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Editor's Correspondence |

Management of Erectile Dysfunction: Do Not Forget Hypertension

Michael Doumas, MD; Panagiota Anyfanti, MD; Areti Triantafyllou, MD
Arch Intern Med. 2012;172(7):597-598. doi:10.1001/archinternmed.2012.132.
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We are grateful to Gupta et al1 for their significant article, which provides further insight on the importance of lifestyle modification and/or pharmacotherapy for existing cardiovascular risk factors to improve erectile function.2 However, there are some points that deserve to be considered.

First, in 2 of the 4 studies analyzing lifestyle interventions, participants also received drugs that might affect erectile function. In particular, in the Look AHEAD (Action for Health in Diabetes) study,3 patients were receiving antihypertensive and antidiabetic drugs, insulin, and even phosphodiesterase type 5 inhibitors, casting doubts that study findings accurately reflect the pure effects of weight loss on erectile function. More importantly, study participants were followed by their own physicians, raising the possibility that they were free to take other drugs affecting erectile function toward opposite directions, ie, angiotensin receptor blockers vs β-blockers.4 In the study from Nigeria, even more significant concerns are raised.5 All patients were given therapy with methyldopa, a drug known to affect erectile function. The washout period (1 week) was too short for the evaluation of erectile function, while the percentage of patients using methyldopa prior to the study as well as the dose of methyldopa during the study are not provided in the original article. Therefore, the validity of study findings to uncover the net effect of exercise training is seriously questioned.

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April 9, 2012
Bhanu P. Gupta, MD; M. Hassan Murad, MD; Stephen L. Kopecky, MD
Arch Intern Med. 2012;172(7):597-598. doi:10.1001/archinternmed.2012.408.
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