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Query: UMLS:C0020538 (hypertension)
 170,190 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The prevalence of diabetes mellitus and hypertension in the United States is increasing partly because of the incidence of these diseases in the growing geriatric population. Diabetes and hypertension have been associated with sexual dysfunction in both men and women. Neuropathy, vascular insufficiency and psychological problems have been implicated in impotence, impaired ejaculation and decreased libido in men and in decreased vaginal lubrication, orgasmic dysfunction and decreased libido in women. Several investigations of women with diabetes suggest fewer reports of sexual dysfunction than have been reported by diabetic men. However, there have been few evaluations of sexual dysfunction in women and no standard methods for assessment. Antihypertensive agents, especially diuretics, sympathetic inhibitors and beta-blocking agents have been associated with sexual dysfunction due to autonomic and hormonal effects. An estimated 40 to 80% of diabetic hypertensives have reported sexual dysfunction in several investigations. Clearly, the diabetic hypertensive patient should be evaluated for sexual dysfunction, and appropriate therapy, including changes in medication or referral for sex counseling, should become routine in clinical care.
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PMID:Sexual dysfunction in the diabetic patient with hypertension. 328 48

Most patients with mild to moderate hypertension are asymptomatic. Any adverse response to nonpharmacologic or pharmacologic therapies can negatively influence some aspect of the patient's sense of well-being and life satisfaction; this will likely limit the compliance with and the resultant benefits of therapy. The diagnosis of hypertension itself is associated with psychological consequences, termed the "labeling effect," that impair life quality. A number of life-style modifications and a variety of highly effective and safe classes of antihypertensive agents can satisfactorily control blood pressure in most patients. Evaluation of the patient's response to an antihypertensive regimen should, in addition to measurement of the level of blood pressure and review of laboratory test values, include assessment of quality of life outcomes: impact of therapy on the patient's daily routine, fatigue or activity limitation, sexual dysfunction, impairment of memory, alertness, mood, or cognitive ability, sleep dysfunction, work performance and satisfaction, and satisfaction with family, social, and leisure time activities.
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PMID:Quality of life issues in hypertension: consequences of diagnosis and considerations in management. 329 6

Sexual dysfunction is common in hypertensive men and often is first reported by patients while receiving hypotensive therapy, leading to a widespread belief by patients and physicians that the sexual dysfunction is caused by a specific antihypertensive medication. However, it is unclear from the literature whether this problem is related to hypertension or to its therapy. Further, whether the erectile failures reported during therapy are a result of 1) reduced penile blood flow secondary to reduction of blood pressure after antihypertensive treatment or to obstructive vascular disease (or both) or 2) specific drug effects has not been well studied. Because of these unresolved issues, this common problem is not well managed and contributes to noncompliance with therapy by hypertensive male patients, which impedes the attainment of satisfactory blood pressure control. The present article reviews the literature related to hypertension and sexual function in men and outlines a management strategy for clinicians that attempts to document normalcy of sexual function before initiating treatment in newly diagnosed hypertensive patients. Further, it does not ascribe causality to specific antihypertensive agents for the sexual dysfunction reported by treated hypertensive patients but attempts instead to delineate the pathogenesis of the dysfunction. Once the pathogenesis is established, treatment plans can be implemented to restore normotension and maintain adequate sexual function among treated hypertensive men. The article also discusses how applied research in this area may be performed.
Hypertension 1988 Jul
PMID:Sexual dysfunction in hypertensive men. A critical review of the literature. 329 76

Guanfacine, a phenylacetyl-guanidine derivative, is a centrally acting alpha-adrenoceptor agonist, with a mechanism of antihypertensive action similar to that of clonidine. It reduces blood pressure in patients with essential hypertension at least as effectively as clonidine or methyldopa. Like lower doses of clonidine, guanfacine can be given once daily due to its relatively long elimination half-life. Although dry mouth and sedation occur frequently with higher doses of guanfacine, their incidence is lower than with other centrally acting antihypertensives; in addition, other troublesome side effects such as orthostatic hypotension or sexual dysfunction also occur much less with guanfacine than with other centrally acting antihypertensive agents. While a withdrawal syndrome may occur on abruptly discontinuing guanfacine administration, the symptoms are generally mild, and the incidence of withdrawal symptoms appears lower than occurs with abrupt withdrawal of clonidine. Thus, guanfacine is an effective and well tolerated alternative to other centrally acting antihypertensive drugs. Whether its final place in therapy will be as an alternative 'second-line' drug, or as initial monotherapy in patients with mild to moderate hypertension, remains to be clarified in comparative studies with diuretics, calcium antagonists, and beta-adrenoceptor blocking drugs.
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PMID:Guanfacine. A review of its pharmacodynamic and pharmacokinetic properties, and therapeutic efficacy in the treatment of hypertension. 351 77

We conducted a multicenter randomized double-blind clinical trial among 626 men with mild to moderate hypertension to determine the effects of captopril, methyldopa, and propranolol on their quality of life. Hydrochlorothiazide was added if needed to control blood pressure. After a 24-week treatment period, all three groups had similar blood-pressure control, although fewer patients taking propranolol required hydrochlorothiazide. Patients taking captopril alone or in combination with a diuretic were least likely to withdraw from treatment because of adverse effects (8 percent vs. 20 percent for methyldopa and 13 percent for propranolol). The treatment groups were similar in scores for sleep dysfunction, visual memory, and social participation. However, patients taking captopril, as compared with patients taking methyldopa, scored significantly higher (P less than 0.05 to less than 0.01) on measures of general well-being, had fewer side effects, and had better scores for work performance, visual-motor functioning, and measures of life satisfaction. Patients taking propranolol also reported better work performance than patients taking methyldopa. Patients taking captopril reported fewer side effects and less sexual dysfunction than those taking propranolol and had greater improvement (P less than 0.05 to less than 0.01) on measures of general well-being. Our findings show that antihypertensive agents have different effects on the quality of life and that these can be meaningfully assessed with available psychosocial measures.
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PMID:The effects of antihypertensive therapy on the quality of life. 352 Mar 18

Diabetes mellitus and hypertension are both prevalent in the adult population. The development of hypertension in the diabetic patient is likely to increase the morbidity and mortality in a subgroup already at high risk for atherosclerosis and deserves special consideration. Several studies have confirmed the beneficial effects of antihypertensive therapy on complications such as diabetic nephropathy. This emphasizes the importance of normalizing blood pressure in the diabetic population. It has been suggested that the threshold for initiating antihypertensive therapy should be lower in diabetic patients. All antihypertensive agents have potential disadvantages in patients with diabetes. The commonly encountered effects include deterioration of diabetic control, sexual dysfunction, electrolyte imbalance, and lipid disorders. The adverse effects of these agents on serum lipids have been implicated in the less-than-expected reduction in coronary heart disease noted in some studies. The recent Lipid Research Council study has emphasized the importance of elevated lipid levels and increased cardiovascular mortality. Antihypertensive therapy has advanced rapidly in the last 5 yr. The special problems in the treatment of hypertension within the diabetic population are now receiving greater attention. Undesirable biochemical side effects of drugs used to treat hypertension have become publicized, and the long-term consequences of these abnormalities are under critical scrutiny. The new antihypertensive medications offer exciting alternative approaches to the more traditional agents with less chance of significant metabolic side effects.
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PMID:Current therapeutic concepts in diabetic hypertension. 352 14

Six hundred and twenty-six male patients with mild to moderate hypertension were enrolled in a multicentre randomized double-blind clinical trial to determine the effect of methyldopa, captopril and propranolol on the quality of life of these patients. During the 6-month trial hydrochlorothiazide was added to the treatment programme of those patients whose blood pressure was not normalized. More individuals in the captopril group (33%) required hydrochlorothiazide than in the propranolol group (22%). As a group, those individuals who required a diuretic were heavier and had higher basal and end-of-study blood pressure than those individuals requiring only monotherapy. However, the basal quality-of-life indices were similar in the six treatment subgroups. The withdrawal rate from the study was twice as high for those patients treated with propranolol and methyldopa as for those treated with captopril, whether a diuretic was added or not. More individuals requiring a diuretic experienced sexual dysfunction and a substantial worsening of their general well-being and of physical symptom indices over the 24 weeks of the study (P less than 0.01), particularly in the captopril and propranolol treatment subgroups. In summary, the present results suggest that diuretic therapy may have a greater negative impact on the quality of life of hypertensive patients than captopril, propranolol or methyldopa alone.
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PMID:Impact of antihypertensive therapy on quality of life: effect of hydrochlorothiazide. 355 93

Sexual dysfunction was studied in 50 patients who had had a myocardial infarction (MI) matched with 50 control patients who were comparable in terms of age, hypertension, diabetes, and smoking. The MI group revealed sexual dysfunction in 76%, with erectile dysfunction in 42%. In the control group there was sexual dysfunction in 68% and erectile dysfunction in 48%. There was no statistically significant difference observed between the two groups. However, there was a significant influence of sex counseling on subsequent sexual functioning. Patients who received information as to when it was safe for them to resume sexual activity showed a lesser degree of apprehension in the post-MI period. The need of sexual rehabilitation for these patients and more thorough epidemiological comparative studies are suggested.
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PMID:Myocardial infarction and its influence on male sexual function. 380 Jun 40

A controlled study was conducted in hypertensive patients to investigate whether captopril can be substituted for the various other antihypertensive drugs (not including diuretics) to reduce side effects and improve the quality of life. Captopril in a twice daily dose of 25-50 mg, was substituted and titrated in 54 patients. Fifty-two patients, matched by age and sex, comprised the control group, and were treated with a variety of agents. During a follow-up of 9 months, 44 of the patients receiving captopril (81%) achieved the goal of supine blood pressure less than 90 mmHg. Captopril was discontinued in two patients due to side effects. Mild proteinuria was observed in two patients. A significant reduction in scores or rates of side effects (numbness, blurred vision, insomnia, vivid dreams, cold extremities, sleepiness, sexual dysfunction and fatigue) and improvement in quality of life (general feeling, mood and concentration) was observed in the study group compared with the control group. Captopril alone in a twice daily dose of 25-50 mg, or in co-treatment with thiazide, provided sustained blood pressure control with minimal side effects and improvement in quality of life compared with the treatment of hypertension with beta-blockers, vasodilators or methyldopa.
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PMID:Captopril as a replacement for multiple therapy in hypertension: a controlled study. 391 Jul 75

It is generally maintained that the variety of endocrine disorders which occur in uraemia and persist in dialysis (above all hormones whose production and/or metabolic clearance are pertinent functions of the kidney) usually abate after successful renal transplantation. However, a retrospective analysis of long-term results in 71 out of 275 cases serially studied by regular checks, indicates that this event occurs in no more than 2/3 of successfully transplanted patients. In the other patients various endocrine abnormalities may be documented: some seem apparently 'inherited' from uraemia (hyperparathyroidism, sexual dysfunction, growth retardation); some are mainly related to steroids (hyperinsulinism), and some have a de novo origin (erythrocytosis, reno-vascular hypertension). These endocrine abnormalities may occur with a normal or reduced graft function, have a baseline or stimulated expression, a clinical or subclinical course, and a reversible or irreversible outcome. A proper grasp of these events in renal transplantation is of clinical significance particularly for the long-term patient and graft prognosis.
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PMID:Hormonal abnormalities in renal transplantation. 391 11


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