Health

Is your hypertension drug impacting your libido?

Published by

3 years ago

Living with high blood pressure doesn’t have to mean giving up a satisfying sex life. SADE OGUNTOLA reports that talking openly with one’s doctor can help with managing treatment and overcoming sexual challenges without it resulting in poor quality of life.

M R Henry Adekola has stopped taking his high blood pressure medicines. At the hospital, the nurse who took the reading was disturbed that he came to ask if he could change the medications that the doctor prescribed for its control.

“I was at the barber’s place and playing draughts when the barber and his other customers were exchanging banter on hypertension drugs and poor libido in men. I couldn’t join them but was listening because initiating sexual relationships was becoming more difficult because of fear of inadequate sexual performance or rejection,” said Mr Adekola.

He added: “Although after I commenced the hypertension drugs, I slept better at night. I fear losing my manhood or having a decreased sexual capacity at age 50, especially now that I have two wives. My younger wife has a baby girl and she is very sexually active.”

Like Mr Adekola, with age, many men experience erectile dysfunction and it could be a sign of a health problem. Trouble getting or keeping an erection, what is medically termed erectile dysfunction, is a common complaint in hypertensive men and can be caused by a systemic vascular disease, a side effect of anti-hypertensive medication or a frequent concern that may impair drug compliance.

The World Health Organisation (WHO) states that a blood pressure reading of more than 140/90 mm/Hg is considered high, while a measurement of over 180/110 mm/Hg is categorised as dangerously severe. If not properly treated, it can lead to other serious health conditions.

ALSO READ FROM NIGERIAN TRIBUNE

Dr Samuel Ajayi, a hypertension expert at the University College Hospital, Ibadan, says erectile difficulty is one complaint why men with hypertension stop medication, although hypertension as a health problem is not its cause.

He stated: “Most people relate erectile dysfunction to having hypertension, but it will not cause a poor sex drive directly. Many people with depression, diabetes, urinary tract diseases, and high cholesterol level, who have lost interest in sexual intercourse or have a lot of worries in life that needs to be addressed, can also experience sexual dysfunction.

“Most of the common drugs that are used in the hospital to treat hypertension today will not cause a sexual problem, but that does not mean that a person that has hypertension cannot have low libido or trouble getting or keeping an erection; that is why people with such complaints must visit the doctor treating them.”

Dr Ajayi said although other some older blood pressure-lowering medications (beta-blockers and diuretics) have been documented to be linked with trouble getting or keeping an erection in a subgroup of men, these older drugs are still safe and commonly prescribed for women that have hypertension during pregnancy.

He said it is a misconception that all blood pressure-lowering medications cause sexual problems, adding that “even complicated hypertension is not one of the common causes of trouble getting or keeping an erection.”

According to him, “Even when a man comes complaining in the hospital that the blood pressure-lowering medications he is taking are making him have sexual problems like erectile dysfunction, all that needs to be done is to change it to another one.”

He stated that many people relate hypertension to erectile dysfunction because both conditions share some risk factors, mainly sedentary lifestyle, diet, obesity, smoking habit and elevated alcohol consumption.

Dr Ajayi, however, warned that poor adherence to blood pressure-lowering medications is dangerous, as it could lead to problems like stroke, heart attack, heart disease, kidney problems and consequently death.

Meanwhile, experts, in a presentation at the European Society of Cardiology (ESC) Congress 2020, said men with untreated high blood pressure have poorer penile blood flow than those with normal blood pressure. Still, the differences disappeared with blood pressure medication.

The study, which provides reassurance to men concerned about the effects of blood pressure-lowering medications, said the blood flow differences across the three blood pressure categories (normal, high-normal, and hypertension) disappeared with treatment, suggesting a medication effect.

The study examined the association between blood pressure level and penile blood flow, and whether blood pressure-lowering medication affected the relationship. It included 356 men with erectile dysfunction and no history of diabetes or cardiovascular disease who attended a clinic between 2006 and 2019.

Dr Augustus Takure, a consultant urologist at the University College Hospital, Ibadan, said poor blood flow to the penis as a result of the hardening and narrowing of the blood vessels, arising from uncontrolled hypertension, can overtime contribute to trouble getting or keeping an erection.

“In some instances, it is worse when the blood pressure is not controlled due to poor blood pressure-lowering medication adherence,” he added.

Dr Takure noted that changing hypertensive medications in men with erectile dysfunction must be handled with caution because different hypertensive medications are prescribed to treat different points in the body, and with consideration for other co-existing diseases.

He said: “Different hypertensive medications treat at different levels; they treat at the levels of the kidney, the heart and the blood vessels to ensure good blood pressure control. All these levels can affect sexual function like erectile dysfunction in a man. For instance, the heart must be pumping blood well and the blood vessels must be in a good form to deliver blood.”

Dr Takure said a combination of hypertension mediations is required in maintain good blood control where there are other coexisting conditions like coronary artery disease, and as such, there is a need for caution in handling complaints on hypertensive medications and the reason they are always referred back to the initial doctor that gave the prescription for the hypertension medication.

He also said it is important that men know that switching to another hypertensive medication does not guarantee either the restoration or improvement of erectile function. As such, their expectations should be reasonable.

Largely, people including health care professionals, believe that erectile dysfunction is psychological in origin. Although considerable advances have been made in its diagnosis and treatment in the past decades, men hardly talk about it due to embarrassment, ignorance, myths, superstition, guilt, stigma and taboo attached to anything sexual in the minds of people. Some also believe it is a normal part of ageing.

Still, the choices that men with high blood pressure make can add to the problem. Smoking, lack of exercise, poor diet and drinking a lot of alcohol, especially, are some of those. Smoking increases blood pressure, damages blood vessels and reduces blood flow. Obesity is an independent predictor of erectile difficulties. Physical activity has been demonstrated to reduce a man’s chance of having this challenge.

In many studies in Nigeria, it is established that erectile difficulties are highly prevalent in men with hypertension and its causes may be diverse. Assessment of hypertensive men for erectile dysfunction ought to be part of routine medical care.

Both issues are highly relevant and need to be actively screened, prevented and treated by physicians involved in patients with hypertension, because it is a marker of higher risk for other health issues like stroke and heart failure. It also impairs quality of life.