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Nebivolol protects erectile functions compared to Metoprolol in hypertensive men with atherogenic, venogenic, psychogenic erectile dysfunction: A prospective, randomized, cross-over, clinical trial (2022)
Gokhan Gungor, Hakki Perk, Sedat Soyupek, Bahattin Baykal, Murat Demir, Mehmet Tugrul Sezer
ABSTRACT
Introduction: Both hypertension and β-blocker drugs used for treating hypertension (HT) can cause erectile dysfunction (ED). Nebivolol, unlike other β-blockers, may not cause impotence since it increases the release of Nitric Oxide (NO), which is the main mediator of erection. This study investigated the effect of Nebivolol and Metoprolol on erectile functions in hypertensive men.
Materials and methods: Married men whose blood pressure was>140/90 mmHg were included in the study. All patients were assessed for ED, and the cause of ED was then investigated. Nebivolol or Metoprolol was started for one month in all patients. After a one-month drugless period, the β-blockers were switched. Blood pressures, pulses, and sexual function tests were evaluated, and plasma NO levels were measured at the end of the treatments and during the drugless period.
Results: There was no difference in antihypertensive efficacy between the two drugs (p = 0.828;0.194 for systolic and diastolic BP). Metoprolol caused a significant decrease in IIEF-5 score, whereas Nebivolol did not cause a decrease in IIEF-5 score in patients with psychogenic, arteriogenic, and venous failure-related ED (respectively, p<0.001,0.004,0.005 for Metoprolol; p = 0.201,0.598,0.088 for Nebivolol). In the non-ED group, both drugs decreased the IIEF-5 score, but the decrease for Metoprolol (p = 0.001) was more than that for Nebivolol (p = 0.012). Plasma NO levels did not change with Metoprolol (p = 0.268) but increased with Nebivolol (p<0.001). There was a positive correlation between plasma NO values and the IIEF-5 score used for the assessment of sexual functions (r = 0.284, p = 0.026).
Conclusion: Nebivolol may be advantageous in terms of preserving sexual functions because of increasing NO in eligible hypertensive male patients.
1. Introduction
Erectile dysfunction (ED) is defined as the inability to achieve or maintain a sufficient erection to engage in sexual intercourse [1]. Erectile functions are related to the quality of life of individuals. Clinical research studies show that erectile dysfunction caused by any reason negatively affects the quality of life of both men and their sexual partners [2,3]. ED etiologies include vascular, neurogenic, hormonal, metabolic, psychogenic, and medication side effects [4].
Hypertension (HT) and some anti-hypertensive drugs can also negatively affect erectile functions. The prevalence of ED among hypertensive patients is approximately double that in a normotensive population [5,6]. Hypertension is associated with many systemic complications, especially vascular complications. The negative effect of hypertension on erectile function is associated with endothelial dysfunction, atherosclerosis, concomitant diabetes, metabolic syndrome, obesity, and vascular pathologies. As the duration of HT increases, the incidence of impotence may also increase. Antihypertensive drugs such as thiazide diuretics, beta-blockers, and spirolonactone can exacerbate ED [7]. Especially, evidence supports the detrimental role of β-blockers on erectile function [8]. It has been reported that the prevalence of ED can be up to 71% with the use of beta-blockers for at least 6 months. β-blockers can cause ED because of different causes such as inhibition of sympathetic activity, weakness, fatigue, sedation, and sleep disturbance. However, some studies have reported that Nebivolol, which induces nitric oxide release, can improve erectile functions [9]. Nebivolol is a new generation β-blocker drug that highly selective β1-adrenergic receptor antagonist and induces nitric oxide (NO)-mediated vasodilation by β3 agonism [10].
NO is released from the endothelium as a non-adrenergic, noncholinergic neurotransmitter and is the basic neurotransmitter stimulating penile erection. NO increases the production of cyclic guanosine monophosphate (cGMP), and this provides erection as a result of relaxation in the penile cavernous sinus and penile vascular smooth muscles. In other words, NO is the main neurotransmitter of erection and does not depend on the source [11–13]. Nebivolol causes the release of NO and activation of endothelial nitric oxide synthase (eNOS) at penis corpus cavernous and penile smooth muscle cells [14]
*Considering all of these, Nebivolol, unlike other β-blockers, may have a positive effect on erectile functions or at least like other β-blockers may not cause impotence since it increases NO release which is the main mediator of erection.
We designed a prospective, cross-over, randomized clinical trial that investigated the effect of Nebivolol and Metoprolol on erectile functions in hypertensive men.
5. Conclusions
Considering all these results, although Nebivolol and Metoprolol have similar antihypertensive effects, Nebivolol may be advantageous in terms of preserving sexual functions because of increasing NO. Nebivolol can be preferred for life quality and adherence to treatment in eligible hypertensive male patients.
Gokhan Gungor, Hakki Perk, Sedat Soyupek, Bahattin Baykal, Murat Demir, Mehmet Tugrul Sezer
ABSTRACT
Introduction: Both hypertension and β-blocker drugs used for treating hypertension (HT) can cause erectile dysfunction (ED). Nebivolol, unlike other β-blockers, may not cause impotence since it increases the release of Nitric Oxide (NO), which is the main mediator of erection. This study investigated the effect of Nebivolol and Metoprolol on erectile functions in hypertensive men.
Materials and methods: Married men whose blood pressure was>140/90 mmHg were included in the study. All patients were assessed for ED, and the cause of ED was then investigated. Nebivolol or Metoprolol was started for one month in all patients. After a one-month drugless period, the β-blockers were switched. Blood pressures, pulses, and sexual function tests were evaluated, and plasma NO levels were measured at the end of the treatments and during the drugless period.
Results: There was no difference in antihypertensive efficacy between the two drugs (p = 0.828;0.194 for systolic and diastolic BP). Metoprolol caused a significant decrease in IIEF-5 score, whereas Nebivolol did not cause a decrease in IIEF-5 score in patients with psychogenic, arteriogenic, and venous failure-related ED (respectively, p<0.001,0.004,0.005 for Metoprolol; p = 0.201,0.598,0.088 for Nebivolol). In the non-ED group, both drugs decreased the IIEF-5 score, but the decrease for Metoprolol (p = 0.001) was more than that for Nebivolol (p = 0.012). Plasma NO levels did not change with Metoprolol (p = 0.268) but increased with Nebivolol (p<0.001). There was a positive correlation between plasma NO values and the IIEF-5 score used for the assessment of sexual functions (r = 0.284, p = 0.026).
Conclusion: Nebivolol may be advantageous in terms of preserving sexual functions because of increasing NO in eligible hypertensive male patients.
1. Introduction
Erectile dysfunction (ED) is defined as the inability to achieve or maintain a sufficient erection to engage in sexual intercourse [1]. Erectile functions are related to the quality of life of individuals. Clinical research studies show that erectile dysfunction caused by any reason negatively affects the quality of life of both men and their sexual partners [2,3]. ED etiologies include vascular, neurogenic, hormonal, metabolic, psychogenic, and medication side effects [4].
Hypertension (HT) and some anti-hypertensive drugs can also negatively affect erectile functions. The prevalence of ED among hypertensive patients is approximately double that in a normotensive population [5,6]. Hypertension is associated with many systemic complications, especially vascular complications. The negative effect of hypertension on erectile function is associated with endothelial dysfunction, atherosclerosis, concomitant diabetes, metabolic syndrome, obesity, and vascular pathologies. As the duration of HT increases, the incidence of impotence may also increase. Antihypertensive drugs such as thiazide diuretics, beta-blockers, and spirolonactone can exacerbate ED [7]. Especially, evidence supports the detrimental role of β-blockers on erectile function [8]. It has been reported that the prevalence of ED can be up to 71% with the use of beta-blockers for at least 6 months. β-blockers can cause ED because of different causes such as inhibition of sympathetic activity, weakness, fatigue, sedation, and sleep disturbance. However, some studies have reported that Nebivolol, which induces nitric oxide release, can improve erectile functions [9]. Nebivolol is a new generation β-blocker drug that highly selective β1-adrenergic receptor antagonist and induces nitric oxide (NO)-mediated vasodilation by β3 agonism [10].
NO is released from the endothelium as a non-adrenergic, noncholinergic neurotransmitter and is the basic neurotransmitter stimulating penile erection. NO increases the production of cyclic guanosine monophosphate (cGMP), and this provides erection as a result of relaxation in the penile cavernous sinus and penile vascular smooth muscles. In other words, NO is the main neurotransmitter of erection and does not depend on the source [11–13]. Nebivolol causes the release of NO and activation of endothelial nitric oxide synthase (eNOS) at penis corpus cavernous and penile smooth muscle cells [14]
*Considering all of these, Nebivolol, unlike other β-blockers, may have a positive effect on erectile functions or at least like other β-blockers may not cause impotence since it increases NO release which is the main mediator of erection.
We designed a prospective, cross-over, randomized clinical trial that investigated the effect of Nebivolol and Metoprolol on erectile functions in hypertensive men.
5. Conclusions
Considering all these results, although Nebivolol and Metoprolol have similar antihypertensive effects, Nebivolol may be advantageous in terms of preserving sexual functions because of increasing NO. Nebivolol can be preferred for life quality and adherence to treatment in eligible hypertensive male patients.
