Intensive Hypertension Therapy Not Tied To Worse Sexual Health.

Intensive hypertension therapy isn't tied to changes in sexual function for women, and the changes men experience are similar to what they report with more conservative treatment, a recent study suggests.

Researchers examined data on 1,268 men and 613 women over age 50 who were part of the Systolic Blood Pressure Intervention Trial (SPRINT), which compared the effect of intensive treatment to a target of 120 mmHg with conservative treatment to a target of 140 mmHg. Among participants in the current analysis, 862 (68%) men and 178 (29%) women reported being sexually active.

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Women reported low satisfaction with their sex life; less than 50% felt sexual desire in at least half of their experiences and 30% reported rarely or never feeling sexual desire. For women, their perception of sexual health wasn't meaningfully different based on whether they were on conservative or intensive blood pressure therapy.

Men reported a slight decline in erection quality over time, but this deterioration was similar with both intensive and conservative anti-hypertensive therapy, researchers report in the American Journal of Hypertension.

"Clinicians should remember that intensifying anti-hypertensive treatment in people with the characteristics of those enrolled in SPRINT to achieve a strict blood pressure control improves cardiovascular outcomes and is not associated with any deterioration in the sexual function of the average patient," said lead study author Dr. Joao Pedro Ferreira of CHRU de Nancy and the University of Lorraine, in France.

"Therefore, intensive anti-hypertensive treatment for a strict blood pressure control should certainly be a goal for such patients," Dr. Ferreira said by email.

Compared with women who said they were not engaged in sexual activity of any kind, those who engaged in sexual activity were younger (64 vs. 69 years), more often current smokers, and with better renal function, the study team notes. Compared with men not engaging in sexual activity, those who did were younger (65 vs. 71), more often Black, with slightly higher body mass index, and with better renal function.

While the study used validated sexual health questionnaires, one limitation of the analysis is that it relies on individual perspectives on sexual function, the study team notes. Researchers also lacked data on certain independent risk factors for sexual dysfunction, such as mood disorders and certain physical comorbidities.

When patients are treated with anti-hypertensive medications, the drop in blood pressure, while beneficial in terms of reducing the progression of vascular disease and heart failure, can be detrimental for sexual function because it also reduces the amount of blood that circulates in the penis or clitoris, said Dr. Carlos Ferrario, a professor of physiology-pharmacology at Wake Forest University Baptist Health Center in Winston-Salem, North Carolina.

It's possible that women didn't perceive a decline in sexual function with anti-hypertensive therapy because clitoral arousal isn't required for penetration during intercourse, Dr. Ferrario, who wasn't involved in the study, said by email.

While how far the blood pressure should be lowered remains a matter for further study, there is no question that a more intense effort toward a systolic blood pressure less than 120 mm Hg should be considered in patients with a high risk of cardiovascular events, Dr. Ferrario said.

Physicians should consider ACE inhibitors and ARBs as first line therapy because these medications act to counteract the pathophysiological mechanisms that account for the alterations in the heart, the cerebral circulation, the kidneys, and the peripheral circulation, Dr. Ferrario advised.

"Whenever possible, ARBs should be favored because of their characteristic absence of side-effects, lack of inducing sexual dysfunction, and their specific action in blocking angiotensin II pathological actions," Dr. Ferrario said.

—Lisa Rapaport

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