Causal Relationship Between Antihypertensive Drugs and Erectile Dysfunction Revealed Using a Mendelian Randomization Study

Background Erectile dysfunction (ED) is the leading cause of sexual dysfunction in hundreds of millions of men worldwide, with serious negative consequences for the quality of life of both men and their partners. Whereas antihypertensive drugs may play a role in the progression of ED, evidence of causality is limited. We aimed to investigate the causal effect of antihypertensive drugs on ED risk using Mendelian randomization (MR). Methods Pooled data based on genome‐wide association studies (GWASs) were included in relation to five antihypertensive drugs including: renin–angiotensin, calcium channel blockers, beta‐blockers, diuretics, and overall antihypertensive medication use. We performed MR analyses to estimate the causal effect of antihypertensive medications on ED risk. We also performed some sensitivity analyses to assess the validity of the MR hypothesis. Results Genetically predicted drug use of drugs acting on the renin–angiotensin system (RAS), calcium channel blockers, β‐blockers, and antihypertensive medications were all found to be significantly and positively associated with ED (agents acting on the RAS: odds ratio [OR] = 1.136; 95% CI = 1.049–1.230; p = 0.002; beta blocking agents: OR = 1.120; 95% CI = 1.001–1.252; p = 0.048; calcium channel blockers: OR = 1.103; 95% CI = 1.017–1.196; p = 0.018; blood pressure medication: OR = 1.867; 95% CI = 1.175–2.965; p = 0.008). In contrast, there was a lack of association between diuretic use and ED (diuretics: OR = 1.083; 95% CI = 0.994–1.180; p = 0.067). Sensitivity analyses showed more robust results. Conclusions Our study supports the idea that medication use of drugs acting on the RAS, calcium channel blockers, β‐blockers, and antihypertensive medications may have a negative effect on ED, whereas diuretic use had no effect on ED.