Riyadh: Dr. Hassan Muhammad Sandakji
Within the activities of the annual conference of the European Society of Cardiology 2020, held between August 29 and September 1, Greek researchers presented the results of their study for the follow-up of treatment of high blood pressure patients in men without causing further impairment of capacity Nationality.
The title of the study was: “Correlation between blood pressure and antihypertensive drug use and male sexual dysfunction: a Doppler study of the penis.”
High blood pressure affects more than 1 billion people worldwide and is a leading cause of premature death. And it is advised to overcome it by practicing a healthy lifestyle in living daily life. This includes: limiting sodium intake, physical exercise, controlling body weight, and quitting smoking. Most patients also need to take regular drug treatment.
But in this aspect arises sometimes, and for some patients, a medical controversial problem whose elements are:
> The extent to which high blood pressure in itself causes erectile dysfunction.
> The extent of the effects of taking medication to reduce or increase the suffering of erectile dysfunction.
> The extent of the effects of “some” these types of drugs on causing erectile dysfunction as a new event that the patient did not have before.
> The psychological effects of the patient’s knowledge that “some” drugs are likely to cause erectile dysfunction, based on how they feel that problem and how committed they are to taking the medicine.
> Other drug solutions to deal with this problem, such as changing the quality of medication or receiving medications that contribute to erectile dysfunction.
These five aspects of this controversial medical controversy, regarding blood pressure and erection, each of them generally need an approach of its own, and at the same time they all need a single and homogeneous approach for each individual patient.
– Blood pressure and erection
In their recent study, the researchers said: “Men’s having high blood pressure doubles the risk of penile blood flow disorder and erectile dysfunction, compared to men with normal blood pressure.” They explained that high blood pressure leads to damage to artery walls, which causes hardening and narrowing and reducing blood flow through them, so the presence of erectile dysfunction may be an early warning sign of damage to blood vessels.
They added: “There is a belief that erectile dysfunction is more common in hypertensive patients who receive drug treatment, compared to those not taking these drugs. Taking some antihypertensives – particularly those in the diuretics and beta blockers – has been linked to decreased sexual function.
They also mentioned that the results of many statistical epidemiological studies indicate that about half of patients with high blood pressure may not take medication to treat it, or stop doing so, for various reasons. And one of them is the potential for it to cause impotence, the researchers report.
– New research
The aim of this recent study was to examine the matter from another angle, by studying the effect of taking blood pressure medication on the relationship between the level of blood pressure and the intensity of blood flow to the penis.
The study included a group of men suffering from erectile dysfunction and no history of diabetes or cardiovascular disease. They were followed between 2006 and 2019, after dividing them into three categories according to their blood pressure at the beginning of the study: the first is the group of men with normal blood pressure (Normal BP), and the second is a group of men with high blood pressure, but did not reach the point of being diagnosed with a disease. High-Normal BP, and the third category of sick men who actually suffer from pathological high blood pressure (Hypertension). Of these patients with high blood pressure, it was observed that about half of them were already taking medication to lower their high blood pressure.
Those under medical follow-up underwent a Color Doppler Ultrasound to assess blood flow to the penis, which is the standard method for evaluating penile blood vessels and erectile dysfunction. The method involves injecting a drug into the bottom of the penis to open the blood vessels and then measuring blood flow. The blood flow in the penis is weak when the velocity is less than 25 cm / s.
The study came out with a number of results: –
The first: that blood flow to the penis was faster in those who had normal blood pressure, slower than in those who suffer from normal high blood pressure, and more slowly in those with high blood pressure.
The second result: that men who had high blood pressure and did not receive antihypertensive drugs, their blood flow velocity in the penis decreased in amounts inversely proportional to the amount of increase in blood pressure.
These are the two results that Professor Charalambos Flashopoulos, the principal investigator of the study from the National Kapodistrian University in Athens, commented on, saying: “In men who do not take antihypertensive drugs, the gradual decrease in the velocity of blood flow to the penis – in the three blood pressure groups – indicates that Significant structural changes within the blood vessels of the penis, as a result of prolonged high blood pressure. This is compared to those with normal blood pressure.
On the other hand, the third result was that when patients with high blood pressure received drugs to treat it, the difference in the speed of blood flow in their penis compared to others would disappear. This is what Professor Vlachopoulos commented by saying: “The disappearance of the difference in the speed of blood flow in these three groups, it is assumed that the reason is the effects of taking medications”, for the treatment of high blood pressure.
The European Heart Association summarized these results and their implications by saying: “Men who suffer from untreated high blood pressure have less blood flow in the penis than those who have normal blood pressure, and these differences disappeared with taking blood pressure medications. These results provide reassurance for men who are concerned about the effects of taking antihypertensive drugs.
– Analytical results more accurate
but when you make a comparison analysis of an additional (in each group of blood pressure three categories) among men who deals with drugs treat high blood pressure and those who do not eat three results: emerged
– the first, that in patients with a class of high blood pressure, it was not There is a difference in the speeds of blood flow to the penis between those taking high blood pressure medication and those not taking them.
Second, the speed of blood flow to the penis decreased in the normal blood pressure group and in the normal high blood pressure group, when they were taking blood pressure lowering drugs, compared to not taking them. Professor Flashopoulos commented by saying: “These results indicate that hypertensive patients already suffer from major structural damage to the arteries of the penis, and that the addition of antihypertensive drugs does not cause them to further reduce blood flow in the penis. And men who have normal or normal blood pressure high, there is little structural damage to the arteries of the penis, but can have a negative impact on the use of pressure medications on blood flow in their penis.
For the sake of these findings, Professor Vlashopoulos urged men who have concerns about impotence to discuss the matter with their doctor. “For men who have not been treated for high blood pressure, the old medications (beta blockers and diuretics) are not ideal, and they should only be used if they are clearly needed,” he said.
– A frank discussion with the doctor
> Under the heading “High Blood Pressure and Sex: Overcoming the Challenges”, the Mayo Clinic doctors say: “The treatment of high blood pressure and the satisfaction of sexual desire can be achieved at the same time, if the person is explicit about the problems he suffers and works perfectly A document with his doctor ».
And they add a summary: «To reduce the likelihood of side effects of drugs, it is worth taking the medicine exactly as prescribed, and discussing the matter openly with the doctor about other medicines available to treat high blood pressure that have fewer side effects, and also taking medicines that help stimulate erection if they are not. There are contraindications for taking it. ”
“Our study shows that high blood pressure can be treated without causing erectile dysfunction, and patients and clinicians need to have open discussions to find the best treatment option,” said Professor Vlashopoulos. “If the coexisting disease dictates the use of a certain class of drugs (for example, beta-blockers for coronary artery disease and heart failure, and diuretics for heart failure), then there is no need to switch,” he said. But it is worth considering alternatives if it is likely that the patient will, by choice (and other than medical advice) stop taking life-saving treatment because of its harmful effect on erection, in order to preserve his life.
– Tests to measure “vascular weakness”
> Cardiology circles do not differ in that erectile dysfunction is one of the indicators of the possibility of a hardening of the arteries, which makes searching for the cause of erectile dysfunction one of the diagnostic steps of health benefit in early detection of other diseases in the body that may be behind the occurrence Erectile dysfunction.
They also do not differ in that the type of “vascular erectile dysfunction” (that is, due to vascular disease) is closely related to cardiovascular disease in terms of risk factors related to their development, such as diabetes, high blood pressure, smoking and obesity. And that the pathological mechanisms (pathological mechanisms) for the emergence of both vascular erectile dysfunction and diseases of the heart arteries are common, and through disturbance of the work of the lining of the arteries, inflammation and hardening of the arteries.
One of the accurate medical examinations in evaluating the work of the arteries feeding the penis, and the extent of blood flow to the “corpora Cavernosa” in it, is the “color Doppler ultrasound” examination (Color Doppler Ultrasound).
The examination uses Doppler technology to measure several indicators of blood flow, through the Cavernosal Artery, to the cavernous body inside the penis. This is before and after injecting a drug that increases blood flow to it.
These steps are explained to the patient, with advice to stop smoking for three days before the examination and review of the medications he is taking.
Before injecting the drug, several measurements are taken, including:
– The diameter of the cavernous artery, which is between 0.3 (zero point three) to 0.5 (zero point five) millimeter.
The speed of blood flow inside this artery, during the period of heart contraction and the period of diastole. And in most men, the normal rate of systolic flow between 30 and 35 cm / second.
The diameter of the cavernous body, then the drug is injected into the cavernous body (Intracavernosally). Then the same measurements are taken in the erection period after 5, 10, 15 and 20 minutes.
It is normal for the cavernous artery to have a diameter of between 0.6 (zero point six) and 1 millimeter.
– And when the velocity is less than 30 cm / second, this indicates a disorder in the work of the arteries supplying the penis. If the velocity is less than 25 cm / second, this indicates the presence of “clear dysfunction” in the arteries.
It is also normal for the cavernous body to increase in diameter by 60 percent.
The influence of the psychological factor
> The researchers say in their recent study: “There has been a link between high blood pressure and sexual problems in men. Over time, high blood pressure damages the lining of blood vessels and causes hardening and narrowing of the arteries and a lack of blood flow through them to the penis, which leads to difficulty in the erection process and maintaining it.
Doctors, Mayo Clinic, confirm that high blood pressure medications may have side effects on the erectile capabilities of some hypertensive patients, including diuretics, which may weaken the force of blood pumping into the penis, which may also cause zinc to deplete from the body. Which is an important component of the secretion of the sexual hormone testosterone.
It also includes beta-blocker drugs whose use, especially the old groups (not the modern ones), is linked to erectile dysfunction through several mechanisms.
But about beta blockers in particular, there is another medical point of view, expressed in a previous study by Italian researchers from San Rafael University in Rome, published in the Journal of the European Society of Cardiology, entitled “Reporting erectile dysfunction after treatment with beta blockers linked to the patient’s knowledge of side effects. And it is reversed by placebo. ”In a summary of her results, they said:“ Complaints of erectile dysfunction are more frequent in patients with cardiovascular disease, when treated with beta-blockers. And we found a startling difference in self-reporting of ED according to the patient’s knowledge of the potential side effect of these drugs on erectile dysfunction, which could only be explained by the psychological effect. “The incidence of erectile dysfunction with beta-blockers is low, and much less than previously thought,” they added. The results of the current study indicate that the expectations of both the patient and the doctor about the risk of developing erectile dysfunction may affect the occurrence of this unpleasant side effect.