Sexual sequelae of antihypertensive drugs: Treatment effects on self-report and physiological measures in middle-aged male hypertensives

A cross-sectional study on 220 men, aged 41-93 yr, was conducted to determine whether age-related changes in circulating pituitary and gonadal hormone levels are related to quantitatively assessed changes in sexuality over this age span. The conclusion of most previous studies, that total and free plasma testosterone (T) levels decline with advancing age as gonadotropins increase, was corroborated. These changes were found to roughly parallel a decline in sexual function affecting the level of sexual activity, libido, and potency measures. PRL and estradiol did not change with age, and the age-related decline in free T was greater than that in total T. Decreases in free T and increases in LH manifested significant, but small, correlations with sexual hypofunction. Behavioral variables were also clearly related to LH and to the ratio of free T to LH and estradiol. The data also suggested that aging and hormonal changes were more strongly related to sexual activity and nocturnal erections that to libido (enjoyment, drive, and thoughts). Partial correlation procedures demonstrated that diseases and drugs were not responsible for the hormone-behavior relationships. Declining androgen levels, reduced sexual activity, and decreased sexual interest thus appear to be related sequelae of the aging process in men. Hormonal factors do not completely account for age-related changes in sexuality, although the full explanation of these changes must include a consideration of hormonal factors.

To evaluate treatment of mild hypertension using combinations of diet and low-dose pharmacologic therapies. Multicenter, randomized, placebo-controlled clinical trial. Three university-based tertiary care centers. Patients (697) 21 to 65 years of age with diastolic blood pressure between 90 and 100 mm Hg as well as weight between 110% and 160% of ideal weight. Patients were stratified by clinical center and race and were randomly assigned to one of three diets (usual, low-sodium and high-potassium, weight loss) and one of three agents (placebo, chlorthalidone, and atenolol). Changes in measures of sexual problems, distress, and well-being after 6 months of therapy were analyzed. Low-dose chlorthalidone and atenolol produced few side effects, except in men. Erection-related problems worsened in 28% (95% CI, 15% to 41%) of men receiving chlorthalidone and usual diet compared with 3% (CI, 0% to 9%) of those receiving placebo and usual diet (P = 0.009) and 11% (CI, 2% to 20%) of those receiving atenolol and usual diet (P greater than 0.05). The weight loss diet ameliorated this effect. The low-sodium diet with placebo was associated with greater fatigue (34%; CI, 23% to 45%) than was either usual diet (18%; CI, 10% to 27%; P = 0.04) or weight reduction (15%; CI, 7% to 23%; P = 0.009). The low-sodium diet with chlorthalidone increased problems with sleep (32%; CI, 22% to 42%) compared with chlorthalidone and usual diet (16%; CI, 8% to 24%; P = 0.04). The weight loss diet benefited quality of life most, reducing total physical complaints (P less than 0.001) and increasing satisfaction with health (P less than 0.001). Total physical complaints decreased in 57% to 76% of patients depending on drug and diet group, and were markedly decreased by weight loss. In general, low-dose antihypertensive drug therapy (with chlorthalidone or atenolol) improves rather than impairs the quality of life; however, chlorthalidone with usual diet increases sexual problems in men.