Antihypertensive drug-associated sexual dysfunction: a prescription analysis-based study

Pharmacoepidemiol Drug Saf. 2003 Apr-May;12(3):203-12. doi: 10.1002/pds.814.


Purpose: To determine whether primary care physicians take into consideration age, gender and diabetes mellitus as risk factors for sexual dysfunction (SD) when prescribing antihypertensives.

Methods: A prescribing survey on hyperternsive patients with or without diabetes mellitus in primary care setting of Bahrain was carried out.

Results: In 5301 hypertensive patients, we found that a beta-blocker (atenolol) was the most commonly prescribed drug and was significantly more often prescribed for young male hypertensives (< 45 years). A relatively high dose of atenolol (100 mg/d) was extensively used as both mono- and combination-therapies. With the exception of middle-aged hypertensives (45-64 years) and elderly diabetic-hypertensives (> or = 65 years), no significant age- and gender-related differences were observed regarding the prescription of thiazide diuretics. A significant trend of prescribing methyldopa in females as monotherapy was evident. Angiotensin converting enzyme (ACE) inhibitors, the second most commonly prescribed drugs, were significantly more often prescribed for young, middle-aged hypertensive males and for middle-aged diabetic-hypertensive males. beta-blocker/diuretic combination was prescribed least for the young and elderly hypertensive males. However, prescription of an ACE inhibitor with either a diuretic or a calcium channel blocker (CCBs) was less frequent and lacked gender-related differences.

Conclusions: We infer that antihypertensive-induced SD received little attention as was evident from: (a) over-prescription of relatively high dose of beta-blockers to young hypertensive males; (b) lack of gender- and age-related difference regarding the type and dose of diuretics prescribed; (c) underutilization of effective and complementary combinations expected to cause least impact on sexual function, such as ACE inhibitors with either a diuretic or with a CCB; and (d) a relative lack of discrimination while selecting antihypertensive drugs, particularly as monotherapy between hypertensive versus diabetic-hypertensive patients. With the exception of ACE inhibitors alone and combination of diuretic/beta-blocker, the choice of antihypertensives did not conform to international guidelines. In view of drug-induced SD adversely influencing the quality of life and thereby drug-compliance, interventions aimed at improving physicians' awareness should be attempted.

Publication types

  • Comparative Study
  • Multicenter Study

MeSH terms

  • Adult
  • Age Factors
  • Aged
  • Antihypertensive Agents / adverse effects*
  • Antihypertensive Agents / therapeutic use
  • Data Collection
  • Diabetes Complications
  • Drug Therapy, Combination
  • Drug Utilization Review*
  • Female
  • Humans
  • Hypertension / drug therapy
  • Hypertension / etiology
  • Male
  • Middle Aged
  • Sex Factors
  • Sexual Dysfunction, Physiological / chemically induced
  • Sexual Dysfunction, Physiological / epidemiology*


  • Antihypertensive Agents