Losartan Mı Nebivolol Mu ? Hangisi Erektil Disfonksiyonda Daha Etkin ?

Yıl 2023, Cilt: 1 Sayı: 2, 119 - 127, 25.09.2023

Ali Haydar Yılmaz , Mustafa Kaplangoray , Edhem Deveci

Öz

Hipertansif hastaları ED (erektil disfonksiyon) karşı korumak ve cinsel sağlık açısından daha iyi klinik düzelme sağlamak ve bu ilaçların ED üzerine olumlu etkilerini değerlendirmek için bu hastalara önerilebilecek daha önce bilinen nebivolol ve çok bilinmeyen losartan içerikli ilaçları karşılaştırmak amaçlanmıştır. 18 yaş üstü diyabetik cinsel aktif erkek hastalara iki ayrı form doldurulacak. Hastalar losartan kullananlar, nebivolol kullananlar ve bu ilaçları kullanmayan kontrol grubu olmak üzere 3 grup olacaktır. Toplam 85 hasta çalışmaya alınmıştır. Erkek cinsel sağlık değerlendirme formuna göre losartan ve nebivolol grubu kontrol grubuna göre anlamlıdır (p<0,0001). Uluslararası erektil işlev formuna göre de losartan ve nebivolol grubu da kontrol grubuna göre istatistiksel olarak anlamlı bulunmuştur (p<0,0001). Nebivolol ED üzerindeki olumlu etkisini damar endotelinden NO salınımını sağlayarak vazodilatasyon yaparak gösterir. Ancak losartan ile kıyaslandığında yapılan çalışmalarda görüldüğü gibi losartan klinik düzelme daha üstün görülmektedir.

Anahtar Kelimeler

Losartan, Nebivolol, Hipertansiyon, Erektil Disfonksiyon.

Losartan or Nebivolol ? Which One Is More Effective in Erectile Dysfunction ?

Öz

To protect hypertensive patients against ED (erectile dysfunction) and to provide better clinical improvement in terms of sexual health and to evaluate the positive effects of these drugs on ED, it is aimed to compare the drugs containing previously known nebivolol and unknown losartan that can be recommended to these patients. Two separate forms will be filled out for diabetic sexually active male patients over the age of 18. Patients will be in 3 groups: those who use losartan, those who use nebivolol, and the control group who do not use these drugs. A total of 85 patients were enrolled in the study. According to the male sexual health assessment form, the losartan and nebivolol group are statistically significant compared to the control group (p<0.0001). According to the international erectile function form, losartan and nebivolol group were also found to be statistically significant compared to the control group (p<0.0001). Nebivolol shows its positive effect on ED by vasodilation by ensuring the release of NO from the vascular endothelium. However, as can be seen from the studies conducted in comparison with losartan, the clinical improvement of losartan is seen to be superior.

Anahtar Kelimeler

Losartan, Nebivolol, Hypertension, Erectile Dysfunction

Destekleyen Kurum

None

Kaynakça

• Andersson, K. E., & Wagner, G. (1995). Physiology of penile erection. Physiological Reviews, 76, 191. https://doi.org/10.1152/physrev.1995.75.1.191
• Ardahanlı, İ., & Çelik, M. (2020). Can myocardial performance index predict early cardiac risks in erectile dysfunction?. The Aging Male, 23(5), 1355-1361. https://doi.org/10.1080/13685538.2020.1768367
• Aytac, I. A., McKinlay, J. B., & Krane R. J. (1999). The likely worldwide increase in erectile dysfunction between 1995 and 2025 and some possible policy consequences. BJU International, 84(1), 50-56. https://doi.org/10.1046/j.1464-410x.1999.00142.x
• Bearelly, P., Moore, S. A., Avellino, G., Ko, D. S. C. (2023). Diabetes and Erectile Dysfunction. In: Johnstone, M., Veves, A. (eds) Diabetes and Cardiovascular Disease. Contemporary Cardiology. Humana, Cham. https://doi.org/10.1007/978-3-031-13177-6_20
• Bortel, L. M. V., Bulpitt, C. J., & Fici, F. (2005). Quality of life and antihypertensive effect with nebivolol and losartan. American journal of hypertension, 18(8), 1060-1066. https://doi.org/10.1016/j.amjhyper.2005.03.733
• Boydak, B., Nalbantgil, S., Fici, F., Nalbantgil, I., Zoghi, M., Ozerkan, F., ... & Onder, R. (2005). A randomised comparison of the effects of nebivolol and atenolol with and without chlorthalidone on the sexual function of hypertensive men. Clinical drug investigation, 25, 409-416. https://doi.org/10.2165/00044011-200525060-00006
• Brixius, K., Middeke, M., Lichtenthal, A., Jahn, E., & Schwinger, R. H. (2007). N itric o xide, e rectile d ysfunction and beta‐blocker treatment (mr noed study): benefit of nebivolol versus metoprolol in hypertensive men. Clinical and Experimental pharmacology and physiology, 34(4), 327-331. https://doi.org/10.1111/j.1440-1681.2007.04551.x
• Caro, J. L. L., Vidal, J. V. L., Roca, M. A., Bravo, C. P., Vicente, J. A., Ferrario, C. M., & Zamorano, M. A. S. (2001). Sexual dysfunction in hypertensive patients treated with losartan. The American journal of the medical sciences, 321(5), 336-341. https://doi.org/10.1097/00000441-200105000-00006
• Chen, Y., Li, S. X., Yao, L. S., Wang, R., & Dai, Y. T. (2007). Valsartan treatment reverses erectile dysfunction in diabetic rats. International Journal Of Impotence Research, 19(4), 366-370. https://doi.org/10.1038/sj.ijir.3901534
• Chiu, A. T., McCall, D. E., Price Jr, W. A., Wong, P. C., Carini, D. J., Duncia, J. V., ... & Timmermans, P. B. (1991). In vitro pharmacology of DuP 753. American Journal of Hypertension, 4(4_Pt_2), 282S-287S. https://doi.org/10.1093/ajh/4.4.282S
• De Nicola, L., Blantz, R. C., & Gabbai, F. B. (1992). Nitric oxide and angiotensin II. Glomerular and tubular interaction in the rat. The Journal of clinical investigation, 89(4), 1248-1256. https://doi.org/10.1172/JCI115709
• Derouet, H., Eckert, R., Trautwein, W., & Ziegler, M. (1994). Muscular cavernous single cell analysis in patients with venoocclusive dysfunction. European urology, 25(2), 145-150. https://doi.org/10.1159/000475270
• Ertemi, H., Mumtaz, F. H., Howie, A. J., Mikhailidis, D. P., & Thompson, C. S. (2011). Effect of angiotensin II and its receptor antagonists on human corpus cavernous contractility and oxidative stress: modulation of nitric oxide mediated relaxation. The Journal of urology, 185(6), 2414-2420. https://doi.org/10.1016/j.juro.2011.02.2645
• Feldman, H. A., Goldstein, I., Hatzichristou, D. G., Krane, R. J., & McKinlay, J. B. (1994). Impotence and its medical and psychological correlates: Results of the Massachusetts male aging study. J Urol, 151, 54-61. https://doi.org/10.1016/s0022-5347(17)34871-1
• Flammer, A. J., Hermann, F., Wiesli, P., Schwegler, B., Chenevard, R., Hürlimann, D., ... & Lehmann, R. (2007). Effect of losartan, compared with atenolol, on endothelial function and oxidative stress in patients with type 2 diabetes and hypertension. Journal of hypertension, 25(4), 785-791. https://doi.org/10.1097/HJH.0b013e3280287a72
• Israilov, S., Shmuely, J., Niv, E., Engelstein, D., Livne, P., & Boniel, J. (2005). Evaluation of a progressive treatment program for erectile dysfunction in patients with diabetes mellitus. International journal of impotence research, 17(5), 431-436. https://doi.org/10.1038/sj.ijir.3901337
• James, P. A., Oparil, S., Carter, B. L., Cushman, W. C., Dennison-Himmelfarb, C., Handler, J., ... & Ortiz, E. (2014). 2014 evidence-based guideline for the management of high blood pressure in adults: report from the panel members appointed to the Eighth Joint National Committee (JNC 8). JAMA, 311(5), 507-520. https://doi.org/.1001/jama.2013.284427
• Johannes, C. B., Araujo, A. B., Feldman, H. A., Derby, C. A., Kleinman, K. P., & McKINLAY, J. B. (2000). Incidence of erectile dysfunction in men 40 to 69 years old: longitudinal results from the Massachusetts male aging study. The Journal of urology, 163(2), 460-463. https://doi.org/10.1016/S0022-5347(05)67900-1
• Kifor, I., & Dzau, V. J. (1987). Endothelial renin-angiotensin pathway: evidence for intracellular synthesis and secretion of angiotensins. Circulation research, 60(3), 422-428. https://doi.org/10.1161/01.RES.60.3.422
• Kifor, I., Williams, G. H., Vickers, M. A., Sullivan, M. P., Jodbert, P., & Dluhy, R. G. (1997). Tissue angiotensin II as a modulator of erectile function. I. Angiotensin peptide content, secretion and effects in the corpus cavernosum. The Journal of urology, 157(5), 1920-1925. Klinge, E., & Sjöstrand, N. O. (1977). Comparative study of some isolated mammalian smooth muscle effectors of penile erection. Acta Physiologica Scandinavica, 100(3), 354-367. https://doi.org/10.1111/j.1748-1716.1977.tb05961.x
• Lerner, S. E., Melman, A., & Christ, G. J. (1993). A review of erectile dysfunction: new insights and more questions. The Journal of urology, 149(5), 1246-1255. https://doi.org/10.1016/S0022-5347(17)36359-0
• Lue, T. F. (2000). Erectile dysfunction. New England journal of medicine, 342(24), 1802-1813. https://doi.org/10.1056/NEJM200006153422407
• Lue, T. F., & Tanagho, E. A. (1987). Physiology of erection and pharmacological management of impotence. J. Urol., 131, 829. https://doi.org/10.1016/s0022-5347(17)44267-4
• McCambridge, J., Witton, J., & Elbourne, D. R. (2014). Systematic review of the Hawthorne effect: new concepts are needed to study research participation effects. Journal of clinical epidemiology, 67(3), 267-277. https://doi.org/10.1016/j.jclinepi.2013.08.015
• Munzenmaier, D. H., & Greene, A. S. (1995). Angiotensin II mediates a sustained rise in nuclear and cytoplasmic calcium via multiple receptor subtypes. American Journal of Physiology-Heart and Circulatory Physiology, 269(2), H565-H570. https://doi.org/10.1152/ajpheart.1995.269.2.H565
• Navar, L. G., Inscho, E. W., Majid, S. A., Imig, J. D., Harrison-Bernard, L. M., & Mitchell, K. D. (1996). Paracrine regulation of the renal microcirculation. Physiological reviews, 76(2), 425-536. https://doi.org/10.1152/physrev.1996.76.2.425
• Orlov, S., Resink, T. J., Bernhardt, J., Ferracin, F., & Buhler, F. R. (1993). Vascular smooth muscle cell calcium fluxes. Regulation by angiotensin II and lipoproteins. Hypertension, 21(2), 195-203. https://doi.org/10.1161/01.HYP.21.2.195
• Park, K., Shin, J. W., Oh, J. K., Ryu, K. S., Kim, S. W., & Paick, J. S. (2005). Restoration of erectile capacity in normotensive aged rats by modulation of angiotensin receptor type 1. Journal of andrology, 26(1), 123-128. https://doi.org/10.1002/j.1939-4640.2005.tb02881.x
• Phillips, M. I., Speakman, E. A., & Kimura, B. (1993). Levels of angiotensin and molecular biology of the tissue renin angiotensin systems. Regulatory peptides, 43(1-2), 1-20. https://doi.org/10.1016/0167-0115(93)90403-U
• Sigmon, D. H., & Beierwaltes, W. H. (1993). Renal nitric oxide and angiotensin II interaction in renovascular hypertension. Hypertension, 22(2), 237-242. https://doi.org/10.1161/01.HYP.22.2.237
• Toblli, J. E., Stella, I., Mazza, O. N., Ferder, L., & Inserra, F. (2004). Different effect of losartan and amlodipine on penile structures in male spontaneously hypertensive rats. American journal of nephrology, 24(6), 614-623. https://doi.org/10.1159/000082598
• Toblli, J. E., Stella, I., Mazza, O. N., Ferder, L., & Inserra, F. (2006). The effect of different antihypertensive drugs on cavernous tissue in experimental chronic renal insufficiency. Journal of Nephrology, 19(4), 419-428.
• Wojciechowski, D., & Papademetriou, V. (2008). β-blockers in the management of hypertension: focus on nebivolol. Expert review of cardiovascular therapy, 6(4), 471-479. https://doi.org/10.1586/14779072.6.4.471
• Yang, R., Yang, B., Wen, Y., Fang, F., Cui, S., Lin, G., ... & Dai, Y. (2009). Losartan, an Angiotensin type I receptor, restores erectile function by downregulation of cavernous renin-angiotensin system in streptozocin-induced diabetic rats. The journal of sexual medicine, 6(3), 696-707. https://doi.org/10.1111/j.1743-6109.2008.01054.x
• Zerrouk, A., Auguet, M., Chabrier, P. E. and Braquet, P. (1994). Endothelial inducible nitric oxide synthase mediates the contractile desensitization of angiotensin I1 in rat aorta. In: The Biology of Nitric Oxide. Physiological and Clinical Aspects. Edited by S. Moncada, M. Feelish, R. Busse, E. A. Higgins. London: Portland Press, pp. 108-110.