitors (ACEis), angiotensin receptor blockers (ARBs), and calcium-channel-blockers (CCBs) have neutral (CCBs) or even positive (ACEis and ARBs) effects on erectile function. Despite some preliminary negative reports, more recent evidence does not confirm the negative impact of thiazides. BBs should be still considered the class of medications more often associated with ED, although better outcomes can be drawn with nebivolol.

Sexual function should be assessed in all patients with arterial hypertension, either at diagnosis or after the prescription of specific medications. A close related patient-physician interaction and discussion can overcome possible negative outcomes allowing a successful management of possible side effects.