Mr Ramesh Chand goyal a 56-year-man visited my center for follow-up of hypertension control. During his history, he reports significant erectile dysfunction (ED) that has progressed over the past 8 months. This has been distressing to him and to his wife and has caused significant marital strife. He has been treated for hypertension for 4 to 5 years and is currently taking a combination of hydrochlorothiazide and atenolol with good blood pressure control. His past history includes obesity and a sedentary lifestyle.His blood pressure is moderately controlled (152/82 mm Hg). He reports no morning erections, nocturnal erections, or spontaneous erections satisfactory for vaginal penetration. He has a normal ejaculatory function. Physical examination is normal with normal genitalia.Laboratory studies include total cholesterol 265 mg/dL, high-density lipoprotein 38 mg/dL, low-density lipoprotein 120 mg/dL, triglycerides 270 mg/dL, and blood sugar 185 mg/dL. Total testosterone 380ng/ml, free testosterone 4.15 pg/ml,Hba1c 6.9 .Patients are suffering from metabolic syndrome, Obesity, dyslipidemia, and high blood sugars, we need to explain regarding risk factors for vascular disease and erectile dysfunction.Since he was not taking nitrates or alpha blockers, phosphodiesterase enzyme 5 (PDE5) inhibitors were initiated to improve his erectile function. the patient was initiated on statin treatment for his dyslipidemia and referred to a dietary controlled weight-loss program. He should encourage to start exercising. It was suspected that another cause of his ED was the combination of antihypertensive medications due to his hypertension. We can change his anti-hypertensive medications from a thiazide diuretic and beta blocker to angiotensin-converting enzyme inhibitor, alpha 2 receptor blocker, calcium channel blocker, alone or in combination. Because of his ED, the patient was motivated to improve his overall risk-factor profile with the assistance of a PDE5 inhibitor as a motivational alternative.The patient and his wife were given the opportunity to seek marital counseling for further improvement in their interpersonal relationship and resolution of ED.
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