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IMR Press / RCM / Volume 23 / Issue 5 / DOI: 10.31083/j.rcm2305173
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β-Blockers and Erectile Dysfunction in Heart Failure. Between Myth and Reality
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1 Department of Clinical and Molecular Medicine, Sapienza University of Rome University, 00189 Rome, Italy
2 Department of Cardiology, University of Foggia, 71122 Foggia, Italy
3 UOC Cardiologia, G da Saliceto Hospital, 29121 Piacenza, Italy
4 Dipartimento di Scienze Cardiovascolari, Respiratorie, Nefrologiche, Anestesiologiche e Geriatriche, Sapienza University of Rome, 00161 Rome, Italy
5 Division of Cardiology, University of Brescia, 25121 Brescia, Italy
6 Department of Clinical sciences and Community health, Cardiovascular Section, University of Milano, 20122 Milano, Italy
7 Centro Cardiologico Monzino, IRCCS, 20138 Milano, Italy
*Correspondence: damiano.magri@uniroma1.it (Damiano Magrì)
Rev. Cardiovasc. Med. 2022, 23(5), 173; https://doi.org/10.31083/j.rcm2305173
Submitted: 11 February 2022 | Revised: 22 March 2022 | Accepted: 24 March 2022 | Published: 13 May 2022
(This article belongs to the Special Issue Heart Failure with Reduced Ejection Fraction)
This is an open access article under the CC BY 4.0 license.
Abstract

Erectile dysfunction (ED) is a major concern in heart failure (HF) due its high prevalence as well as its negative impact on the quality of life, this condition being usually unrecognized and thus untreated. A number of possible causes might contribute to the above mentioned tight association, i.e., shared risk factors, comorbidities and several physiologic HF abnormalities such as impaired exercise tolerance, psychogenic factors and neurohumoral, metabolic and vascular changes. Medications have been blamed for playing also a pivotal role in the ED occurrence and, particularly, the $\beta{}$-blockers. Remarkably, the underlying mechanisms have not been fully identified. All the available scientific literature dealing with this topic derives from studies not addressing this issue in HF, but in other settings, (e.g., arterial hypertension) and are also characterized by important methodological flaws. Thus, given the solid evidences arguing in favor of $\beta{}$-blockers in HF in terms of morbidity, mortality and quality of life, $\beta{}$-blockers at the maximal tolerated dosage in this patients’ category should be recommended, regardless of ED. However, the ED-related issues should not be neglected, and adequate psychological counseling and management should be provided, pursuing the correction of risk factors, the choice of more suitable medications and, in selected cases, adopting specific drugs or devices. The purpose of this narrative review is to highlight the close relationship between ED and HF and, specifically, to focus on a possible $\beta{}$-blockers’ role in determining or, at least, worsening this condition.

Keywords
heart failure
erectile dysfunction
beta-blocker
therapy
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