systhiperСистемные гипертензииSystemic Hypertension2075-082X2542-2189LLC «ИнтерМедсервис»10.26442/2075082X.2021.2.200836systhiper-631Research ArticleМНЕНИЕ ЭКСПЕРТОВEXPERT OPINIONКонсенсус экспертов Российского медицинского общества по артериальной гипертонии. Артериальная гипертония и эректильная дисфункцияConsensus of experts from the Russian Medical Society of Arterial Hypertension. Arterial hypertension and erectile dysfunctionhttps://orcid.org/0000-0001-5499-0482АлексееваТ. А.AlekseevaT. A.t-a86@mail.ruhttps://orcid.org/0000-0001-5918-9969ЛитвинА. Ю.LitvinA. Yu.t-a86@mail.ruhttps://orcid.org/0000-0002-3140-5030ЕлфимоваЕ. М.ElfimovaE. M.t-a86@mail.ruhttps://orcid.org/0000-0002-3609-2504МихайловаО. О.MikhailovaO. O.t-a86@mail.ruhttps://orcid.org/0000-0001-7825-5597ЛаринаВ. Н.LarinaV. N.t-a86@mail.ruhttps://orcid.org/0000-0003-1121-9430ШпотьЕ. В.ShpotE. V.t-a86@mail.ruhttps://orcid.org/0000-0002-0758-5609ПодзолковВ. И.PodzolkovV. I.t-a86@mail.ruhttps://orcid.org/0000-0002-9822-4357ЧазоваИ. Е.ChazovaI. E.t-a86@mail.ruФГБУ «Национальный медицинский исследовательский центр кардиологии» Минздрава РоссииРоссияNational Medical Research Center of CardiologyRussian FederationФГБУ «Национальный медицинский исследовательский центр кардиологии» Минздрава России; ФГАОУ ВО «Российский национальный исследовательский медицинский университет им. Н.И. Пирогова» Минздрава РоссииРоссияNational Medical Research Center of Cardiology; Pirogov Russian National Research Medical UniversityRussian FederationФГАОУ ВО «Российский национальный исследовательский медицинский университет им. Н.И. Пирогова» Минздрава РоссииРоссияPirogov Russian National Research Medical UniversityRussian FederationФГАОУ ВО «Первый Московский государственный медицинский университет им. И.М. Сеченова» Минздрава России (Сеченовский Университет)РоссияSechenov First Moscow State Medical University (Sechenov University)Russian Federation2021231220221826979Copyright © Алексеева Т.А., Литвин А.Ю., Елфимова Е.М., Михайлова О.О., Ларина В.Н., Шпоть Е.В., Подзолков В.И., Чазова И.Е., 20222022Алексеева Т.А., Литвин А.Ю., Елфимова Е.М., Михайлова О.О., Ларина В.Н., Шпоть Е.В., Подзолков В.И., Чазова И.Е.Alekseeva T.A., Litvin A.Y., Elfimova E.M., Mikhailova O.O., Larina V.N., Shpot E.V., Podzolkov V.I., Chazova I.E.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.syst-hypertension.ru/jour/article/view/631

Сексуальное здоровье является неотъемлемой частью здоровья в целом, и активная и здоровая сексуальная жизнь - важный аспект хорошего качества жизни. Сердечно-сосудистые заболевания и нарушения сексуального здоровья имеют общие факторы риска (артериальная гипертония, сахарный диабет, дислипидемия, ожирение и курение) и общие патогенетические механизмы развития (эндотелиальная дисфункция, воспаление и атеросклероз). Все это привело к размышлениям о патофизиологии и возможностях лечения сексуальных нарушений. Применение препаратов из группы ингибиторов фосфодиэстеразы 5-го типа произвело революцию в лечении эректильной дисфункции (ЭД) у мужчин. Эта статья будет посвящена ЭД и ее связи с артериальной гипертонией. Данный документ создан экспертами Российского медицинского общества по артериальной гипертонии при участии члена рабочей группы по сексуальной дисфункции и артериальной гипертонии Европейского общества по артериальной гипертонии. Группа экспертов была очень активна в последние годы в ознакомлении специалистов по гипертонии и смежным специальностям с проблемой ЭД посредством многочисленных лекций на национальных и международных конгрессах. Было отмечено, что ЭД предшествует развитию ишемической болезни сердца. Гипотеза диаметра артерий была предложена как возможное объяснение данного наблюдения. Клинические проявления атеросклеротического поражения и/или эндотелиальной дисфункции артерий полового члена могут предшествовать соответствующим проявлениям в более крупных артериях. Больные гипертонией, получающие гипотензивную терапию, чаще страдают нарушениями сексуального характера по сравнению с нелечеными пациентами. Возникновение ЭД, по-видимому, связано с нежелательными эффектами гипотензивных препаратов на ткани полового члена. Имеется информация, указывающая на различные эффекты гипотензивных препаратов на эректильную функцию.

Sexual health is an essential part of overall health, and an active and healthy sex life is an important aspect of a good quality of life. Cardiovascular diseases and sexual health disorders have common risk factors (arterial hypertension, diabetes mellitus, dyslipidemia, obesity and smoking) and common pathogenesis (endothelial dysfunction, inflammation and atherosclerosis). All this led to speculations about the pathophysiology and treatment options for sexual dysfunctions. The use of phosphodiesterase type 5 inhibitors has revolutionized the treatment of erectile dysfunction (ED) in men. This article focuses on ED and its relationship with hypertension. This document was created by experts from the Russian Medical Society of Arterial Hypertension with the participation of a member of the European Society of Hypertension Working Group on Sexual Dysfunction and Arterial Hypertension. In recent years, the expert group was very active in educating hypertension specialists and related specialties physicians about ED via numerous lectures at national and international congresses. It has been noted that ED precedes the development of coronary heart disease. The artery diameter hypothesis has been proposed as a possible explanation for this observation. Clinical manifestations of atherosclerotic lesions and/or endothelial dysfunction of the penile arteries may precede those in larger arteries. Patients with hypertension who receive antihypertensive drugs are more likely to suffer from sexual dysfunctions compared to untreated patients. The occurrence of ED appears to be related to the undesirable effects of antihypertensive drugs on the penile tissues. There is information about various effects of antihypertensive drugs on erectile function.

приверженность гипотензивной терапииартериальная гипертонияэректильная дисфункциялечение эректильной дисфункциисердечно-сосудистые заболеванияadherence to antihypertensive therapyarterial hypertensionerectile dysfunctiontreatment of erectile dysfunctioncardiovascular diseasesReferencesHigh Blood Pressure is a Global Health Tragedy. World Health Organization by Ryan Kraudel. 2019.High Blood Pressure is a Global Health Tragedy. World Health Organization by Ryan Kraudel. 2019.Национальные рекомендации по кардиоваскулярной профилактике. Российское кардиологическое общество. Национальное общество профилактической кардиологии. 2017Natsional'nye rekomendatsii po kardiovaskuliarnoi profilaktike. Rossiiskoe kardiologicheskoe obshchestvo. Natsional'noe obshchestvo profilakticheskoi kardiologii. 2017 (in Russian).Barnes GD. Effect of Intensive Blood Pressure Lowering on CV Outcomes. 2020.Barnes GD. Effect of Intensive Blood Pressure Lowering on CV Outcomes. 2020.Zhao B, Hong Z, Wei Y. Erectile Dysfunction Predicts Cardiovascular Events as an Independent Risk Factor: A Systematic Review and Meta-Analysis. J Sex Med. 2019;16:1005e1017.Zhao B, Hong Z, Wei Y. Erectile Dysfunction Predicts Cardiovascular Events as an Independent Risk Factor: A Systematic Review and Meta-Analysis. J Sex Med. 2019;16:1005e1017.Mills K, Stefanescu A, He J. The global epidemiology of hypertension. Nat Rev Nephrol. 2020;16(4):223-37. DOI:10.1038/s41581-019-0244-2Mills K, Stefanescu A, He J. The global epidemiology of hypertension. Nat Rev Nephrol. 2020;16(4):223-37. doi: 10.1038/s41581-019-0244-2NCD Risk Factor Collaboration (NCD-RisC). Worldwide trends in blood pressure from 1975 to 2015: a pooled analysis of 1479 population - based measurement studies with 19.1 million participants. Lancet. 2017;389:37-55.NCD Risk Factor Collaboration (NCD-RisC). Worldwide trends in blood pressure from 1975 to 2015: a pooled analysis of 1479 population – based measurement studies with 19.1 million participants. Lancet. 2017;389:37-55.Catala-Lopez F, Feigin V, Fernandes J, et al. Global burden of hypertension and systolic blood pressure of at least 110 to 115mm Hg, 1990-2015. JAMA. 2017;317:165-82.Catala-Lopez F, Feigin V, Fernandes J, et al. Global burden of hypertension and systolic blood pressure of at least 110 to 115mm Hg, 1990-2015. JAMA. 2017;317:165-82.Lewington S, Clarke R, Qizilbash N, et al. Prospective Studies Collaboration. Age-specific relevance of usual blood pressure to vascular mortality: a meta-analysis of individual data for one million adults in 61 prospective studies. Lancet. 2002;360:1903-13.Lewington S, Clarke R, Qizilbash N, et al. Prospective Studies Collaboration. Age-specific relevance of usual blood pressure to vascular mortality: a meta-analysis of individual data for one million adults in 61 prospective studies. Lancet. 2002;360:1903-13.Johannes C, Araujo A, Feldman H, et al. Incidence of erectile dysfunction in men 40 to 69 years old: longitudinal results from the Massachusetts Male Aging Study. J Urol. 2000;163:460-3.Johannes C, Araujo A, Feldman H, et al. Incidence of erectile dysfunction in men 40 to 69 years old: longitudinal results from the Massachusetts Male Aging Study. J Urol. 2000;163:460-3.Shiri R, Koskimaki J, Hakkinen J, et al. Effects of age, comorbidity and lifestyle factors on erectile function: Tampere Ageing Male Urological Study (TAMUS). Eur Urol. 2004;45:628-33.Shiri R, Koskimaki J, Hakkinen J, et al. Effects of age, comorbidity and lifestyle factors on erectile function: Tampere Ageing Male Urological Study (TAMUS). Eur Urol. 2004;45:628-33.Rosen R, Fischer W, Eardley I, et al. The Multinational Men’s Attitudes to Life Events and Sexuality (MALES) study: I. Prevalence of erectile dysfunction and related health concerns in the general population. Curr Med Res Opin. 2004;20:607-17.Rosen R, Fischer W, Eardley I, et al. The Multinational Men’s Attitudes to Life Events and Sexuality (MALES) study: I. Prevalence of erectile dysfunction and related health concerns in the general population. Curr Med Res Opin. 2004;20:607-17.Holden C, McLachlan R, Pitts M, et al. Men in Australia, Telephone Survey (MATeS) I: a national survey of the reproductive health and concerns of middle aged and older Australian men. Lancet. 2005;366:218-24.Holden C, McLachlan R, Pitts M, et al. Men in Australia, Telephone Survey (MATeS) I: a national survey of the reproductive health and concerns of middle aged and older Australian men. Lancet. 2005;366:218-24.Braun M, Wassmer G, Klotz T, et al. Epidemiology of erectile dysfunction: results of the "Cologne Male Survey". Intern J Impot Res. 2000;12:305-11.Braun M, Wassmer G, Klotz T, et al. Epidemiology of erectile dysfunction: results of the "Cologne Male Survey". Intern J Impot Res. 2000;12:305-11.Goldstein I, Goren A, Li V, et al. Epidemiology Update of Erectile Dysfunction in Eight Countries with High Burden. Sex Med Rev. 2020;8(1):48-58. DOI:10.1016/j.sxmr.2019.06.008Goldstein I, Goren A, Li V, et al. Epidemiology Update of Erectile Dysfunction in Eight Countries with High Burden. Sex Med Rev. 2020;8(1):48-58. doi: 10.1016/j.sxmr.2019.06.008Grimm R, Grandits G, Prineas R, et al. Long-term effects on sexual function of five antihypertensive drugs and nutritional hygienic treatment in hypertensive men and women: Treatment of Mild Hypertension Study (TOMHS). Hypertension. 1997;29(1 Pt. 1):8-14.Grimm R, Grandits G, Prineas R, et al. Long-term effects on sexual function of five antihypertensive drugs and nutritional hygienic treatment in hypertensive men and women: Treatment of Mild Hypertension Study (TOMHS). Hypertension. 1997;29(1 Pt. 1):8-14.Doumas M, Douma S. Sexual dysfunction in essential hypertension: myth or reality? J Clin Hypertens. 2006;8:269-74.Doumas M, Douma S. Sexual dysfunction in essential hypertension: myth or reality? J Clin Hypertens. 2006;8:269-74.Doumas M, Tsakiris A, Douma S, et al. Factors affecting the increased prevalence of erectile dysfunction in Greek hypertensive compared with normotensive subjects. J Androl. 2006;27:469-77.Doumas M, Tsakiris A, Douma S, et al. Factors affecting the increased prevalence of erectile dysfunction in Greek hypertensive compared with normotensive subjects. J Androl. 2006;27:469-77.Boston University School of Medicine. Sexual Medicine. 2002.Boston University School of Medicine. Sexual Medicine. 2002.Skrypnik D, Bogdański P, Musialik K, et al. Obesity - significant risk factor for erectile dysfunction in men. Pol Merkur Lekarski. 2014;36(212):137-41.Skrypnik D, Bogdański P, Musialik K, et al. Obesity – significant risk factor for erectile dysfunction in men. Pol Merkur Lekarski. 2014;36(212):137-41.Bohm M, Baumhakel M, Teo K, et al. ONTARGET/TRANSCEND Erectile Dysfunction Substudy Investigators. Erectile dysfunction predicts cardiovascular events in high-risk patients receiving telmisartan, ramipril, or both: the ONgoing Telmisartan Alone and in combination with Ramipril Global Endpoint Trial/Telmisartan Randomized Assess me Nt Study in ACE iNtolerant subjects with cardiovascular Disease (ONTARGET/TRANSCEND) Trials. Circulation. 2010;121:1439-46.Bohm M, Baumhakel M, Teo K, et al. ONTARGET/TRANSCEND Erectile Dysfunction Substudy Investigators. Erectile dysfunction predicts cardiovascular events in high-risk patients receiving telmisartan, ramipril, or both: the ONgoing Telmisartan Alone and in combination with Ramipril Global Endpoint Trial/Telmisartan Randomized Assess me Nt Study in ACE iNtolerant subjects with cardiovascular Disease (ONTARGET/TRANSCEND) Trials. Circulation. 2010;121:1439-46.Thomas H, Evans G, Berlowitz D, et al. SPRINT Study Group. Antihypertensive medications and sexual function in women: baseline data from the SBP intervention trial (SPRINT). J Hypertens. 2016;34:1224-31.Thomas H, Evans G, Berlowitz D, et al. SPRINT Study Group. Antihypertensive medications and sexual function in women: baseline data from the SBP intervention trial (SPRINT). J Hypertens. 2016;34:1224-31.Vlachopoulos C, Ioakeimidis N, Stefanadis C. Biomarkers, erectile dysfunction, and cardiovascular risk prediction: the latest of an evolving concept. Asian J Androl. 2015;17:17-20.Vlachopoulos C, Ioakeimidis N, Stefanadis C. Biomarkers, erectile dysfunction, and cardiovascular risk prediction: the latest of an evolving concept. Asian J Androl. 2015;17:17-20.Rosen R, Riley A, Wagner G, et al. The International Index of Erectile Function (IIEF): amultidimensional scale for assessment of erectile dysfunction. Urology. 1997;49:822-30.Rosen R, Riley A, Wagner G, et al. The International Index of Erectile Function (IIEF): amultidimensional scale for assessment of erectile dysfunction. Urology. 1997;49:822-30.Cappelleri J, Rosen R. The Sexual Health Inventory for Men (SHIM): a 5-year review of research and clinical experience. Int J Impot Res. 2005;17:1307-19.Cappelleri J, Rosen R. The Sexual Health Inventory for Men (SHIM): a 5-year review of research and clinical experience. Int J Impot Res. 2005;17:1307-19.Inman B, St. Sauver J, Jacobson D, et al. A population-based longitudinal study of erectile dysfunction and future coronary artery disease. Mayo Clin Proc. 2009;84(2):108-13.Inman B, St. Sauver J, Jacobson D, et al. A population-based longitudinal study of erectile dysfunction and future coronary artery disease. Mayo Clin Proc. 2009;84(2):108-13.Feldman HA, Goldstein I, Hatzichristou DG, et al. Impotence and its medical and psychosocial correlates: results of the Massachusetts Male Aging Study. J Urology. 1994;151:54-61.Feldman HA, Goldstein I, Hatzichristou DG, et al. Impotence and its medical and psychosocial correlates: results of the Massachusetts Male Aging Study. J Urology. 1994;151:54-61.Blouin K, Boivin A, Tchernof A. Androgens and body fat distribution. J Steroid Biochem Mol Biol. 2008;108:272-80.Blouin K, Boivin A, Tchernof A. Androgens and body fat distribution. J Steroid Biochem Mol Biol. 2008;108:272-80.Singh R, Artaza JN, Taylor WE, et al. Androgens stimulate myogenic differentiation and inhibit adipogenesis in C3H 10T1/2 pluripotent cells through an androgen receptor-mediated pathway. Endocrinology. 2003;144:5081-8.Singh R, Artaza JN, Taylor WE, et al. Androgens stimulate myogenic differentiation and inhibit adipogenesis in C3H 10T1/2 pluripotent cells through an androgen receptor-mediated pathway. Endocrinology. 2003;144:5081-8.Гамидов С.И., Тажетдинов О.Х., Павловичев А.А., и др. Особенности патогенеза, диагностики и лечения эректильной дисфункции у больных с гипогонадизмом. Проблемы эндокринологии. 2010;5:33-42Gamidov SI, Tazhetdinov OKh, Pavlovichev AA, et al. Osobennosti patogeneza, diagnostiki i lecheniia erektil'noi disfunktsii u bol'nykh s gipogonadizmom. Problemy endokrinologii. 2010;5:33-42 (in Russian).Jackson G, Boon N, Eardley I, et al. Erectile dysfunction and coronary artery disease prediction: evidencebased guidance and consensus. Int J Clin Pract. 2010;64:848-57.Jackson G, Boon N, Eardley I, et al. Erectile dysfunction and coronary artery disease prediction: evidencebased guidance and consensus. Int J Clin Pract. 2010;64:848-57.Hatzimouratidis K, Giuliano F, Moncada I, et al. EAU Guidelines on Erectile Dysfunction, Premature Ejaculation, Penile Curvature and Priapism. European Association of Urology, 2016.Hatzimouratidis K, Giuliano F, Moncada I, et al. EAU Guidelines on Erectile Dysfunction, Premature Ejaculation, Penile Curvature and Priapism. European Association of Urology, 2016.Пушкарь Д.Ю. Эректильная дисфункция - современные методы диагностики и лечения. Справочник поликлинического врача. 2004;2Pushkar' DIu. Erektil'naia disfunktsiia – sovremennye metody diagnostiki i lecheniia. Handbook for Practitioners Doctors. 2004;2 (in Russian).Altinbas N, Hamidi N. Penile Doppler ultrasonography and elastography evaluation in patients with erectile dysfunction. Pol J Radiol. 2018;83:e491-e499. DOI:10.5114/pjr.2018.80301Altinbas N, Hamidi N. Penile Doppler ultrasonography and elastography evaluation in patients with erectile dysfunction. Pol J Radiol. 2018;83:e491-e499. doi: 10.5114/pjr.2018.80301Vlachopoulos C, Jackson G, Stefanadis C, Montorsi P. Erectile dysfunction in the cardiovascular patient. Eur Heart J. 2013;34:2034-46.Vlachopoulos C, Jackson G, Stefanadis C, Montorsi P. Erectile dysfunction in the cardiovascular patient. Eur Heart J. 2013;34:2034-46.Jackson G, Nehra A, Miner M, et al. The assessment of vascular risk in men with erectile dysfunction: the role of the cardiologist and general physician. Int J Clin Pract. 2013;67:1163-72.Jackson G, Nehra A, Miner M, et al. The assessment of vascular risk in men with erectile dysfunction: the role of the cardiologist and general physician. Int J Clin Pract. 2013;67:1163-72.Viigimaa M. Lifestyle modification in erectile dysfunction and hypertension. In: Viigimaa M, Vlachopoulos C, Doumas M, ed. Erectile dysfunction in hypertension and cardiovascular disease. Cham, Switzerland: Springer, 2015; p. 167-74.Viigimaa M. Lifestyle modification in erectile dysfunction and hypertension. In: Viigimaa M, Vlachopoulos C, Doumas M, ed. Erectile dysfunction in hypertension and cardiovascular disease. Cham, Switzerland: Springer, 2015; p. 167-74.Rew T, Heidelbaugh J. Erectile Dysfunction. Am Fam Physician. 2016;94(10):820-7.Rew T, Heidelbaugh J. Erectile Dysfunction. Am Fam Physician. 2016;94(10):820-7.Sighinolfi M, Mofferdin А, De Stefani S, et al. Immediate improvement in penile hemodynamics after cessation of smoking: previous results. Urology. 2007;69:163-5.Sighinolfi M, Mofferdin А, De Stefani S, et al. Immediate improvement in penile hemodynamics after cessation of smoking: previous results. Urology. 2007;69:163-5.Silva R, Cipriano B, Silva DA, et al. Anthropometric measures change and incidence of high blood pressure levels among adults: a population-based prospective study in Southern Brazil. J Hypertens. 2017;35(1):39-46.Silva R, Cipriano B, Silva DA, et al. Anthropometric measures change and incidence of high blood pressure levels among adults: a population-based prospective study in Southern Brazil. J Hypertens. 2017;35(1):39-46.Giugliano F, Esposito K, Di Palo C, et al. Erectile dysfunction associates with endothelial dysfunction and raised proinflammatory cytokine levels in obese men. J Endocrinol Invest. 2004;27(7):665-9.Giugliano F, Esposito K, Di Palo C, et al. Erectile dysfunction associates with endothelial dysfunction and raised proinflammatory cytokine levels in obese men. J Endocrinol Invest. 2004;27(7):665-9.Zabelina D, Erickson A, Kolotkin R, Crosby R. The effect of age on weight-related quality of life in overweight and obese individuals. Obesity (Silver Spring). 2009;17:1410-3.Zabelina D, Erickson A, Kolotkin R, Crosby R. The effect of age on weight-related quality of life in overweight and obese individuals. Obesity (Silver Spring). 2009;17:1410-3.Demir T. Prevalence of erectile dysfunction in patients with metabolic syndrome. Int J Urol. 2006;13:385-8.Demir T. Prevalence of erectile dysfunction in patients with metabolic syndrome. Int J Urol. 2006;13:385-8.Esposito K, Giugliano F, Di Palo C, et al. Effect of lifestyle changes on erectile dysfunction in obese men: a randomized controlled trial. JAMA. 2004;291(23):2978-84.Esposito K, Giugliano F, Di Palo C, et al. Effect of lifestyle changes on erectile dysfunction in obese men: a randomized controlled trial. JAMA. 2004;291(23):2978-84.Dallal R, Chernoff A, O’Leary M, et al. Sexual dysfunction is common in the morbidly obese male and improves after gastric bypass surgery. J Am Coll Surg. 2008;207:859-64.Dallal R, Chernoff A, O’Leary M, et al. Sexual dysfunction is common in the morbidly obese male and improves after gastric bypass surgery. J Am Coll Surg. 2008;207:859-64.Rosenblatt A, Faintuch J, Cecconello I. Sexual hormones and erectile function more than 6 years after bariatric surgery. Surg Obes Relat Dis. 2013;9:636-40.Rosenblatt A, Faintuch J, Cecconello I. Sexual hormones and erectile function more than 6 years after bariatric surgery. Surg Obes Relat Dis. 2013;9:636-40.Sofi F, Abbate R, Gensini G, Casini A. Accruing evidence on benefits of adherence to the Mediterranean diet on health: an updated systematic review and meta-analysis. Am J Clin Nutr. 2010;92:1189-96.Sofi F, Abbate R, Gensini G, Casini A. Accruing evidence on benefits of adherence to the Mediterranean diet on health: an updated systematic review and meta-analysis. Am J Clin Nutr. 2010;92:1189-96.Meldrum D, Gambone J, Morris M, Ignarro L. Multifaceted approach to maximize erectile function and vascular health. Fertil Steril. 2010;94:2514-20.Meldrum D, Gambone J, Morris M, Ignarro L. Multifaceted approach to maximize erectile function and vascular health. Fertil Steril. 2010;94:2514-20.Nicolosi A, Glasser D, Moreira E, Villa M. Erectile Dysfunction Epidemiology Cross National Study Group. Prevalence of erectile dysfunction and associated factors among men without concomitant diseases: a population study. Int J Impot Res. 2003;15:253-7.Nicolosi A, Glasser D, Moreira E, Villa M. Erectile Dysfunction Epidemiology Cross National Study Group. Prevalence of erectile dysfunction and associated factors among men without concomitant diseases: a population study. Int J Impot Res. 2003;15:253-7.Beckerman J. High Blood Pressure and Erectile Dysfunction. FACC. 2019; March 21.Beckerman J. High Blood Pressure and Erectile Dysfunction. FACC. 2019; March 21.Wang W, Wang J, Wan F, Yang L. Physical exercise improves erectile function in young and middle-aged men. Zhonghua Nan Ke Xue. 2014;20:1086-9.Wang W, Wang J, Wan F, Yang L. Physical exercise improves erectile function in young and middle-aged men. Zhonghua Nan Ke Xue. 2014;20:1086-9.Ettala O, Syvanen K, Korhonen P, et al. High-intensity physical activity, stable relationship, and high education level associate with decreasing risk of erectile dysfunction in 1,000 apparently healthy cardiovascular risk subjects. J Sex Med. 2014;11:2277-84.Ettala O, Syvanen K, Korhonen P, et al. High-intensity physical activity, stable relationship, and high education level associate with decreasing risk of erectile dysfunction in 1,000 apparently healthy cardiovascular risk subjects. J Sex Med. 2014;11:2277-84.Simon R, Howard L, Zapata D, et al. The association of exercise with both erectile and sexual function in black and white men. J Sex Med. 2015;12:1202-10.Simon R, Howard L, Zapata D, et al. The association of exercise with both erectile and sexual function in black and white men. J Sex Med. 2015;12:1202-10.Compostella L, Compostella C, Truong L, et al. History of erectile dysfunction as a predictor of poor physical performance after an acute myocardial infarction. Eur J Prev Cardiol. 2017;24:460-7.Compostella L, Compostella C, Truong L, et al. History of erectile dysfunction as a predictor of poor physical performance after an acute myocardial infarction. Eur J Prev Cardiol. 2017;24:460-7.Ioakeimidis N, Samentzas A, Vlachopoulos C, et al. Chronotropic incompetence and dynamic postexercise autonomic dysfunction are associated with the presence and severity of erectile dysfunction. Ann Noninvasive Electrocardiol. 2016;21:256-62.Ioakeimidis N, Samentzas A, Vlachopoulos C, et al. Chronotropic incompetence and dynamic postexercise autonomic dysfunction are associated with the presence and severity of erectile dysfunction. Ann Noninvasive Electrocardiol. 2016;21:256-62.Kałka D, Domagała Z, Rusiecki L, et al. Heart rate recovery, cardiac rehabilitation and erectile dysfunction in males with ischaemic heart disease. Anatol J Cardiol. 2016;16:256-63.Kałka D, Domagała Z, Rusiecki L, et al. Heart rate recovery, cardiac rehabilitation and erectile dysfunction in males with ischaemic heart disease. Anatol J Cardiol. 2016;16:256-63.Kalka D, Domagala Z, Kowalewski P, et al. Effect of endurance cardiovascular training intensity on erectile dysfunction severity in men with ischemic heart disease. Am J Mens Health. 2015;9:360-9.Kalka D, Domagala Z, Kowalewski P, et al. Effect of endurance cardiovascular training intensity on erectile dysfunction severity in men with ischemic heart disease. Am J Mens Health. 2015;9:360-9.Condorelli R, Calogero A, Di Mauro M, et al. Effects of tadalafil treatment combined with physical activity in patients with low onset hypogonadism: results from a not-randomized single arm phase 2 study. Aging Male. 2016;19:155-60.Condorelli R, Calogero A, Di Mauro M, et al. Effects of tadalafil treatment combined with physical activity in patients with low onset hypogonadism: results from a not-randomized single arm phase 2 study. Aging Male. 2016;19:155-60.Kirilmaz U, Guzel O, Aslan Y, et al. The effect of lifestyle modification and glycemic control on the efficiency of sildenafil citrate in patients with erectile dysfunction due to type-2 diabetes mellitus. Aging Male. 2015;18:244-8.Kirilmaz U, Guzel O, Aslan Y, et al. The effect of lifestyle modification and glycemic control on the efficiency of sildenafil citrate in patients with erectile dysfunction due to type-2 diabetes mellitus. Aging Male. 2015;18:244-8.Gregoire J, Moisan J, Guibert R, et al. Determinants of discontinuation of new courses of antihypertensive medications. J Clin Epidemiol. 2002;55:728-35.Gregoire J, Moisan J, Guibert R, et al. Determinants of discontinuation of new courses of antihypertensive medications. J Clin Epidemiol. 2002;55:728-35.Shah A, Singh V, Patil P. Factors Affecting Compliance to Antihypertensive Treatment among Adults in a Tertiary Care Hospital in Mumbai. Indian J Community Med. 2018;43(1):53-5. DOI:10.4103/ijcm.IJCM_40_17Shah A, Singh V, Patil P. Factors Affecting Compliance to Antihypertensive Treatment among Adults in a Tertiary Care Hospital in Mumbai. Indian J Community Med. 2018;43(1):53-5. doi: 10.4103/ijcm.IJCM_40_17Harmon G, Lefante J, Krousel-Wood M. Overcoming barriers: the role of providers in improving patient adherence to antihypertensive medications. Curr Opin Cardiol. 2006;21:310-5.Harmon G, Lefante J, Krousel-Wood M. Overcoming barriers: the role of providers in improving patient adherence to antihypertensive medications. Curr Opin Cardiol. 2006;21:310-5.Fergus IV. Antihypertensive pharmacotherapy: adverse effects of medications promote nonadherence. J Cardiometab Syndr. 2009;4:E1-E3.Fergus IV. Antihypertensive pharmacotherapy: adverse effects of medications promote nonadherence. J Cardiometab Syndr. 2009;4:E1-E3.McLaughlin T, Harnett J, Burhani S, Scott B. Evaluation of erectile dysfunction therapy in patients previously nonadherent to long-term medications: a retrospective analysis of prescription claims. Am J Ther. 2005;12:605-11.McLaughlin T, Harnett J, Burhani S, Scott B. Evaluation of erectile dysfunction therapy in patients previously nonadherent to long-term medications: a retrospective analysis of prescription claims. Am J Ther. 2005;12:605-11.Korhonen P, Ettala O, Kautiainen H, Kantola I. Factors modifying the effect of blood pressure on erectile function. J Hypertens. 2015;33:975-80.Korhonen P, Ettala O, Kautiainen H, Kantola I. Factors modifying the effect of blood pressure on erectile function. J Hypertens. 2015;33:975-80.Baumhakel M, Schimmer N, Kratz M, et al. Cardiovascular risk, drugs and erectile function - a systematic analysis. Int J Clin Pract. 2011;65:289-98.Baumhakel M, Schimmer N, Kratz M, et al. Cardiovascular risk, drugs and erectile function – a systematic analysis. Int J Clin Pract. 2011;65:289-98.Fogari R, Zoppi A, Poletti L, et al. Sexual activity in hypertensive men treated with valsartan or carvedilol: a crossover study. Am J Hypertens. 2001;14:27-31.Fogari R, Zoppi A, Poletti L, et al. Sexual activity in hypertensive men treated with valsartan or carvedilol: a crossover study. Am J Hypertens. 2001;14:27-31.Fogari R, Preti P, Derosa G, et al. Effect of antihypertensive treatment with valsartan or atenolol on sexual activity and plasma testosterone in hypertensive men. Eur J Clin Pharmacol. 2001;58:177-80.Fogari R, Preti P, Derosa G, et al. Effect of antihypertensive treatment with valsartan or atenolol on sexual activity and plasma testosterone in hypertensive men. Eur J Clin Pharmacol. 2001;58:177-80.Van Bortel L, Bulpitt C, Fici F. Quality of life and antihypertensive effect with nebivolol and losartan. Am J Hypertens. 2005;18:1060-6.Van Bortel L, Bulpitt C, Fici F. Quality of life and antihypertensive effect with nebivolol and losartan. Am J Hypertens. 2005;18:1060-6.Chen Y, Cui S, Lin H, et al. Losartan improves erectile dysfunction in diabetic patients: a clinical trial. Int J Impot Res. 2012;24:217-20.Chen Y, Cui S, Lin H, et al. Losartan improves erectile dysfunction in diabetic patients: a clinical trial. Int J Impot Res. 2012;24:217-20.Yang L, Yu J, Ma R, et al. The effect of combined antihypertensive treatment (felodipine with either irbesartan or metoprolol) on erectile function: a randomized controlled trial. Cardiology. 2013;125:235-41.Yang L, Yu J, Ma R, et al. The effect of combined antihypertensive treatment (felodipine with either irbesartan or metoprolol) on erectile function: a randomized controlled trial. Cardiology. 2013;125:235-41.Llisterri J, Lozano Vidal J, Aznar Vicente J, et al. Sexual dysfunction in hypertensive patients treated with losartan. Am J Med Sci. 2001;321:336-41.Llisterri J, Lozano Vidal J, Aznar Vicente J, et al. Sexual dysfunction in hypertensive patients treated with losartan. Am J Med Sci. 2001;321:336-41.Baumhakel M, Schlimmer N, Bohm M. Effect of irbesartan on erectile function in patients with hypertension and metabolic syndrome. Int J Impot Res. 2008;20:493-500.Baumhakel M, Schlimmer N, Bohm M. Effect of irbesartan on erectile function in patients with hypertension and metabolic syndrome. Int J Impot Res. 2008;20:493-500.Erdmann E. Safety and tolerability of beta-blockers: prejudices and reality. Eur Heart J Supple. 2009.Erdmann E. Safety and tolerability of beta-blockers: prejudices and reality. Eur Heart J Supple. 2009.Prisant L, Weir M, Frishman W, et al. Self reported sexual dysfunction in men and women treated with bisoprolol, hydrochlorothiazide, enalapril, amlodipine, placebo, or bisoprolol/hydrochlorothiazide. J Clin Hypertens (Greenwich). 1999;1:22-6.Prisant L, Weir M, Frishman W, et al. Self reported sexual dysfunction in men and women treated with bisoprolol, hydrochlorothiazide, enalapril, amlodipine, placebo, or bisoprolol/hydrochlorothiazide. J Clin Hypertens (Greenwich). 1999;1:22-6.Manolis A, Doumas M. Erectile function in cardiovascular disease and hypertension: the role of nebivolol. J Hypertens Open Access. 2016;5:2.Manolis A, Doumas M. Erectile function in cardiovascular disease and hypertension: the role of nebivolol. J Hypertens Open Access. 2016;5:2.Angulo J, Wright H, Cuevas P, et al. Nebivolol dilates human penile arteries and reverses erectile dysfunction in diabetic rats through enhancement of nitric oxide signalling. J Sex Med. 2010;7:2681-97.Angulo J, Wright H, Cuevas P, et al. Nebivolol dilates human penile arteries and reverses erectile dysfunction in diabetic rats through enhancement of nitric oxide signalling. J Sex Med. 2010;7:2681-97.Baumhakel M, Schlimmer N, Buyukafsar K, et al. Nebivolol, but not metoprolol, improves endothelial function of the corpus cavernosum in apolipoprotein E-knockout mice. J Pharmacol Exp Ther. 2008;325:818-23.Baumhakel M, Schlimmer N, Buyukafsar K, et al. Nebivolol, but not metoprolol, improves endothelial function of the corpus cavernosum in apolipoprotein E-knockout mice. J Pharmacol Exp Ther. 2008;325:818-23.Cordero A, Bertomeu-Martinez V, Mazon P, et al. Erectile dysfunction in high-risk hypertensive patients treated with beta-blockers agents. Cardiovasc Ther. 2010;28:15-22.Cordero A, Bertomeu-Martinez V, Mazon P, et al. Erectile dysfunction in high-risk hypertensive patients treated with beta-blockers agents. Cardiovasc Ther. 2010;28:15-22.Cordero A, Bertomeu-Martinez V, Mazon P, et al. Erectile dysfunction may improve by blood pressure control in patients with high-risk hypertension. Postgrad Med. 2010;122:51-6.Cordero A, Bertomeu-Martinez V, Mazon P, et al. Erectile dysfunction may improve by blood pressure control in patients with high-risk hypertension. Postgrad Med. 2010;122:51-6.Brixius K, Middeke M, Lichtenthal A, et al. Nitric oxide, erectile dysfunction and beta-blocker treatment (MR NOED study): benefit of nebivolol versus metoprolol in hypertensive men. Clin Exp Pharmacol Physiol. 2007;34:327-31.Brixius K, Middeke M, Lichtenthal A, et al. Nitric oxide, erectile dysfunction and beta-blocker treatment (MR NOED study): benefit of nebivolol versus metoprolol in hypertensive men. Clin Exp Pharmacol Physiol. 2007;34:327-31.Boydak B, Nalbantgil S, Fici F, et al. A randomized comparison of the effects of nebivolol and atenolol with and without chlorthalidone on the sexual function of hypertensive men. Clin Drug Invest. 2005;25:409-16.Boydak B, Nalbantgil S, Fici F, et al. A randomized comparison of the effects of nebivolol and atenolol with and without chlorthalidone on the sexual function of hypertensive men. Clin Drug Invest. 2005;25:409-16.Gur O, Gurkan S, Yumun G, Turker P. The comparison of the effects of nebivolol and metoprolol on erectile dysfunction in the cases with coronary artery bypass surgery. Ann Thorac Cardiovasc Surg. 2017;23:91-5.Gur O, Gurkan S, Yumun G, Turker P. The comparison of the effects of nebivolol and metoprolol on erectile dysfunction in the cases with coronary artery bypass surgery. Ann Thorac Cardiovasc Surg. 2017;23:91-5.Williams B, Mancia G, Spiering W, et al. 2018 ESC/ESH Guidlines for the management of arterial hypertension: The Task Force for the management of arterial hypertension of the European Society of Cardiology and the European Society of Hypertension: The Task Force for the management of arterial hypertension of the European Society of Cardiology and the European Society of Hypertension. J Hypertens. 2018;36:1953-2041.Williams B, Mancia G, Spiering W, et al. 2018 ESC/ESH Guidlines for the management of arterial hypertension: The Task Force for the management of arterial hypertension of the European Society of Cardiology and the European Society of Hypertension: The Task Force for the management of arterial hypertension of the European Society of Cardiology and the European Society of Hypertension. J Hypertens. 2018;36:1953-2041.Della Chiesa A, Pfiffner D, Meier B, Hess OM. Sexual activity in hypertensive men. J Hum Hypertens. 2003;17:515-21.Della Chiesa A, Pfiffner D, Meier B, Hess OM. Sexual activity in hypertensive men. J Hum Hypertens. 2003;17:515-21.Dusing R. Effect of the angiotensin II antagonist valsartan on sexual function in hypertensive men. Blood Press Suppl. 2003;2:29-34.Dusing R. Effect of the angiotensin II antagonist valsartan on sexual function in hypertensive men. Blood Press Suppl. 2003;2:29-34.Martin S, Atlantis E, Lange K, et al. Male Ageing Study. Predictors of sexual dysfunction incidence and remission in men. J Sex Med. 2014;11:1136-47.Martin S, Atlantis E, Lange K, et al. Male Ageing Study. Predictors of sexual dysfunction incidence and remission in men. J Sex Med. 2014;11:1136-47.Budweiser S, Enderlein S, Jorres R, et al. Sleep apnea is an independent correlate of erectile and sexual dysfunction. J Sex Med. 2009;6:3147-57.Budweiser S, Enderlein S, Jorres R, et al. Sleep apnea is an independent correlate of erectile and sexual dysfunction. J Sex Med. 2009;6:3147-57.Gianatti E, Dupuis P, Hoermann R, et al. Effect of testosterone treatment on constitutional and sexual symptoms in men with type 2 diabetes in a randomized, placebo-controlled clinical trial. J Clin Endocrinol Metab. 2014;99:3821-28.Gianatti E, Dupuis P, Hoermann R, et al. Effect of testosterone treatment on constitutional and sexual symptoms in men with type 2 diabetes in a randomized, placebo-controlled clinical trial. J Clin Endocrinol Metab. 2014;99:3821-28.Szymanski F, Filipiak K, Hrynkiewicz-Szymanska A, et al. The high risk of obstructive sleep apnea - an independent risk factor of erectile dysfunction in ST-segment elevation myocardial infarction patients. J Sex Med. 2011;8(5):1434-8.Szymanski F, Filipiak K, Hrynkiewicz-Szymanska A, et al. The high risk of obstructive sleep apnea – an independent risk factor of erectile dysfunction in ST-segment elevation myocardial infarction patients. J Sex Med. 2011;8(5):1434-8.Margel D, Cohen M, Livne PM, Pillar G. Severe, but not mild, obstructive sleep apnea syndrome is associated with erectile dysfunction. Urology. 2004;63(3):545-9.Margel D, Cohen M, Livne PM, Pillar G. Severe, but not mild, obstructive sleep apnea syndrome is associated with erectile dysfunction. Urology. 2004;63(3):545-9.Pittaras F. Erectile Dysfunction in Hypertension and Cardiovascular Disease: A Guide for Clinicians. Journal of Hypertension. 2011;29:403-7.Pittaras F. Erectile Dysfunction in Hypertension and Cardiovascular Disease: A Guide for Clinicians. Journal of Hypertension. 2011;29:403-7.Andersen M, Tufik S. The effects of testosterone on sleep and sleep-disordered breathing in men: its bidirectional interaction with erectile function. Sleep Med Rev. 2008;12(5):365-79.Andersen M, Tufik S. The effects of testosterone on sleep and sleep-disordered breathing in men: its bidirectional interaction with erectile function. Sleep Med Rev. 2008;12(5):365-79.Kouchiyama S, Honda Y, Kuriyama T. Influence of nocturnal oxygen desaturation on circadian rhythm of testosterone secretion. Respiration. 1990;57:359-63.Kouchiyama S, Honda Y, Kuriyama T. Influence of nocturnal oxygen desaturation on circadian rhythm of testosterone secretion. Respiration. 1990;57:359-63.Grunstein R, Handelsman D, Lawrence S, et al. Neuroendocrine dysfunction in sleep apnea: reversal by continuous positive airways pressure therapy. J Clin Endocrinol Metab. 1989;68(2):352-8.Grunstein R, Handelsman D, Lawrence S, et al. Neuroendocrine dysfunction in sleep apnea: reversal by continuous positive airways pressure therapy. J Clin Endocrinol Metab. 1989;68(2):352-8.Fletcher E. Hypertension in patients with sleep apnoea, a combined effect. Thorax. 2000;55:726-8.Fletcher E. Hypertension in patients with sleep apnoea, a combined effect. Thorax. 2000;55:726-8.Dudenbostel T, Calhoun D. Resistant hypertension, obstructive sleep apnea and aldosterone. J Hum Hypertens. 2011;26:281-7.Dudenbostel T, Calhoun D. Resistant hypertension, obstructive sleep apnea and aldosterone. J Hum Hypertens. 2011;26:281-7.Pedrosa R, Drager L, Gonzaga C, et al. Obstructive sleep apnea: the most common secondary cause of hypertension associated with resistant hypertension. Hypertension. 2011;58(5):811-7.Pedrosa R, Drager L, Gonzaga C, et al. Obstructive sleep apnea: the most common secondary cause of hypertension associated with resistant hypertension. Hypertension. 2011;58(5):811-7.Muxfeldt E, Margallo V, Guimarães G, Salles G. Prevalence and associated factors of obstructive sleep apnea in patients with resistant hypertension. Am J Hypertens. 2014;27(8):1069-78. DOI:10.1093/ajh/hpu023Muxfeldt E, Margallo V, Guimarães G, Salles G. Prevalence and associated factors of obstructive sleep apnea in patients with resistant hypertension. Am J Hypertens. 2014;27(8):1069-78. doi: 10.1093/ajh/hpu023Dong J, Zhang Y, Qin L. Obstructive sleep apnea and cardiovascular risk: meta-analysis of prospective cohort studies. Atherosclerosis. 2013;229(2):489-95. DOI:10.1016/j.atherosclerosis.2013.04.026Dong J, Zhang Y, Qin L. Obstructive sleep apnea and cardiovascular risk: meta-analysis of prospective cohort studies. Atherosclerosis. 2013;229(2):489-95. doi: 10.1016/j.atherosclerosis.2013.04.026Schulz R, Bischof F, Galetke W, et al. German Sleep Apnea Research Network (GERSAN). CPAP therapy improves erectile function in patients with severe obstructive sleep apnea. Sleep Med. 2019;53:189-94.Schulz R, Bischof F, Galetke W, et al. German Sleep Apnea Research Network (GERSAN). CPAP therapy improves erectile function in patients with severe obstructive sleep apnea. Sleep Med. 2019;53:189-94.Cruz I, Drummond M, Winck J. Obstructive sleep apnea symptoms beyond sleepiness and snoring: effects of nasal APAP therapy. Sleep Breath. 2012;16:361-6.Cruz I, Drummond M, Winck J. Obstructive sleep apnea symptoms beyond sleepiness and snoring: effects of nasal APAP therapy. Sleep Breath. 2012;16:361-6.Budweiser S, Luigart R, Jorres R, et al. Long-term changes of sexual function in men with obstructive sleep apnea after initiation of continuous positive airway pressure. J Sex Med. 2013;10:524-31.Budweiser S, Luigart R, Jorres R, et al. Long-term changes of sexual function in men with obstructive sleep apnea after initiation of continuous positive airway pressure. J Sex Med. 2013;10:524-31.Campos-Juanatey F, Fernandez-Barriales M, Gonzalez M, Portillo-Martin J. Effects of obstructive sleep apnea and its treatment over the erectile function: a systematic review. Asian J Androl. 2017;19:303-10.Campos-Juanatey F, Fernandez-Barriales M, Gonzalez M, Portillo-Martin J. Effects of obstructive sleep apnea and its treatment over the erectile function: a systematic review. Asian J Androl. 2017;19:303-10.Li X, Dong Z, Wan Y, Wang Z. Sildenafil versus continuous positive airway pressure for erectile dysfunction in men with obstructive sleep apnea: a meta-analysis. Aging Male. 2010;13:82-6.Li X, Dong Z, Wan Y, Wang Z. Sildenafil versus continuous positive airway pressure for erectile dysfunction in men with obstructive sleep apnea: a meta-analysis. Aging Male. 2010;13:82-6.Pastore A, Palleschi G, Ripoli A, et al. Severe obstructive sleep apnoea syndrome and erectile dysfunction: a prospective randomised study to compare sildenafil vs. nasal continuous positive airway pressure. Int J Clin Pract. 2014;68:995-1000.Pastore A, Palleschi G, Ripoli A, et al. Severe obstructive sleep apnoea syndrome and erectile dysfunction: a prospective randomised study to compare sildenafil vs. nasal continuous positive airway pressure. Int J Clin Pract. 2014;68:995–1000.Melehan K, Hoyos C, Hamilton G, et al. Randomized trial of CPAP and vardenafil on erectile and arterial function in men with obstructive sleep apnea and erectile dysfunction. J Clin Endocrinol Metab. 2018;103:1601-11.Melehan K, Hoyos C, Hamilton G, et al. Randomized trial of CPAP and vardenafil on erectile and arterial function in men with obstructive sleep apnea and erectile dysfunction. J Clin Endocrinol Metab. 2018;103:1601-11.Chrysant S, Chrysant G. The pleiotropic effects of phosphodiesterase 5 inhibitors on function and safety in patients with cardiovascular disease and hypertension. J Clin Hypertens (Greenwich). 2012;14:644-9.Chrysant S, Chrysant G. The pleiotropic effects of phosphodiesterase 5 inhibitors on function and safety in patients with cardiovascular disease and hypertension. J Clin Hypertens (Greenwich). 2012;14:644-9.Carson C, Burnett A, Levine L, Nehra A. The efficacy of sildenafil citrate (Viagra) in clinical populations: an update. Urology. 2002;60(2 Suppl. 2):12-27.Carson C, Burnett A, Levine L, Nehra A. The efficacy of sildenafil citrate (Viagra) in clinical populations: an update. Urology. 2002;60(2 Suppl. 2):12-27.Gupta M, Kovar A, Meibohm B. The clinical pharmacokinetics of phosphodiesterase-5 inhibitors for erectile dysfunction. J Clin Pharmacol. 2005;45:987-1003.Gupta M, Kovar A, Meibohm B. The clinical pharmacokinetics of phosphodiesterase-5 inhibitors for erectile dysfunction. J Clin Pharmacol. 2005;45:987-1003.Viigimaa M, Vlachopoulos C, Lazaridis A, Doumas M. Management of erectile dysfunction in hypertension: Tips and tricks. World J Cardiol. 2014;6:908-15.Viigimaa M, Vlachopoulos C, Lazaridis A, Doumas M. Management of erectile dysfunction in hypertension: Tips and tricks. World J Cardiol. 2014;6:908-15.Sanford M. Avanafil: a review of its use in patients with erectile dysfunction. Drugs Aging. 2013;30:853-62.Sanford M. Avanafil: a review of its use in patients with erectile dysfunction. Drugs Aging. 2013;30:853-62.Park H, Park N, Shim H, et al. An openlabel, multicenter, flexible dose study to evaluate the efficacy and safety of Viagra (sildenafil citrate) in Korean men with erectile dysfunction and arterial hypertension who are taking antihypertensive agents. J Sex Med. 2008;5:2405-13.Park H, Park N, Shim H, et al. An openlabel, multicenter, flexible dose study to evaluate the efficacy and safety of Viagra (sildenafil citrate) in Korean men with erectile dysfunction and arterial hypertension who are taking antihypertensive agents. J Sex Med. 2008;5:2405-13.Van Ahlen H, Wahle K, Kupper W, et al. Safety and efficacy of vardenafil, a selective phosphodiesterase 5 inhibitor, in patients with erectile dysfunction and arterial hypertension treated with multiple antihypertensives. J Sex Med. 2005;2:856-64.Van Ahlen H, Wahle K, Kupper W, et al. Safety and efficacy of vardenafil, a selective phosphodiesterase 5 inhibitor, in patients with erectile dysfunction and arterial hypertension treated with multiple antihypertensives. J Sex Med. 2005;2:856-64.Kloner R, Brown M, Prisant L, Collins M. Effect of sildenafil in patients with erectile dysfunction taking antihypertensive therapy. Sildenafil Study Group. Am J Hypertens. 2001;14:70-3.Kloner R, Brown M, Prisant L, Collins M. Effect of sildenafil in patients with erectile dysfunction taking antihypertensive therapy. Sildenafil Study Group. Am J Hypertens. 2001;14:70-3.Kloner R, Sadovsky R, Johnson E, et al. Efficacy of tadalafil in the treatment of erectile dysfunction in hypertensive men on concomitant thiazide diuretic therapy. Int J Impot Res. 2005;17:450-4.Kloner R, Sadovsky R, Johnson E, et al. Efficacy of tadalafil in the treatment of erectile dysfunction in hypertensive men on concomitant thiazide diuretic therapy. Int J Impot Res. 2005;17:450-4.Benjamin E, Blaha M, Chiuve S, et al. American Heart Association Statistics Committee, Stroke Statistics Subcommittee. Heart Disease and Stroke Statistics-2017 Update: A Report From the American Heart Association. Circulation. 2017;135:e146-e603.Benjamin E, Blaha M, Chiuve S, et al. American Heart Association Statistics Committee, Stroke Statistics Subcommittee. Heart Disease and Stroke Statistics-2017 Update: A Report From the American Heart Association. Circulation. 2017;135:e146-e603.Sperling H, Gittleman M, Norenberg C, et al. Efficacy and safety of orodispersible vardenafil formulation for the treatment of erectile dysfunction in elderly men and those with underlying conditions: an integrated analysis of two pivotal trials. J Sex Med. 2011;8:261-71.Sperling H, Gittleman M, Norenberg C, et al. Efficacy and safety of orodispersible vardenafil formulation for the treatment of erectile dysfunction in elderly men and those with underlying conditions: an integrated analysis of two pivotal trials. J Sex Med. 2011;8:261-71.Corona G, Rastrelli G, Burri A, et al. The safety and efficacy of Avanafil, a new 2nd generation PDE5i: comprehensive review and meta-analysis. Expert Opin Drug Saf. 2016;15:237-47.Corona G, Rastrelli G, Burri A, et al. The safety and efficacy of Avanafil, a new 2nd generation PDE5i: comprehensive review and meta-analysis. Expert Opin Drug Saf. 2016;15:237-47.DeBusk R, Pepine C, Glasser D, et al. Efficacy and safety of sildenafil citrate in men with erectile dysfunction and stable coronary artery disease. Am J Cardiol. 2004;93:147-53.DeBusk R, Pepine C, Glasser D, et al. Efficacy and safety of sildenafil citrate in men with erectile dysfunction and stable coronary artery disease. Am J Cardiol. 2004;93:147-53.Katz S, Parker J, Glasser D, et al. Efficacy and safety of sildenafil citrate in men with erectile dusfunction and chronic heart failure. Am J Cardiol. 2005;95:36-42.Katz S, Parker J, Glasser D, et al. Efficacy and safety of sildenafil citrate in men with erectile dusfunction and chronic heart failure. Am J Cardiol. 2005;95:36-42.Van Ahlen H, Zumbe J, Stauch K, Hanish J. The real-life safety and efficacy of vardenafil (REALISE) study: results in men from Europe and overseas with erectile dysfunction and cardiovascular or metabolic conditions. J Sex Med. 2010;7:3161-9.Van Ahlen H, Zumbe J, Stauch K, Hanish J. The real-life safety and efficacy of vardenafil (REALISE) study: results in men from Europe and overseas with erectile dysfunction and cardiovascular or metabolic conditions. J Sex Med. 2010;7:3161–9.Feenstra J, Van Drie-Pierik R, Lacle C, Stricker B. Acute myocardial infarction associated with sildenafil. Lancet. 1998;352:957-8.Feenstra J, Van Drie-Pierik R, Lacle C, Stricker B. Acute myocardial infarction associated with sildenafil. Lancet. 1998;352:957-8.Mittleman M, Maclure M, Glasser D. Evaluation of acute risk for myocardial infarction in men treated with sildenafil citrate. Am J Cardiol. 2005;96:443-6.Mittleman M, Maclure M, Glasser D. Evaluation of acute risk for myocardial infarction in men treated with sildenafil citrate. Am J Cardiol. 2005;96:443-6.Tsertsvadze A, Yazdi F, Fink H, et al. Oral sildenafil citrate (Viagra) for erectile dysfunction: a systematic review and meta-analysis of harms. Urology. 2009;74:831.e8-836.e8.Tsertsvadze A, Yazdi F, Fink H, et al. Oral sildenafil citrate (Viagra) for erectile dysfunction: a systematic review and meta-analysis of harms. Urology. 2009;74:831.e8–836.e8.Lowe G, Costabile R. 10-year analysis of adverse event reports to the Food and Drug Administration for phosphodiesterase type-5 inhibitors. J Sex Med. 2012;9:265-70.Lowe G, Costabile R. 10-year analysis of adverse event reports to the Food and Drug Administration for phosphodiesterase type-5 inhibitors. J Sex Med. 2012;9:265-70.Webb D, Muirhead G, Wulff M, et al. Sildenafil citrate potentiates the hypotensive effects of nitric oxide donor drugs in male patients with stable angina. J Am Coll Cardiol. 2000;36:25-31.Webb D, Muirhead G, Wulff M, et al. Sildenafil citrate potentiates the hypotensive effects of nitric oxide donor drugs in male patients with stable angina. J Am Coll Cardiol. 2000;36:25-31.Vardenafil - summary of product characteristics. Available at: http://www.ema.europa.eu/docs/en_GB/document_library/EPAR_ _Product_Information/human/000475/WC500039992.pdf. Accessed: 18.08.2018.Vardenafil – summary of product characteristics. Available at: http://www.ema.europa.eu/docs/en_GB/document_library/EPAR_ _Product_Information/human/000475/WC500039992.pdf. Accessed: 18.08.2018.Kloner R, Hutter A, Emmick J, et al. Time course of the interaction between tadalafil and nitrates. J Am Coll Cardiol. 2003;42:1855-60.Kloner R, Hutter A, Emmick J, et al. Time course of the interaction between tadalafil and nitrates. J Am Coll Cardiol. 2003;42:1855-60.Oliver J, Bell K, Leckie S, Webb D. Interaction between glyceryl trinitrate and sildenafil citrate (Viagra) may last less than four hours. Int J Impot Res. 2002;14(Suppl. 3):522.Oliver J, Bell K, Leckie S, Webb D. Interaction between glyceryl trinitrate and sildenafil citrate (Viagra) may last less than four hours. Int J Impot Res. 2002;14(Suppl. 3):522.Guillaume M, Lonsdale F, Darstein C, et al. Hemodynamic interaction between a daily dosed phosphodiesterase 5 inhibitor, tadalafil, and the alpha-adrenergic blockers, doxazosin and tansulosin, in middle-aged healthy male subjects. J Clin Pharmacol. 2007;47:1303-10.Guillaume M, Lonsdale F, Darstein C, et al. Hemodynamic interaction between a daily dosed phosphodiesterase 5 inhibitor, tadalafil, and the alpha-adrenergic blockers, doxazosin and tansulosin, in middle-aged healthy male subjects. J Clin Pharmacol. 2007;47:1303-10.Goldfischer E, Kowalczyk J, Clark W, et al. Hemodynamic effects of once-daily tadalafil in men with signs and symptoms of benign prostatic hyperplasia on concomitant a1-adrenergic antagonist therapy: results of a randomized, doubleblind, placebo-controlled trial. Urology. 2012;79(4):875-82.Goldfischer E, Kowalczyk J, Clark W, et al. Hemodynamic effects of once-daily tadalafil in men with signs and symptoms of benign prostatic hyperplasia on concomitant a1-adrenergic antagonist therapy: results of a randomized, doubleblind, placebo-controlled trial. Urology. 2012;79(4):875-82.Bancroft J. The endocrinology of sexual arousal. J Endocrinol. 2005;186:411-27.Bancroft J. The endocrinology of sexual arousal. J Endocrinol. 2005;186:411-27.Wang C, Nieschlag E, Swerdloff R, et al. Investigation, treatment, and monitoring of late-onset hypogonadism in males: ISA, ISSAM, EAU, EAA, and ASA recommendations. Eur Urol. 2009;55:121-30.Wang C, Nieschlag E, Swerdloff R, et al. Investigation, treatment, and monitoring of late-onset hypogonadism in males: ISA, ISSAM, EAU, EAA, and ASA recommendations. Eur Urol. 2009;55:121-30.Corona G, Rastelli G, Monami M, et al. Hypogonadism as a risk factor for cardiovascular mortality in men: a meta-analytic study. Eur J Endocrinol. 2011;165:687-701.Corona G, Rastelli G, Monami M, et al. Hypogonadism as a risk factor for cardiovascular mortality in men: a meta-analytic study. Eur J Endocrinol. 2011;165:687-701.Araujo A, Dixon J, Suarez E, et al. Endogenous testosterone and mortality in men: a systematic review and meta-analysis. J Clin Endocrinol. 2011;96:3007-19.Araujo A, Dixon J, Suarez E, et al. Endogenous testosterone and mortality in men: a systematic review and meta-analysis. J Clin Endocrinol. 2011;96:3007-19.Calof O, Singh A, Lee M, et al. Adverse events associated with testosterone replacement in middleaged and older men: a meta-analysis of randomized, placebo-controlled trials. J Gerontol A Biol Sci Med Sci. 2005;60:1451-7.Calof O, Singh A, Lee M, et al. Adverse events associated with testosterone replacement in middleaged and older men: a meta-analysis of randomized, placebo-controlled trials. J Gerontol A Biol Sci Med Sci. 2005;60:1451-7.Haddad R, Kennedy C, Caples S, et al. Testosterone and cardiovascular risk in men: a systematic review and meta-analysis of randomized placebo-controlled trials. Mayo Clin Proc. 2007;82:29-39.Haddad R, Kennedy C, Caples S, et al. Testosterone and cardiovascular risk in men: a systematic review and meta-analysis of randomized placebo-controlled trials. Mayo Clin Proc. 2007;82:29-39.Fernandez-Balsells M, Murad M, Lane M, et al. Clinical review 1: adverse effects of testosterone therapy in adult men: a systemic review and metaanalysis. J Clin Endocrinol Metab. 2010;95:2560-75.Fernandez-Balsells M, Murad M, Lane M, et al. Clinical review 1: adverse effects of testosterone therapy in adult men: a systemic review and metaanalysis. J Clin Endocrinol Metab. 2010;95:2560-75.Basaria S, Coviello A, Travison T, et al. Adverse events associated with testosterone administration. N Engl J Med. 2010;363:109-22.Basaria S, Coviello A, Travison T, et al. Adverse events associated with testosterone administration. N Engl J Med. 2010;363:109-22.Vigen R, O’Donnell C, Baron A, et al. Association of testosterone therapy with mortality, myocardial infarction, and stroke in men with low testosterone levels. JAMA. 2013;310:1829-36.Vigen R, O’Donnell C, Baron A, et al. Association of testosterone therapy with mortality, myocardial infarction, and stroke in men with low testosterone levels. JAMA. 2013;310:1829-36.Finkle W, Greenland S, Ridgeway G, et al. Increased risk of nonfatal myocardial infarction following testosterone therapy prescription in men. PLoS One. 2014;9:e85805.Finkle W, Greenland S, Ridgeway G, et al. Increased risk of nonfatal myocardial infarction following testosterone therapy prescription in men. PLoS One. 2014;9:e85805.Traish A, Guay A, Morgentaler A. Death by testosterone? We think not! J Sex Med. 2014;11:624-9.Traish A, Guay A, Morgentaler A. Death by testosterone? We think not! J Sex Med. 2014;11:624-9.Kloner R. Testosterone and cardiovascular health: safety of treatment of hypogonadism. Sex Med Rev. 2015;3:56-62.Kloner R. Testosterone and cardiovascular health: safety of treatment of hypogonadism. Sex Med Rev. 2015;3:56-62.Shores M, Smith N, Fosberg C, et al. Testosterone treatment and mortality in men with low testosterone levels. J Clin Endocrinol Metab. 2012;97:2050-8.Shores M, Smith N, Fosberg C, et al. Testosterone treatment and mortality in men with low testosterone levels. J Clin Endocrinol Metab. 2012;97:2050-8.Muraleedharan V, Marsh H, Kapoor D, et al. Testosterone deficiency is associated with increased risk of mortality and testosterone replacement improves survival in men with type 2 diabetes. Eur J Endocrinol. 2013;169:725-73.Muraleedharan V, Marsh H, Kapoor D, et al. Testosterone deficiency is associated with increased risk of mortality and testosterone replacement improves survival in men with type 2 diabetes. Eur J Endocrinol. 2013;169:725-73.Anderson J, May H, Lappe D, et al. Impact of testosterone replacement therapy on myocardial infarction, stroke, and death in men with low testosterone concentration in an integrated healthcare system. Am J Cardiol. 2016;117:794-9.Anderson J, May H, Lappe D, et al. Impact of testosterone replacement therapy on myocardial infarction, stroke, and death in men with low testosterone concentration in an integrated healthcare system. Am J Cardiol. 2016;117:794-9.Cheetham T, Ann J, Jacobsen S, et al. Association of testosterone replacement with cardiovascular outcomes among men with androgen deficiency. JAMA Intern Med. 2017;177:491-9.Cheetham T, Ann J, Jacobsen S, et al. Association of testosterone replacement with cardiovascular outcomes among men with androgen deficiency. JAMA Intern Med. 2017;177:491-9.Wallis C, Lo K, Lee Y, et al. Survival and cardiovascular events in men treated with testosterone replacement therapy: an intention-to-treat observational cohort study. Lancet Diabetes Endocrinol. 2016;363:498-506.Wallis C, Lo K, Lee Y, et al. Survival and cardiovascular events in men treated with testosterone replacement therapy: an intention-to-treat observational cohort study. Lancet Diabetes Endocrinol. 2016;363:498-506.Sharma R, Oni Q, Gupta K, et al. Normalization of testosterone level is associated with reduced incidence of myocardial infarction and mortality in men. Eur Heart J. 2015;36:2706-15.Sharma R, Oni Q, Gupta K, et al. Normalization of testosterone level is associated with reduced incidence of myocardial infarction and mortality in men. Eur Heart J. 2015;36:2706-15.Montorsi F, Briganti A, Salonia A, et al. Erectile dysfunction prevalence, time of onset and association with risk factors in 300 consecutive patients with acute chest pain and angiographically documented coronary artery disease. Eur Urol. 2003;44:360-4.Montorsi F, Briganti A, Salonia A, et al. Erectile dysfunction prevalence, time of onset and association with risk factors in 300 consecutive patients with acute chest pain and angiographically documented coronary artery disease. Eur Urol. 2003;44:360-4.Hodges L, Kirby M, Solanki J, et al. The temporal relationship between erectile dysfunction and cardiovascular disease. Int J Clin Pract. 2007;61:2019-25.Hodges L, Kirby M, Solanki J, et al. The temporal relationship between erectile dysfunction and cardiovascular disease. Int J Clin Pract. 2007;61:2019-25.Vlachopoulos C, Rokkas K, Ioakeimidis N, et al. Prevalence of asymptomatic coronary artery disease in men with vasculogenic erectile dysfunction: a prospective angiographic study. Eur Urol. 2005;48:996-1002.Vlachopoulos C, Rokkas K, Ioakeimidis N, et al. Prevalence of asymptomatic coronary artery disease in men with vasculogenic erectile dysfunction: a prospective angiographic study. Eur Urol. 2005;48:996-1002.

The authors declare that there are no conflicts of interest present.