Dr. Muhammad Zohaib Siddiq
Cardiology
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Patient's Query
Hi doctor,
I am a doctor practicing in a rural area and aged 55 years. I am having high blood pressure for last seven years. My blood pressure was 180/100 mmHg before treatment and now I am on Telmisartan H 40 mg once daily. My BP fluctuates between 128 and 135 systolic to 85 and 90 diastolic. I do not have any symptoms of hypertension either before or after starting treatment. My only concern now is that I am having ED. Is it due the drugs I am using or BP itself or just age factor? I have tried Sildenafil, but no effect. Can you suggest me any solution either by changing the antihypertensive drug that is less likely to cause ED or any other medication? Or do you advise me to accept the situation? I can understand and follow your advice. Thank you.
Hello,
Welcome to icliniq.com.
Regarding your ED (erectile dysfunction), definitely your age can be factor. But, if ED developed suddenly, then this could be caused by anxiety. It is one of the most important causes of ED. Yes, some ARBs (angiotensin receptor blockers) can cause ED as a side effect and also Thiazide diuretics, which is present in your medication. I suggest you switch to ACE inhibitors such as Lisinopril with or without calcium channel blockers. If you are diabetic, then it is also a cause of ED. Moreover, ED can be an indicator of future cardiovascular risk. I suggest you to rule out vascular cause of ED. You can have a penile Doppler ultrasound with Caverject injection (Alprostadil) to rule out vascular element. Do exercise, yoga and remain happy. Sildenafil had no effect means it can be due to anxiety or depression. Have a lipid profile done and exercise tolerance test to rule out impending cardiovascular risk. Also, keep your BP well controlled.
Patient's Query
Thank you doctor,
I am not diabetic and to my knowledge I have no tension or anxiety or depression. I do regular walking and yoga. My recent cardiac checkup and lipid profile are normal. One thing I do want to get done is the penile ultrasound Doppler actually I did not think of. Can you please suggest me the dose and name of ACE?
Hi,
Welcome back to icliniq.com.
I suggest Acinopril 10 mg (Lisinopril) at night time. It may be combined with Acord 5 mg (Amlodipine) at daytime. Monitor your blood pressure for about 15 days. Consult your specialist doctor, discuss with him or her and take the medicine with consent. Before penile Doppler US, do not forget to take anxiolytic such as Alprazolam 1 mg or any other anxiolytic drug about two hours before the procedure.
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Cardiology
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