¹Heart Institute, Good Samaritan Hospital (USC), Los Angeles, CA, USA

Correspondence: Dr R Kloner, Heart Institute, Good Samaritan Hospital (USC), 1225 Wilshire Blvd, 9th Floor Research, Los Angeles, CA 90017, USA. E-mail: rkloner@goodsam.org

Received 10 August 2006; Revised 21 September 2006; Accepted 27 September 2006; Published online 7 December 2006.

Abstract

Recent analyses suggest that about 67–68% of men with hypertension have some degree of erectile dysfunction (ED). With about 25 million men in the US with hypertension, substantial numbers of hypertension-related ED exist that tend to be of a more severe nature than the general population. Men with ED are also more likely to have hypertension. Thiazide diuretic and beta-blocker therapy may contribute to ED. Phosphodiesterase-5 (PDE5) inhibitors are effective therapy in men with ED owing to hypertension who are taking antihypertensive medicines including those on multiple antihypertensive medicines. The addition of PDE5 inhibitors to usual common antihypertensive medicines (diuretics, beta blockers, calcium blockers, angiotensin converting enzyme inhibitors and angiotensin receptor blockers) results in either no or small additive reductions in blood pressure (BP) and no increase in serious clinical adverse events. There are however precautions regarding the use of PDE5 inhibitors in patients taking alpha blockers for either hypertension or benign prostatic hypertrophy, as some patients may develop orthostatic hypotension. Organic nitrates remain an absolute contraindication for PDE5 inhibitors because synergistic and symptomatic reductions in BP may occur in some patients with this drug combination.