By: Thomas Pickering, MD, DPhil, FRCP, Director of Integrative and Behavioral Cardiology Program
of the Cardiovascular Institute at Mount Sinai School of Medicine, New York.

It is a not an uncommon experience for men being treated with blood pressure lowering medications to develop problems with their sexual function. The drugs that have been found to most likely cause a problem are diuretics, beta blockers, and drugs like clonidine, which act on the brain.

In an Italian study, placebo (inert) pills were given to 90 hypertensive men aged 40 to 49, all of whom were married and with normal sexual function, for four weeks. After this time, blood pressure was lowered either with atenolol (Tenormin), a beta blocker, or lisinopril (brand names Vasotec and Zestril), an ACE (angiotensin converting enzyme) inhibitor. These were both given for 16 weeks. The men were asked about their sexual function before and after they were started on the drugs.

There was a slight decrease of sexual activity during the placebo treatment (from nine to seven episodes of intercourse a month). After four weeks of drug treatment, sexual activity decreased with both drugs by about the same amount (from about seven per month to about four), but in the men given atenolol, it stayed down for the 20-week duration of the study (at four episodes a month). However, in the men given lisinopril it recovered to seven episodes. More men in the atenolol group reported loss of libido (11%, versus two percent in the lisinopril group), and impotence (five percent versus one percent). The blood pressure reductions were the same with both drugs.

Doctor's Comments

Although several earlier studies have reported the effects of blood pressure-lowering drugs on sexual function, what makes this study unique is that in this study it was the primary goal. The men in the study were all relatively young, and none had had problems in the past. The finding that the beta blocker atenolol caused more problems than the ACE inhibitor is no great surprise. But what is particularly interesting is that the ACE inhibitor caused a transient problem. The lesson to be learned here is that men who do develop impotence or lack of libido after starting on an ACE inhibitor should persist for at least a month before deciding that the side effects are unacceptable.

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