Effects of Major Antihypertensive Drug Classes on Erectile Function: a Network Meta-analysis.

PURPOSE: To determine the effect of major antihypertensive classes on erectile function (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 angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, ß-blockers, calcium channel blockers, and thiazide diuretics on EF compared to each other and to placebo (PROSPERO: CRD42020189529). Similarly, we performed a network meta-analysis to explore the effect of different ß-blockers on erectile function (nebivolol, other vasodilating and non-vasodilating ß-blockers, placebo). 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 ß-blockers analysis, nebivolol contributed a beneficial effect on EF only when compared to non-vasodilatory ß-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 ß-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.