Problematiche sessuali nell'ipertensione arteriosa: Aspetti fisiopatologici

Summary Sexual dysfunction represents an important but poorly investigated issue in patients, both men and women, with essential hypertension. Sexual dysfunction recognizes, in hypertensive patients, multiple causes, such as vascular, hormonal, pharmacological and psychological. Endothelial dysfunction, induced by hypertension, plays a major role in both sexual dysfunction and heart disease. Nitric oxide is the most important molecule involved in erection and its levels are reduced in endothelial dysfunction. A significant proportion of patients with angiographically documented coronary artery disease have erectile dysfunction and this latter condition may become evident prior to angina symptoms in almost 70% of cases. There is a close association between hypertension and sexual dysfunction because these conditions share common cardiovascular risk factors, such as diabetes mellitus, obesity, smoking, hyperlipidemia. The incidence of sexual dysfunction is exacerbated by antihypertensive drug treatment. There is evidence that some classes of drugs, such as diuretics, centrally acting sympatholytic drugs, and beta-blockers have a greater impact on sexual dysfunction than other classes, such as calcium antagonists and angiotensina converting enzyme inhibitors. Recent studies suggest that sexual dysfunction could be considered a potential marker for underlying silent cardiac or vascular disease processes. Thus a systematic and standardized cardiological work-up should be considered in patients with sexual dysfunction, multiple risk factors and no symptoms or signs of coronary artery disease.