IMPACT OF BETA-BLOCKERS ON ERECTILE FUNCTION: A META-ANALYSIS

Although the use of beta-blockers (BBs) has been associated with worse erectile function, their real contribution is still conflicting. To better clarify their role on erectile dysfunction (ED), we systematically investigated date derived from epidemiological studies as well as those obtained in randomized controlled trials (RCTs).

A comprehensive review was performed using Medline, Embase and Cochrane searches to identify all the studies reporting erectile function among subjects receiving BBs treatment. Publications from January 1st, 1969 up to February 29th, 2024 were included.

Out of 212, 18 epidemiological studies (including 264 425 subjects) and 21 RCTs (including 5095 patients) were included. When unadjusted adjusted data were considered, overall, the use of BBs was associated with an increased risk of ED which decreased according to the increase of other cardiovascular (CV) risk factors, including enlarged body mass index and the prevalence of arterial hypertension a past history of CV diseases. In line with these observations, when adjusted data were analyzed, no risk of ED was observed when subjects using BBs were compared to controls (OR = 1.05[0.86;1.28]; p = 0.64). Among 21 RCTs, 14 were placebo-controlled. When any kind of BBs was compared to placebo or other drugs (ie, verapamil, telmisartan or losartan) no difference in ED rate between groups was detected. The same results were confirmed when only placebo-controlled studies were analyzed (OR = 1.21 [0.91;1.59]; p = 0.19). However, when the weekly frequency of coital intercourses was investigated, the use of BBs was associated with a reported lower number of sexual intercourses, when compared to placebo. Moreover, no difference in ED rate was observed between groups when we compared nebivolol to other BBS. However, when only studies using international index of erectile function (IIEF) were considered, the use of Nebivolol resulted in better outcomes when compared to other BBs.

Present data showed that BBs represent the class of medications more often associated with ED, although better results can be obtained with the use of nebivolol. However, the presence of associated morbidities can modulate the impact of BBs on ED.

none.