Effects of major antihypertensive drug classes on erectile function: a network meta-analysis

Abstract Aims Major antihypertensive medication classes are suggested to exert diverse effects on erectile function (EF). Guideline recommendations suggest that thiazide diuretics and β-blockers possess the worst profile regarding erectile function (EF), while angiotensin receptor blockers and nebivolol the best profile. We aimed to determine the comparative effect of major antihypertensive classes on EF in patients with or at high risk of cardiovascular disease. Methods We performed a systematic review and frequentist network meta-analysis of randomized controlled trials assessing the effect of antihypertensive agents on EF (PROSPERO: CRD42020189529). Records were identified through search of PubMed, Cochrane Library and Scopus databases and sources of grey literature until September 2020. Results We included 25 studies (7784 patients) in the qualitative and 16 studies in the quantitative synthesis. The risk of bias was concerning or high in the majority of studies and inconsistency was also high. No significant differences in EF were demonstrated in the pairwise comparisons between major antihypertensive classes. Similarly, when placebo was set as the reference treatment group, no treatment strategy yielded significant effects on EF. In the β-blockers analysis, nebivolol contributed a beneficial effect on EF only when compared to non-vasodilatory β-blockers (OR 2.92, 95% CI 1.3–6.5) and not when compared to placebo (OR 2.87, 95% CI 0.75–11.04) or to other vasodilatory β-blockers (OR 2.15, 95% CI 0.6–7.77). Conclusion All antihypertensive medication classes seem to exert neutral or insignificant effects on EF. Further high-quality studies are needed to better explore the effects of antihypertensive medication on EF.