Antihypertensive drug-associated sexual dysfunction: a prescription analysis-based study.
OBJECTIVE
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.
Department of Pharmacology and Therapeutics, College of Medicine and Medical Sciences, Arabian Gulf University, PO Box No. 22979, Bahrain. khlidj@agu.edu.bh
K A Jassim
KA
al Khaja
R P
RP
Sequeira
A H H
AH
al Damanhori
V S
VS
Mathur
D000328:Adult; D000367:Age Factors; D000368:Aged; D000959:Antihypertensive Agents / Q000009:adverse effects* / Q000627:therapeutic use; D003625:Data Collection; D048909:Diabetes Complications; D004359:Drug Therapy, Combination; D017723:Drug Utilization Review; D005260:Female; D006801:Humans; D006973:Hypertension / Q000188:drug therapy / Q000209:etiology; D008297:Male; D008875:Middle Aged; D012737:Sex Factors; D012735:Sexual Dysfunction, Physiological / Q000139:chemically induced / Q000453:epidemiology*
D000959:Antihypertensive Agents