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Newest Hypertension Drugs May Improve Sexual Function

Sexual dysfunction in men with high blood pressure may be aided by the newest type of hypertension drug, according to a study in this month''s American Journal of the Medical Sciences, a publication of the Southern Society for Clinical Investigation.

After 12 weeks of treatment with the drug losartan, 88 percent of hypertensive males with sexual dysfunction reported improvement in at least one area of sexuality, said Carlos Ferrario, M.D., of Wake Forest University Baptist Medical Center (WFUBMC). The percentage of men reporting impotence dropped from 75.3 to 11.8.

"These results suggest a possible solution for people who''ve stopped taking blood pressure medicines because they interfere with sexual function," said Ferrario, director of WFUBMC''s Hypertension and Vascular Disease Center. "In addition to controlling blood pressure as well or better than other medications, losartan seems to have a positive effect on sexuality."

This is the first published report of the results, which were presented orally at a satellite session of the American Heart Association''s annual meeting last fall.

The study was conducted in Spain by Ferrario and colleagues at the University of Valencia School of Medicine and Hospital Marina Alta. It used a self-administered questionnaire to screen 323 men and women with hypertension for sexual dysfunction, which includes decreased libido, impotence, and poor sexual satisfaction. Sexual dysfunction was diagnosed in 82 men, a prevalence of 42 percent.

These 82 men were compared to an equal number of hypertensive men without sexual dysfunction. Both groups took 50 to 100 milligrams of losartan (sold under the brand name of Cozaar) daily for 12 weeks. They completed the questionnaire at both the beginning and end of the treatment period.

In the men with sexual dysfunction, 88 percent reported improvement in at least one area of sexual function after treatment with losartan. The number reporting overall sexual satisfaction increased from 7.3 percent to 58.5 percent. The number reporting a high frequency (at least once a week) of sexual activity improved from 40.5 percent to 62.3 percent. An improved quality of life was reported by 73.7 percent of the men with sexual dysfunction.

Similar results were reported in a small group of women treated with losartan. The sample size, however, was too small for the results to be statistically validated.

In the group of men without sexual dysfunction, the drug treatment produced no changes in sexual function or satisfaction.

Ferrario said the results are promising and point to the need for additional research.

"This study was performed in a non-random sample, so we must be careful in extrapolating the findings to the general hypertensive population," said Ferrario. "However, the consistent nature of the findings points out the need for larger clinical trials on this subject."

In the study, losartan was equal to or better than other drugs at controlling blood pressure. Losartan works by blocking angiotensin, a hormone that causes high blood pressure, and keeping it from binding to body tissues.

"Our finding that impotence improved in men taking losartan supports the theory that angiotensin contributes to sexual dysfunction," said Ferrario. "This helps debunk the myth that impotence is caused by hypertension drugs. In fact, it appears that sexual dysfunction is part of the hypertension disease process. Certain drugs, such as beta blockers and diuretics, can aggravate sexual dysfunction, but we don''t believe they cause it."

Ferrario said losartan may improve sexual function and satisfaction in two ways: by acting on blood vessels in the penis that have been damaged by high blood pressure and by acting in the brain to improve well-being.

"Aside from its vascular effects, losartan may affect the central nervous system," said Ferrario. "This suggestion comes from findings that sexual satisfaction improved even in men who had reported having sex once a day."

The research was funded by an unrestricted educational grant from Merck Sharp & Dohme Spain to the Spanish investigators.

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