Abstract
Pathogenesis of erectile dysfunction (ED) is related to endothelial dysfunction and therefore associated with cardiovascular risk factors. Patients with a combination of risk factors, as in metabolic syndrome, are thus likely to have an increased risk of developing endothelial and ED. The angiotensin receptor antagonist irbesartan has been shown to improve endothelial function in cardiovascular high-risk patients, which suggests a beneficial effect of treatment with irbesartan on ED. The aim of the present study was to determine the influence of irbesartan on ED in patients with a metabolic syndrome. A total of 1069 consecutive hypertensive patients with a metabolic syndrome from the Documentation of hypertension and metabolic syndrome in patients with Irbesartan Treatment survey were included. Patients were treated with irbesartan or the combination of irbesartan/hydrochlorothiazide for 6 months. ED was assessed using the international index of erectile function. The Cologne Evaluation Questionnaire of Erectile Dysfunction served as a control. Erectile function increased significantly (P<0.0001) after 6 months of treatment with irbesartan, irrespective of dosage and independent of additional treatment with hydrochlorothiazide. Prevalence of ED declined to 63.7% from 78.5% at baseline, along with a significant increase in orgasmic function (P<0.001) and intercourse satisfaction (P<0.001). Treatment with irbesartan alone, as well as in combination with hydrochlorothiazide is associated with an improvement of sexual desire, frequency of sexual contacts and erectile function in hypertensive patients with the metabolic syndrome. These results suggest a beneficial role of angiotensin receptor antagonists in the treatment of metabolic syndrome, and ED.
This is a preview of subscription content, access via your institution
Access options
Subscribe to this journal
Receive 8 print issues and online access
$259.00 per year
only $32.38 per issue
Rent or buy this article
Prices vary by article type
from$1.95
to$39.95
Prices may be subject to local taxes which are calculated during checkout
Similar content being viewed by others
References
National Institutes of Health. Impotence. NIH Consens State 1992; 10: 1–33.
Braun M, Wassmer G, Klotz T, Reifenrath B, Mathers M, Engelmann U . Epidemiology of erectile dysfunction: results of the ‘Cologne Male Survey’. Int J Impot Res 2000; 12: 305–311.
Feldman HA, Johannes CB, Derby CA, Kleinman KP, Mohr BA, Araujo AB et al. Erectile dysfunction and coronary risk factors: prospective results from the Massachusetts male aging study. Prev Med 2000; 30: 328–338.
Feldman HA, Goldstein I, Hatzichristou DG, Krane RJ, McKinlay JB . Impotence and its medical and psychosocial correlates: results of the Massachusetts male aging study. J Urol 1994; 151: 54–61.
Griendling KK, Minieri CA, Ollerenshaw JD, Alexander RW . Angiotensin II stimulates NADH and NADPH oxidase activity in cultured vascular smooth muscle cells. Circ Res 1994; 74: 1141–1148.
Rajagopalan S, Kurz S, Munzel T, Tarpey M, Freeman BA, Griendling KK et al. Angiotensin II-mediated hypertension in the rat increases vascular superoxide production via membrane NADH/NADPH oxidase activation. Contribution to alterations of vasomotor tone. J Clin Invest 1996; 97: 1916–1923.
Kifor I, Williams GH, Vickers MA, Sullivan MP, Jodbert P, Dluhy RG . Tissue angiotensin II as a modulator of erectile function. I. Angiotensin peptide content, secretion and effects in the corpus cavernosum. J Urol 1997; 157: 1920–1925.
Friedrich EB, Teo KK, Bohm M . ACE inhibition in secondary prevention: are the results controversial? Clin Res Cardiol 2006; 95: 61–67.
Llisterri JL, Lozano Vidal JV, Aznar Vicente J, Argaya Roca M, Pol Bravo C, Sanchez Zamorano MA et al. Sexual dysfunction in hypertensive patients treated with losartan. Am J Med Sci 2001; 321: 336–341.
Dusing R . Effect of the angiotensin II antagonist valsartan on sexual function in hypertensive men. Blood Press Suppl 2003; 2: 29–34.
Fogari R, Zoppi A, Poletti L, Marasi G, Mugellini A, Corradi L . Sexual activity in hypertensive men treated with valsartan or carvedilol: a crossover study. Am J Hypertens 2001; 14: 27–31.
Fogari R, Zoppi A, Corradi L, Mugellini A, Poletti L, Lusardi P . Sexual function in hypertensive males treated with lisinopril or atenolol: a cross-over study. Am J Hypertens 1998; 11: 1244–1247.
Sola S, Mir MQ, Cheema FA, Khan-Merchant N, Menon RG, Parthasarathy S et al. Irbesartan and lipoic acid improve endothelial function and reduce markers of inflammation in the metabolic syndrome: results of the Irbesartan and Lipoic Acid in Endothelial Dysfunction (ISLAND) study. Circulation 2005; 111: 343–348.
Ortlepp JR, Breuer J, Eitner F, Kluge K, Kluge R, Floege J et al. Inhibition of the renin-angiotensin system ameliorates genetically determined hyperinsulinemia. Eur J Pharmacol 2002; 436: 145–150.
Lewis EJ, Hunsicker LG, Rodby RA . A clinical trial in type 2 diabetic nephropathy. Am J Kidney Dis 2001; 38: S191–S194.
Rosen RC, Riley A, Wagner G, Osterloh IH, Kirkpatrick J, Mishra A . The international index of erectile function (IIEF): a multidimensional scale for assessment of erectile dysfunction. Urology 1997; 49: 822–830.
Baumhakel M, Werner N, Bohm M, Nickenig G . Circulating endothelial progenitor cells correlate with erectile function in patients with coronary heart disease. Eur Heart J 2006; 27: 2184–2188.
Laufs U, Endres M, Custodis F, Gertz K, Nickenig G, Liao JK et al. Suppression of endothelial nitric oxide production after withdrawal of statin treatment is mediated by negative feedback regulation of rho GTPase gene transcription. Circulation 2000; 102: 3104–3110.
Pershadsingh HA . Treating the metabolic syndrome using angiotensin receptor antagonists that selectively modulate peroxisome proliferator-activated receptor-gamma. Int J Biochem Cell Biol 2006; 38: 766–781.
Bohm M, Baumhakel M, Probstfield JL, Schmieder R, Yusuf S, Zhao F et al. Sexual function, satisfaction, and association of erectile dysfunction with cardiovascular disease and risk factors in cardiovascular high-risk patients: substudy of the ONgoing Telmisartan Alone and in Combination with Ramipril Global Endpoint Trial/Telmisartan Randomized AssessmeNT Study in ACE-INtolerant Subjects with Cardiovascular Disease (ONTARGET/TRANSCEND). Am Heart J 2007; 154: 94–101.
Mannino DM, Klevens RM, Flanders WD . Cigarette smoking: an independent risk factor for impotence? Am J Epidemiol 1994; 140: 1003–1008.
Modebe O . Erectile failure among medical clinic patients. Afr J Med Med Sci 1990; 19: 259–264.
Grimm Jr RH, Grandits GA, Prineas RJ, McDonald RH, Lewis CE, Flack JM et al. Long-term effects on sexual function of five antihypertensive drugs and nutritional hygienic treatment in hypertensive men and women. Treatment of Mild Hypertension Study (TOMHS). Hypertension 1997; 29: 8–14.
Barksdale JD, Gardner SF . The impact of first-line antihypertensive drugs on erectile dysfunction. Pharmacotherapy 1999; 19: 573–581.
Franzen D, Metha A, Seifert N, Braun M, Hopp HW . Effects of beta-blockers on sexual performance in men with coronary heart disease. A prospective, randomized and double blinded study. Int J Impot Res 2001; 13: 348–351.
Silvestri A, Galetta P, Cerquetani E, Marazzi G, Patrizi R, Fini M et al. Report of erectile dysfunction after therapy with beta-blockers is related to patient knowledge of side effects and is reversed by placebo. Eur Heart J 2003; 24: 1928–1932.
Wassmann S, Ribaudo N, Faul A, Laufs U, Bohm M, Nickenig G . Effect of atorvastatin 80 mg on endothelial cell function (forearm blood flow) in patients with pretreatment serum low-density lipoprotein cholesterol levels <130 mg/dl. Am J Cardiol 2004; 93: 84–88.
Laufs U, La Fata V, Plutzky J, Liao JK . Upregulation of endothelial nitric oxide synthase by HMG CoA reductase inhibitors. Circulation 1998; 97: 1129–1135.
Nangle MR, Cotter MA, Cameron NE . Effects of rosuvastatin on nitric oxide-dependent function in aorta and corpus cavernosum of diabetic mice: relationship to cholesterol biosynthesis pathway inhibition and lipid lowering. Diabetes 2003; 52: 2396–2402.
Bank AJ, Kelly AS, Kaiser DR, Crawford WW, Waxman B, Schow DA et al. The effects of quinapril and atorvastatin on the responsiveness to sildenafil in men with erectile dysfunction. Vasc Med 2006; 11: 251–257.
Sowers JR, Neutel JM, Saunders E, Bakris GL, Cushman WC, Ferdinand KC et al. Antihypertensive efficacy of Irbesartan/HCTZ in men and women with the metabolic syndrome and type 2 diabetes. J Clin Hypertens (Greenwich) 2006; 8: 470–480.
Carson C, Shabsigh R, Segal S, Murphy A, Fredlund P, Kuepfer C . Efficacy, safety, and treatment satisfaction of tadalafil versus placebo in patients with erectile dysfunction evaluated at tertiary-care academic centers. Urology 2005; 65: 353–359.
Acknowledgements
The DO-IT-EDE study was sponsored by a grant of Bristol-Myers-Squibb, Munich, Germany, and was conducted with the help of GKM Gesellschaft für Therapieforschung, Munich, Germany. The authors thank Dr F Münzel, BMS, Germany, who helped developing the study and H Gnann, GKM Gesellschaft für Therapieforschung, Germany, for statistical analysis.
Author information
Authors and Affiliations
Consortia
Corresponding author
Rights and permissions
About this article
Cite this article
Baumhäkel, M., Schlimmer, N., Böhm, M. et al. Effect of irbesartan on erectile function in patients with hypertension and metabolic syndrome. Int J Impot Res 20, 493–500 (2008). https://doi.org/10.1038/ijir.2008.28
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1038/ijir.2008.28
Keywords
This article is cited by
-
Interactions between erectile dysfunction, cardiovascular disease and cardiovascular drugs
Nature Reviews Cardiology (2022)
-
Evaluation and Management of Erectile Dysfunction in the Hypertensive Patient
Current Cardiology Reports (2017)
-
The Different Therapeutic Choices with ARBs. Which One to Give? When? Why?
American Journal of Cardiovascular Drugs (2016)
-
A review of the positive and negative effects of cardiovascular drugs on sexual function: a proposed table for use in clinical practice
Netherlands Heart Journal (2014)