The interlinked depression, erectile dysfunction, and coronary heart disease syndrome in older men: a triad often underdiagnosed.

The prevalence of depression, erectile dysfunction (ED), and coronary heart disease (CHD) increases with age, and the symptoms related to these three illnesses are closely interlinked. The term "DEC syndrome" is introduced to refer to this triad of comorbid conditions. When a patient presents with one component of the DEC syndrome, physicians should also screen for the other two components. Studies have shown that depression may predispose an individual to an increased risk of developing CHD, and older men with CHD are more likely to be depressed. Likewise, patients with ED are more likely to be clinically depressed, and patients with clinical depression often have ED. Furthermore, patients presenting with ED are often hypertensive, and thus have a significantly higher prevalence of cardiovascular complications. Multifactorial problems require multifactorial approaches, and the care of older men can improve if physicians are aware of this interlinked syndrome.

Sexual dysfunction in patients with hypertension: implications for therapy.

Sexual dysfunction associated with hypertension or antihypertensive therapies may impact the ability of patients to stay on therapy and lead to deterioration in patients' quality of life. Therefore, it is important for practitioners to become familiar with the wide variation in sexual side effects produced by antihypertensive agents and to discuss the potential occurrence of these side effects with their patients. In many cases, a change in the patient's drug regimen may help patients overcome specific sexual side effects experienced with certain treatments. Practitioners should consider selecting an antihypertensive therapy that is highly effective in lowering blood pressure but preserves patients quality of life. The effect of medications on sexual function remains controversial. Some blinded trials report little difference between placebo and specific medications, whereas other studies indicate that antihypertensive medications increase sexual dysfunction, which has an impact on quality of life. Recent evidence suggests that losartan, an angiotensin II antagonist, is not typically associated with development of sexual dysfunction and may actually positively impact several indices of sexual function (erectile function, sexual satisfaction, and frequency of sexual activity) as well as perceived quality of life. Thus, angiotensin II antagonists may offer a therapeutic option to prevent or correct erectile dysfunction in patients with hypertension. The favorable effects of these agents on sexual function may be related, in part, to their ability to block angiotensin II, which has recently become recognized as an important mediator of detumescence and possibly erectile dysfunction.

Cardiovascular effects of Tadalafil ( Cialis ) in patients on common antihypertensive therapies.

Tadalafil is a potent, selective, reversible phosphodiesterase 5 inhibitor under investigation for the treatment of erectile dysfunction (ED). Because some oral agents for ED have vasodilator properties, interaction studies were performed between Tadalafil ( Cialis ) and commonly prescribed antihypertensive agents. In addition, cardiovascular safety assessments were made from a safety database of phase 3 studies comparing patients who were and who were not receiving antihypertensives. In patients receiving concomitant antihypertensive therapy, Tadalafil ( Cialis ) administration may result in a reduction in blood pressure, which is, in general, mild and not likely to be of clinical concern. In the phase 3 studies, no statistically significant differences were observed between Tadalafil ( Cialis ) and placebo in the mean changes in blood pressure from baseline in patients taking >or=2 antihypertensive agents. The incidence rates of cardiovascular events were comparable between patients who were and were not treated with concomitant antihypertensive therapy, with the exception of events recorded as hypertension, which would be expected to occur periodically in this patient population despite treatment. Hypotension or postural hypotension was not reported in any Tadalafil ( Cialis ) -treated patient, compared with 1 report of each in the placebo-treated patients. Syncope was reported in 1 Tadalafil ( Cialis ) -treated patient (0.1%) who was not on concomitant antihypertensive medication and in 2 patients (1.9%) who received placebo with concomitant antihypertensive agents. The data presented herein suggest that Tadalafil ( Cialis ) is safe in patients receiving >or=1 concomitant antihypertensive agent.

Erectile dysfunction: oral pharmacotherapy options.

Erectile dysfunction (ED) (impotence) is a widespread, age-related problem, which affects 52% of men between 40 and 70 years of age. It is classified as psychogenic, organic, or mixed psychogenic and organic. ED is not a problem only of men, because the relationship between partners can also be disturbed. Therefore, adequate treatment of ED is needed and the most convenient and simplest way is oral drug therapy. Sildenafil, phosphodiesterase-(PDE)-5-selective inhibitor has been the drug of choice for patients with ED since it has been launched in March 1998. The results of various studies have confirmed the efficacy of the drug in men with ED of various etiologies, as well as the positive effect of Sildenafil Citrate ( Viagra ) on the quality of a partnership. The most frequent adverse effects documented with Sildenafil Citrate ( Viagra ) usage are headache, flushes, dyspepsia, visual disturbances and nasal congestion/rhinitis. These adverse effects are dose-related, usually transient and mild, with low withdrawal rate. Several studies performed recently have shown that Sildenafil Citrate ( Viagra ) is a safe and effective treatment of ED in patients with cardiovascular disease, who do not take nitrates or nitrate donors concomitantly. Other oral medications for ED include apomorphine, phentolamine, yohimbine, trazodone, testosterone and new PDE-5 inhibitors in Phase III clinical trials, such as Vardenafil ( Levitra ) and Tadalafil ( Cialis ) . It is obvious, according to recent data, that the concept of PDE-5 inhibition has a central position in oral pharmacotherapy of ED. However, larger clinical studies of efficacy and safety should be carried out using most of the other above-mentioned oral agents and these may also gain a place in the therapy of ED. There are no studies directly comparing Sildenafil Citrate ( Viagra ) and other treatments of ED or assessing its role in combination with other therapies. According to the present knowledge, the quality of life, not only of patients but also of their sexual partners, will be improved significantly with Sildenafil Citrate ( Viagra ) usage and this is an important precondition for overall health ofboth. Sildenafil Citrate ( Viagra ) is thus a highly effective peroral treatment for ED in patients without contraindications for its use, which can be considered as the firstline therapy with an acceptable risk-benefit ratio.