Hypertension erectile dysfunction with

There is a higher incidence of impaired sexual function in men who take finasteride compared with placebo (58,59). The incidence of erectile dysfunction has been estimated at 5% (60), but it is difficult to estimate, since in many users of the drug other causes are present, including advanced age, heart disease, diabetes, hypertension, smoking, and hypercholesterolemia. Benign prostatic hyperplasia itself can also aggravate or even induce erectile dysfunction. A questionnaire study in New Jersey... 

The adverse effects of thiazide and thiazide-like diuretics on male sexual function include reduced libido, erectile dysfunction, and difficulty in ejaculating. The exact incidence of sexual dysfunction in patients taking diuretics is poorly documented, perhaps because of the personal nature of the problem and the reluctance of patients and/or physicians to discuss it. However, these abnormalities have been reported with incidence rates of 3-32%. The true incidence of sexual dysfunction probably lies closer to the lower end of this range (119). In a meta-analysis of 13 randomized, placebo-controlled trials conducted over a mean of 4 years the NNH (number needed to harm) for erectile impotence with thiazide diuretics in hypertension was 20 and the relative risk was 5.0 (120). 

To date, the actions of sildenafil in vascular disorders distinct from that of erectile dysfunction have yet to be studied adequately. For example, oral sildenafil is an effective and specific pulmonary vasodilator in patients with pulmonary arterial hypertension (146a). 

Hypertensive men frequently have arterial dysfunction, which can result in erectile dysfunction. Therefore, erectile dysfunction may be associated mostly with chronic arterial changes resulting from elevated BP, and lack of control may increase the risk of erectile dysfunction. These changes are even more pronounced in hypertensive men with diabetes. 

Although erectile dysfunction is sometimes assumed to be a symptom of the aging process in men, it is unclear if the incidence is directly related to increasing patient age. Erectile dysfunction more likely results from concurrent medical conditions of the patient (e.g., hypertension, arteriosclerosis, hyperlipidemia, diabetes melli-tus, or psychiatric disorders) or from medications that patients may be taking for these diseases. " For example, up to 50% of patients with diabetes mellitus develop erectile dysfunction, and medications such as /3-blockers are associated with a high incidence of erectile dysfunction. 

Diseases that compromise vascular flow to the corpora caver-nosum (e.g., peripheral vascular disease, arteriosclerosis, and essential hypertension) are associated with an increased incidence of erectile dysfunction. Diseases that impair nerve conduction to the brain (e.g., spinal cord injury or stroke) or conditions that impair peripheral nerve conduction to the penile vasculature (e.g., diabetes mellitus) can result in erectile dysfunction. 

Cirrhosis, alcoholic hepatitis, pancreatitis, gastric or duodenal ulcer, esophageal varices, middle-age onset of diabetes, gastrointestinal cancer, hypertension, peripheral neuropathies, myopathies, cardiomyopathy, cerebral vascular accidents, erectile dysfunction, vitamin deficiencies, pernicious anemia, and brain disorders including Wemicke-Korsakoff syndrome (mortality rate of untreated Wernicke is 50% treatment is with thiamine)... 

For sildenafil, when used for erectile dysfunction, the manufacturers recommend that a low starting dose of sildenafil (25 mg) should be considered if ketoconazole or itraconazole are used concurrently. When used for pulmonary hypertension, the manufacturers say that concurrent use of sildenafil with ketoconazole and itraconazole is contraindicated in the UK, or not recommended in the US. ... 

For sildenafil, the manufacturers recommend that a low starting dose of sildenafil 25 mg should be considered in patients with erectile dysfunction taking inhibitors of CYP3A4 such as erythromycin. For pulmonary hypertension, the UK manufacturer says that a downward reduction of the sildenafil dose to 20 mg twice daily should be considered with erythromycin, and 20 mg once daily with clarithromycin or telithromycin, (however, note that erythromycin had a greater effect than clarithromycin in the studies above) whereas the US manufacturer says that no dose adjustment is needed with erythromycin. ... 

Vascular pathology may involve lesions of the inflow or outflow mechanisms of penile erection. Erectile dysfunction may be a manifestation of generalized atherosclerosis and may even be its initial presentation. Common risk factors associated with generalized penile arterial insufficiency include hypertension, hyperlipidemia, cigarette smoking, diabetes mellitus, and pelvic irradiation (Rosen et al. 1991). Less commonly, local stenosis of the conunon penile artery may occur in men who have sustained blunt pelvic or perineal trauma (Levine et al. 1990). 

Erectile dysfunction may be the first manifestation of many diseases including diabetes mellitus, coronary artery disease, hyperlipidemia, hypertension, spinal-cord compression, pituitary tumors, and pelvic malignancies. For example, a recent prevalence study found that men with erectile dysfunction were twice as likely to have DM and concluded that erectile dysfunction may be used as an early marker for DM. This relationship was particularly strong in the younger age groups, in vdiich the odds ratio of having DM was 3 (Sun et al. 2006). Two earlier studies found that 11% (Maatman et al. 1987) and 12% (Deutsch and Sherman 1980) of impotent men were found to have previously undiagnosed DM. 

Erectile dysfunction is a multi-factorial disorder and a common presentation for several systemic illnesses, particularly vascular ocdusive diseases such as diabetes, arterial hypertension, and atherosclerosis. Few patients consult their dortor, and only a small proportion of them receive treatment Only few doctors take the initiative to discuss the question of their patients sex life (Costa et al. 2005). In fact, the dinician must be familiar with the pathophysiologic mechanisms of erectile dysfunction, its associations with other systemic diseases, the indications for spedalist referral, and the role of specialized testing to diagnose and treat this disorder effectively (Lobo and Nehra 2005). 

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