Влияние сердечно-сосудистых препаратов на эректильную функцию: обзор литературы

Нарушение эректильной функции (ЭФ) является распространенной проблемой среди мужского населения старше 40 лет. Артериальная гипертония, дислипидемия и другие заболевания сердечно-сосудистой системы, часто встречающиеся в среднем и пожилом возрасте, и сами по себе могут лежать в основе снижения ЭФ. Некоторые из медикаментозных средств, используемых для лечения болезней системы кровообращения, могут оказывать дополнительное неблагоприятное влияние на ЭФ. В статье рассмотрены актуальные данные о влиянии сердечно-сосудистых препаратов на ЭФ, проанализирована научная литература из следующих научных баз данных: PubMed, ScienceDirect, eLIBRARY.RU. Положительным влиянием на ЭФ обладают блокаторы рецепторов к ангиотензину II. Эректильная дисфункция как один из возможных побочных эффектов может наблюдаться при использовании большинства бета-блокаторов (за исключением небиволола), диуретиков, неселективных антагонистов минералокортикоидных рецепторов. Не найдено убедительных данных за негативное влияние на ЭФ ингибиторов ангиотензинпревращающего фермента, блокаторов кальциевых каналов, селективных антагонистов минералокортикоидных рецепторов, метопролола. Данные о взаимосвязи статинотерапии и ЭФ противоречивы. Ограниченное количество исследований посвящено взаимодействию ангиотензиновых рецепторов и неприлизина ингибитора на ЭФ. В большинстве проведенных исследований применяются исключительно субъективные методы оценки ЭФ. Публикуется все больше данных о том, что сердечно-сосудистые заболевания (ССЗ) и ЭФ имеют общие факторы риска и общие патогенетические механизмы. Исследования больших данных биобанков с использованием менделевской рандомизации показывают, что эректильная дисфункция в большей степени связана с наличием у пациента ССЗ, чем с препаратами, которые он получает. Для уточнения воздействия средств для лечения ССЗ на ЭФ необходимо проводить исследования с объективной оценкой ЭФ с помощью мониторирования ночных пенильных тумесценций. Знание особенностей препаратов для лечения ССЗ позволяет индивидуально подбирать терапию, избегая нежелательных явлений, и обеспечить высокий уровень приверженности пациента лечению.

1. Goldstein I, Goren A, Li V, Tang W, Hassan T. Epidemiology Update of Erectile Dysfunction in Eight Countries with High Burden. Sex Med Rev. 2020;8(1):48–58. https://doi.org/10.1016/j.sxmr.2019.06.008.

2. Köhler T, Kloner R, Rosen R, Burnett A, Blaha M, Ganz P et al. The Princeton IV Consensus Recommendations for the Management of Erectile Dysfunction and Cardiovascular Disease. Mayo Clin Proc. 2024;99(9):1500–1517. https://doi.org/10.1016/j.mayocp.2024.06.002.

3. DeVries J, Zinmer K, Walsh M. Coexistence of vasculogenic erectile dysfunction and peripheral artery disease. J Vasc Nurs. 2020;38(3):160–162. https://doi.org/10.1016/j.jvn.2020.07.005.

4. Жуков ОБ, Васильев АЭ, Жуматаев МБ. Новые методы лечения васкулогенной эректильной дисфункции. Андрология и генитальная хирургия. 2018;19(2):58–68. https://doi.org/10.17650/2070-9781-2018-19-2-58-68.

5. Matsui H, Sopko N, Hannan J, Bivalacqua T. Pathophysiology of erectile dysfunction. Curr Drug Targets. 2015;16(5):411–419. https://doi.org/10.2174/138945011605150504114041.

6. Калинченко СЮ, Тюзиков ИА. Практическая андрология. М.: Практическая медицина; 2009. 399 с. Режим доступа: https://studfile.net/preview/3569084/.

7. Terentes-Printzios D, Loakeimidis N, Rokkas K, Vlachopoulos C. Interactions between erectile dysfunction, cardiovascular disease and cardiovascular drugs. Nat Rev Cardiol. 2022;19(1):59–74. https://doi.org/10.1038/s41569-021-00593-6.

8. Freemantle N, Cleland J, Young P, Mason J, Harrison J. beta Blockade after myocardial infarction: systematic review and meta regression analysis. BMJ. 1999;318(7200):1730–1737. https://doi.org/10.1136/bmj.318.7200.1730.

9. Gür Ö, 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. Annals of Thoracic and Cardiovascular Surgery. 2017;23(2):91–95. https://doi.org/10.5761/atcs.oa.16-00242.

10. Corradetti S, Gallo G, Correale M, Piepoli M, Badagliacca R, Nodari S et al. β-Blockers and Erectile Dysfunction in Heart Failure. Between Myth and Reality. Rev Cardiovasc Med. 2022;23(5):173. https://doi.org/j.rcm2305173.

11. Corona G, Vena W, Pizzocaro A, Salvio G, Sparano C, Sforza A, Maggi M. Antihypertensive medications and erectile dysfunction: focus on β-blockers. Endocrine. 2025;87(1):11–26. https://doi.org/10.1007/s12020-024-04020-x.

12. Dai Y, Mei Z, Zhang S, Shali S, Ren D, Xu L et al. Sexual Dysfunction and the Impact of Beta-Blockers in Young Males With Coronary Artery Disease. Front Cardiovasc Med. 2021;8:708200. https://doi.org/10.3389/fcvm.2021.708200.

13. Zhao C, Feng J, Deng S, Wang X, Fu Y, Wang B et al. Genetically predicted hypertension, antihypertensive drugs, and risk of erectile dysfunction: a Mendelian randomization study. Front Cardiovasc Med. 2023;10:1157467. https://doi.org/10.3389/fcvm.2023.1157467.

14. Lou I, Chen J, Ali K, Chen Q. Relationship Between Hypertension, Antihypertensive Drugs and Sexual Dysfunction in Men and Women: A Literature Review. Vasc Health Risk Manag. 2023;19:691–705. https://doi.org/10.2147/VHRM.S439334.

15. Manolis A, Doumas M, Ferri C, Mancia G. Erectile dysfunction and adherence to antihypertensive therapy: Focus on β-blockers. Eur J Intern Med. 2020;81:1–6. https://doi.org/10.1016/j.ejim.2020.07.009.

16. Rosen R, Kostis J, Jekelis A. Beta-Blocker effects on sexual function in normal males. Arch Sex Behav. 1988;17(3):241–255. https://doi.org/10.1007/BF01541742.

17. Shiri R, Koskimaki J, Hakkinen J, Auvinen A, Tammela T, Hakama M. Cardiovascular drug use and the incidence of erectile dysfunction. Int J Impot Res. 2007;19(2):208–212. https://doi.org/10.1038/sj.ijir.3901516.

18. Avorn J, Everitt D, Weiss S. Increased antidepressant use in patients prescribed beta-blockers. JAMA. 1986;255(3):357–360. Available at: https://pubmed.ncbi.nlm.nih.gov/2867235/.

19. Baumhäkel M, Schlimmer N, Kratz M, Hackett G, Jackson G, Bohm M. Cardiovascular risk, drugs and erectile function – A systematic analysis. Int J Clin Pract. 2011;65(3):289–298. https://doi.org/10.1111/j.1742-1241.2010.02563.x.

20. Adverse reactions to bendrofluazide and propranolol for the treatment of mild hypertension. Report of Medical Research Council Working Party on Mild to Moderate Hypertension. Lancet. 1981;2(8246):539–543. Available at: https://pubmed.ncbi.nlm.nih.gov/6115999/.

21. Croog S, Levine S, Testa M, Brown B, Bulpitt C, Jenkins C et al. The effects of antihypertensive therapy on the quality of life. N Engl J Med. 1986;314(26):1657–1664. https://doi.org/10.1056/NEJM198606263142602.

22. Ferri C. The role of nebivolol in the management of hypertensive patients: From pharmacological profile to treatment guidelines. Future Cardiol. 2021;17(8):1421–1433. https://doi.org/10.2217/fca-2021-0048.

23. Cordero A, Bertomeu-Martinez V, Mazon P, Facila L, Bertomeu-Gonzalez V, Conthe P, Gonzalez-Juanatey JR. Erectile dysfunction in high-risk hypertensive patients treated with beta-blockade agents. Cardiovasc Ther. 2010;28(1):15–22. https://doi.org/10.1111/j.1755-5922.2009.00123.x.

24. Gao Y, Vanhoutte P. Nebivolol: An Endothelium-Friendly Selective b 1-Adrenoceptor Blocker. J Cardiovasc Pharmacol. 2012;59(1):16–21. https://doi.org/10.1097/FJC.0b013e3182073e27.

25. de Simone G, Mancusi C. Erectile dysfunction and arterial hypertension: Still looking for a scapegoat. Eur J Intern Med. 2020;81:22–23. https://doi.org/10.1016/j.ejim.2020.09.004.

26. Wikananda I, Nurcahya I, Wijaya P, Widiana I, Sindhughosa D. Effects of Nebivolol therapy on hemodynamic parameters and lipid profile compared to other beta blockers in patients with essential hypertension: a systematic review and meta-analysis. Caspian J Intern Med. 2024;15(1):28–37. https://doi.org/10.22088/cjim.15.1.2.

27. Bruckert E, Giral P, Heshmati H, Turpin G. Men treated with hypolipidaemic drugs complain more frequently of erectile dysfunction. J Clin Pharm Ther. 1996;21(2):89–94. https://doi.org/10.1111/j.1365-2710.1996.tb00006.x.

28. Elgendy A, Elgendy I, Mahmoud A, Al-Ani M, Moussa M, Mahmoud A et al. Statin Use in Men and New Onset of Erectile Dysfunction: A Systematic Review and Meta-Analysis. Am J Med. 2018;131(4):387–394. https://doi.org/10.1016/j.amjmed.2017.10.043.

29. Камалов АА, Мацкеплишвили СТ, Чалый МЕ, Стригунов АА, Охоботов ДА, Сорокин НИ и др. Оценка влияния факторов риска сердечно-сосудистых заболеваний на степень тяжести эректильной дисфункции: комплексный статистический анализ. Вестник урологии. 2022;10(1):15–31. https://doi.org/10.21886/2308-6424-2022-10-1-15-31.

30. Vlachopoulos C, Aznaouridis K, Ioakemidis N, Rokkas K, Tsekoura D, Vasiliadou C et al. Arterial function and intima-media thickness in hypertensive patients with erectile dysfunction. J Hypertens. 2008;26(9):1829–1836. https://doi.org/10.1097/HJH.0b013e3283050886.

31. Марцевич СЮ, Лукина ЮВ, Кутишенко НП, Дмитриева НА, Благодатских СВ, Лерман ОВ и др. Приверженность к терапии статинами пациентов высокого и очень высокого сердечно-сосудистого риска в условиях реальной клинической практики: диагностика и возможные пути решения проблемы (по данным наблюдательного исследования ПРИОРИТЕТ). Рациональная фармакотерапия в кардиологии. 2018;14(6):891–900. https://doi.org/10.20996/1819-6446-2018-14-6-891-900.

32. Ridker P, Danielson E, Fonseca F, Genest J, Gotto AM, Kastelein JJP et al. Rosuvastatin to prevent vascular events in men and women with elevated c-reactive protein. N Engl J Med. 2008;359(21):2195–2207. https://doi.org/10.1056/NEJMoa0807646.

33. Taguchi I, Iimuro S, Iwata H, Takashima H, Abe M, Amiya E et al. High-Dose Versus Low-Dose Pitavastatin in Japanese Patients With Stable Coronary Artery Disease (REAL-CAD): A Randomized Superiority Trial. Cicrulation. 2018;137(19):1997–2009. https://doi.org/10.1161/CIRCULATIONAHA.117.032615.

34. Omolaoye T, Halabi M, Mubarak M, Cyril A, Duvuru R, Radhakrishnan R, Plessis SSD. Statins and Male Fertility: Is There a Cause for Concern? Toxics. 2022;10(10):627. https://doi.org/10.3390/toxics10100627.

35. Schooling C, Yeung S, Freeman G, Cowling B. The effect of statins on testosterone in men and women, a systematic review and meta-analysis of randomized controlled trials. BMC Med. 2013;11:57. https://doi.org/10.1186/1741-7015-11-57.

36. Akorede B, Hassan S, Akhigbe R. Penile erection and cardiovascular function: effects and pathophysiology. Aging Male. 2024;27(1):2336627. https://doi.org/10.1080/13685538.2024.2336627.

37. Saltzman E, Guay A, Jacobson J. Improvement in erectile function in men with organic erectile dysfunction by correction of elevated cholesterol levels: a clinical observation. J Urol. 2004;172(1):255–258. https://doi.org/10.1097/01.ju.0000132368.10458.66.

38. El-Sisi A, Hegazy K, Salem K, AbdElkawy K. Atorvastatin improves erectile dysfunction in patients initially irresponsive to Sildenafil by the activation of endothelial nitric oxide synthase. Int J Impot Res. 2013;25(4):143–148. https://doi.org/10.1038/ijir.2012.46.

39. Cui Y, Zong H, Yan H, Zhang Y. The Effect of Statins on Erectile Dysfunction: A Systematic Review and Meta-Analysis. J Sex Med. 2014;11(6):1367–1375. https://doi.org/10.1111/jsm.12497.

40. Gokkaya S, Ozden C, Ozdal O, Koyuncu H, Guzel O, Memis A. Effect of correcting serum cholesterol levels on erectile function in patients with vasculogenic erectile dysfunction. Scand J Urol Nephrol. 2008;42(5):437–440. https://doi.org/10.1080/00365590801950279.

41. Fibbi B, Morelli A, Marini M, Zhang X, Mancina R, Vignozzi L et al. Atorvastatin but not elocalcitol increases sildenafil responsiveness in spontaneously hypertensive rats by regulating the RhoA/ROCK pathway. J Androl. 2008;29(1):70–84. https://doi.org/10.2164/jandrol.107.003152.

42. Stamerra C, Giosia P, Ferri C, Giorgini P, Reiner Z, Johnston T, Sahebkar A. Statin therapy and sex hormones. Eur J Pharmacol. 2021;890:173745. https://doi.org/10.2164/jandrol.107.003152.

43. Pons-Rejraji H, Brugnon F, Sion B, Maqdasy S, Gouby G, Pereira B et al. Evaluation of atorvastatin efficacy and toxicity on spermatozoa, accessory glands and gonadal hormones of healthy men: A pilot prospective clinical trial. Reprod Biol Endocrinol. 2014;12:65. https://doi.org/10.1186/1477-7827-12-65.

44. Silva P, Borges C, Rosa J, Pacheco T, Figueiredo T, Leite G et al. Effects of isolated or combined exposure to sibutramine and rosuvastatin on reproductive parameters of adult male rats. J Appl Toxicol. 2020;40(7):947–964. https://doi.org/10.1002/jat.3955.

45. Heeba G, Hamza A. Rosuvastatin ameliorates diabetes-induced reproductive damage via suppression of oxidative stress, inflammatory and apoptotic pathways in male rats. Life Sci. 2015;141:13–19. https://doi.org/10.1016/j.lfs.2015.09.015.

46. Azzarito C, Boiardi L, Zini M, Agosti A, Dotti C, Biagi R, Portioli I. Long-term therapy with high-dose simvastatin does not affect adrenocortical and gonadal hormones in hypercholesterolemic patients. Metabolism. 1992;41(2):148–153. https://doi.org/10.1016/0026-0495(92)90143-x.

47. Ahmed S, Emad S, Ali A, Mhao N, Hadi N, Jamil D et al. Assessment of spermatozoal oxidative stress response to simvastatin in male infertility. Iraq Med J. 2018;2(2):36–39. Available at: https://iraqmedj.org/index.php/imj/article/view/390.

48. Ose L, Davidson M, Stein E, Kastelein J, Scott R, Hunninghake D et al. Lipidaltering efficacy and safety of simvastatin 80 mg/day: Long-term experience in a large group of patients with hypercholesterolemia. Clin Cardiol. 2000;23(1):39–46. https://doi.org/10.1002/clc.4960230108.

49. Bhasin S, Pencina M, Jasuja G, Travison T, Coviello A, Orwoll E et al. Reference ranges for testosterone in men generated using liquid chromatography tandem mass spectrometry in a community-based sample of healthy nonobese young men in the framingham heart study and applied to three geographically distinct cohorts. J Clin Endocrinol Metab. 2011;96(8):2430–2439. https://doi.org/10.1210/jc.2010-3012.

50. Bancroft J. The endocrinology of sexual arousal. J Endocrinol. 2005;186(3):411–427. https://doi.org/10.1677/joe.1.06233.

51. Do C, Huyghe E, Lapeyre-Mestre M, Montastruc J, Bagheri H. Statins and Erectile Dysfunction Results of a Case/Non-Case Study using the French Pharmacovigilance System Database. Drug Saf. 2009;7(32):591–597. https://doi.org/10.2165/00002018-200932070-00005.

52. De Graaf L, Brouwers A, Diemont W. Is decreased libido associated with the use of HMG-CoA-reductase inhibitors? Br J Clin Pharmacol. 2004;58(3):326–328. https://doi.org/10.1111/j.1365-2125.2004.02128.x.

53. Joseph P, Lonn E, Bosch J, Lopez P, Zhu J, Keltai M et al. Long-term Effects of Statins, Blood Pressure-Lowering, and Both on Erectile Function in Persons at Intermediate Risk for Cardiovascular Disease: A Substudy of the Heart Outcomes Prevention Evaluation-3 (HOPE-3) Randomized Controlled Trial. Can J Cardiol. 2018;34(1):38–44. https://doi.org/10.1016/j.cjca.2017.09.026.

54. Чалый МЕ, Охоботов ДА, Стригунов АА, Кадрев АВ, Дячук ЛИ, Нестерова ОЮ и др. Нормативные показатели мониторинга ночных пенильных тумесценций: результаты собственных наблюдений и апробация разработанных нормативных критериев. Урология. 2022;(5):39–45. https://doi.org/10.18565/urology.2022.5.39-45.

55. Doumas M, Tsakiris A, Douma S, Grigorakis A, Papadopoulos A, Hounta A et al. Factors affecting the increased prevalence of erectile dysfunction in greek hypertensive compared with normotensive subjects. J Androl. 2006;27(3):469–477. https://doi.org/10.2164/jandrol.04191.

56. Oliveira A, Nunes K. Hypertension and erectile dysfunction: breaking down the challenges. Am J Hypertens. 2021;2(34):134–142. https://doi.org/10.1093/ajh/hpaa143.

57. Hsiao W, Bertsch R, Hung Y, Aaronson D. Tighter Blood Pressure Control Is Associated with Lower Incidence of Erectile Dysfunction in Hypertensive Men. J Sex Med. 2019;16(3):410–417. https://doi.org/10.1016/j.jsxm.2019.01.011.

58. Xiao H, Zhao L, Yang J, Tong N, An L, Wang G et al. Increasing angiotensinconverting enzyme (ACE) 2/ACE axes ratio alleviates early pulmonary vascular remodeling in a porcine model of acute pulmonary embolism with cardiac arrest. World J Emerg Med. 2022;3(13):208–214. https://doi.org/10.5847/wjem.j.1920-8642.2022.052.

59. Llisterri J, Vidal J, Vicente J, Roca M, Bravo C, Zamorano M, Ferrario CM. Sexual dysfunction in hypertensive patients treated with losartan. Am J Med Sci. 2001;321(5):336–341. https://doi.org/10.1097/00000441-200105000-00006.

60. Baumhäkel M, Schlimmer N, Böhm M. Effect of irbesartan on erectile function in patients with hypertension and metabolic syndrome. Int J Impot Res. 2008;20(5):493–500. https://doi.org/10.1038/ijir.2008.28.

61. Becker A, Uckert S, Stief C, Truss M, Machtens S, Scheller F et al. Possible role of bradykinin and angiotensin II in the regulation of penile erection and detumescence. Urology. 2001;1(57):193–198. https://doi.org/10.1016/s0090-4295(00)00881-5.

62. Fogari R, Zoppi A, Corradi L, Mugellini A, Poletti L, Lusardi P. Sexual function in hypertensive males treated with lisinopril or atenolol: a cross-over study. Am J Hypertens. 1998;11(10):1244–1247. https://doi.org/10.1016/s0895-7061(98)00139-3.

63. Ismail S, Noor N, Hussain N, Sulaiman Z, Shamsudin M, Irfan M. Angiotensin Receptor Blockers for Erectile Dysfunction in Hypertensive Men: A Brief Meta-Analysis of Randomized Control Trials. Am J Mens Health. 2019;13(6):1557988319892735. https://doi.org/10.1177/1557988319892735.

64. Böhm M, Baumhakel M, Teo K, Sleight P, Probstfield J, Gao Peggy et al. 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 assessment study in ace intolerant subjects with cardiovascular disease (ontarget/transcend) Trials. Circulation. 2010;121(12):1439–1446. https://doi.org/10.1161/CIRCULATIONAHA.109.864199.

65. Accetto R, Chazova I, Sirenko Y, Vincelj J, Widimsky JJr, Barbic-Zagar B. The efficacy and safety of valsartan and combination of valsartan and hydrochlorothiazide in the treatment of patients with mild to moderate arterial hypertension – The VICTORY trial. Kardiol Pol. 2017;75(1):55–64. https://doi.org/10.5603/KP.a2016.0135.

66. Siregar S, Rulianov R, Ksatriapraja R, Stefanus D. The role of angiotensin receptor blocker (losartan) on decreasing fibrotic process of corpora cavernosa in priapism model of wistar rats. F1000Res. 2024;11:831. https://doi.org/10.12688/f1000research.123040.3.

67. Barman H, Dogan O, Tanyolac S, Atici A, Arabici H, Ebeoglu A et al. Impact of Treatment With Sacubitril/Valsartan on Erectile Dysfunction in Patients With Heart Failure With Reduced Ejection Fraction. Am J Cardiol. 2024;212:1–5. https://doi.org/10.1016/j.amjcard.2023.11.022.

68. Baumhäkel M, Shlimmer N, Kratz M, Hackett G, Jackson G, Bohm M. Cardiovascular risk, drugs and erectile function – A systematic analysis. Int J Clin Pract. 2011;65(3):289–298. https://doi.org/10.1111/j.1742-1241.2010.02563.x.

69. Yang L, Yu J, Ma R, Zhao F, Lin X, Liu P et al. The effect of combined antihypertensive treatment (felodipine with either irbesartan or metoprolol) on erectile function: A randomized controlled trial. Cardiology. 2013;125(4):235–241. https://doi.org/10.1159/000350955.

70. Frishman W. Calcium channel blockers: differences between subclasses. Am J Cardiovasc Drugs. 2007;7(Suppl. 1):17–23. https://doi.org/10.2165/00129784-200707001-00003.

71. Corona G, Vena W, Pizzocaro A, Salvio G, Sparano C, Sforza A, Maggi M. Antihypertensive medications and erectile dysfunction: focus on β-blockers. Endocrine. 2025;87(1):11–26. https://doi.org/10.1007/s12020-024-04020-x.

72. Marley J. Safety and efficacy of nifedipine 20 mg tablets in hypertension using electronic data collection in general practice. J R Soc Med. 1989;82(5):272–275. https://doi.org/10.1177/014107688908200509.

73. Lou I, Chen J, Ali K, Chen Q. Relationship Between Hypertension, Antihypertensive Drugs and Sexual Dysfunction in Men and Women: A Literature Review. Vasc Health Risk Manag. 2023;19:691–705. https://doi.org/10.2147/VHRM.S439334.

74. Ushiyama M, Kuramochi T, Katayama S. Treatment with hypotensive agents affects the impaired relaxation of the penile corpus cavernosum in hypertensive rats. Hypertens Res. 2006;29(7):523–532. https://doi.org/10.1291/hypres.29.523.

75. Fovaeus M, Andersson K, Hedlund H. Effects of some calcium channel blockers on isolated human penile erectile tissues. J Urol. 1987;138(5):1267–1272. https://doi.org/10.1016/s0022-5347(17)43582-8.

76. Poole-Wilson P, Kirwan B, Voko Z, Brouwer S, Dalen F, Lubsen J. Safety of nifedipine GITS in stable angina: The ACTION trial. Cardiovasc Drugs Ther. 2006;20(1):45–54. https://doi.org/10.1007/s10557-006-6312-4.

77. Chang S, Fine R, Siegel D, Chesney M, Black D, Hulley S. The impact of diuretic therapy on reported sexual function. Arch Intern Med. 1991;12(151):2402–2408. Available at: https://pubmed.ncbi.nlm.nih.gov/1746997/.

78. Amrin S, Tendean L, Turalaki G. Pengaruh Obat Antihipertensi terhadap Disfungsi Ereksi. eBiomedik. 2021;9(1):87–93. https://doi.org/10.35790/ebm.v9i1.31766.

79. Farmakis I, Pyrgidis N, Doundoulakis I, Mykoniatis I, Akrivos E, Giannakoulas G. Effects of Major Antihypertensive Drug Classes on Erectile Function: a Network Meta-analysis. Cardiovasc Drugs Ther. 2022;36(5):903–914. https://doi.org/10.1007/s10557-021-07197-9.

80. Kloner R, Sadovsky R, Johnson E, Mo D, Ahuja S. Efficacy of tadalafil in the treatment of erectile dysfunction in hypertensive men on concomitant thiazide diuretic therapy. Int J Impot Res. 2005;17(5):450–454. https://doi.org/10.1038/sj.ijir.3901360.

81. Gagliano-Jucá T, Napolitano M, Carvalho F, Campos R, Monica F, Claudino M et al. Hydrochlorothiazide Potentiates Contractile Activity of Mouse Cavernosal Smooth Muscle. Sex Med. 2016;4(2):e115–e125. https://doi.org/10.1016/j.esxm.2016.02.003.

82. Stripp B, Taylor A, Bartter F, Gillette J, Loriaux D, Easley R, Menard RH. Effect of Spironolactone on Sex Hormones in Man. J Clin Endocrinol Metab. 1975;41(4s):777–781. https://doi.org/10.1210/jcem-41-4-777.

83. Young WF. Primary aldosteronism – treatment options. Growth Horm IGF Res. 2003;13:102–108. https://doi.org/10.1016/s1096-6374(03)00064-9.

84. Burgess E, Lacourciere Y, Ruilope-Urioste L, Oparil S, Kleiman J, Krause S et al. Long-Term Safety and Efficacy of the Selective Aldosterone Blocker Eplerenone in Patients with Essential Hypertension. Clin Ther. 2003;25(9):2388–2404. https://doi.org/10.1016/s0149-2918(03)80282-5.

85. Reyes A, Leary W, Crippa G, Maranhao M, Hernandez R. The aldosterone antagonist and facultative diuretic eplerenone: A critical review. Eur J Intern Med. 2005;16(1):3–11. https://doi.org/10.1016/j.ejim.2004.10.007.

86. Sica D. Pharmacokinetics and Pharmacodynamics of Mineralocorticoid Blocking Agents and their Effects on Potassium Homeostasis. Heart Fail Rev. 2005;10(1):23–29. https://doi.org/10.1007/s10741-005-2345-1.

87. Parthasarathy H, Menard J, White W, Young WFJr, Williams G, Williams B et al. A double-blind, randomized study comparing the antihypertensive effect of eplerenone and spironolactone in patients with hypertension and evidence of primary aldosteronism. J Hypertens. 2011;29(5):980–990. https://doi.org/10.1097/HJH.0b013e3283455ca5.

88. Sabina M, Trube J, Shah S, Lurie A, Grimm M, Bizanti A. Finerenone: A Third-Generation MRA and Its Impact on Cardiovascular Health-Insight from Randomised Controlled Trials. J Clin Med. 2024;13(21):6398. https://doi.org/10.3390/jcm13216398.