Sexual function among controlled and uncontrolled hypertensive females receiving beta-blockers or ACEI/ARB and thiazides: a prospective randomized controlled study

TL;DR

This study found that ACEIs/ARBs and BBs may improve sexual function in hypertensive women, with ACEIs/ARBs showing the most favorable effects.

Contribution

The study is the first to compare the effects of BBs, ACEIs/ARBs, and thiazides on sexual function in controlled and uncontrolled hypertensive females.

Findings

ACEIs/ARBs significantly improved all domains of female sexual function after 3 months.

Controlled hypertensive patients on BBs showed improvements in most sexual function domains.

Uncontrolled hypertensive patients on BBs had significant increases in desire, arousal, orgasm, and satisfaction.

Abstract

Female sexual dysfunction (FSD) among females with hypertension (HTN) is frequently overlooked, with a reported prevalence of 42.1%.

We aimed to determine the impact of beta-blockers (BBs), angiotensin-converting enzyme inhibitors/angiotensin receptor blockers (ACEIs/ARBs), and thiazides on sexual function in hypertensive females.

A prospective randomized controlled trial enrolled 125 female participants. Group (1) included 25 normotensive females serving as the controls. Groups (2) and (3) consisted of 50 controlled and uncontrolled hypertensive patients who received BBs, respectively. Groups (4) and (5) consisted of 50 patients with controlled and uncontrolled HTN who received ACIs/ARBs, respectively. Each group consisted of patients who received one tablet daily of ramipril 2.5 mg for one month, while the other half received one tablet daily of valsartan (VAL) 80 mg for the same duration. After one month, the subjects were transitioned to a daily regimen of one tablet of ramipril 2.5 mg combined with hydrochlorothiazide 12.5 mg, as well as one tablet of VAL 80 mg with hydrochlorothiazide 12.5 mg for two months, respectively.

Controlled and uncontrolled hypertensive patients receiving ACEIs/ARBs, as well as controlled hypertensive patients receiving BBs, demonstrated a significant decrease in serum total testosterone and free testosterone levels, accompanied by a significant increase in estradiol after 3 months. Furthermore, controlled and uncontrolled hypertensive patients receiving ACEI/ARBs showed significant increases in all female sexual function (FSF) domains and total FSF scores after 3 months. Consistently, controlled hypertensive patients receiving BBs showed significant improvements across all domains of the validated Arabic version of the female sexual function index (ArFSFI) and the total score, comparable to the ACEI/ARB groups, except for pain. Conversely, uncontrolled hypertensive patients receiving BBs demonstrated significant increases in scores for desire and arousal and orgasm and satisfaction after 3 months. After three months, there was a significant reduction in the GAD-7 scores among all hypertensive patients.

ACEIs/ARBs demonstrated a favorable effect on FSF. Future large-scale cohort studies are warranted to validate these findings as this study was a single center and of small sample size.

The online version contains supplementary material available at 10.1038/s41598-026-40790-2.

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