Impact of antihypertensive drugs on male fertility: mechanistic insights from experimental and clinical evidence
DOI:
https://doi.org/10.18554/acbiobras.v9i00.8922Keywords:
Spermatogenesis, Testicular oxidative stres, Renin-angiotensin system, Sexual dysfunction, Semen parametersAbstract
Systemic arterial hypertension (SAH) is a highly prevalent chronic condition associated with significant adverse cardiovascular outcomes. In parallel, a progressive decline in seminal quality and male fertility rates has been observed, raising concerns about the impact of SAH and chronic antihypertensive therapy on male reproductive function. Physiological systems involved in blood pressure regulation, such as the renin–angiotensin and adrenergic systems, also play key roles in spermatogenesis, steroidogenesis, and sperm function. This literature review critically analyzed the effects of major antihypertensive drug classes on male fertility, integrating experimental and clinical evidence. Findings indicate distinct reproductive profiles among drug classes: aldosterone antagonist diuretics and beta-blockers are associated with hormonal alterations, sexual dysfunction, and impaired semen parameters; calcium channel blockers interfere with sperm physiology by disrupting calcium homeostasis; and angiotensin-converting enzyme inhibitors may exert unfavorable effects, particularly through testicular oxidative stress. In contrast, angiotensin II receptor blockers demonstrate heterogeneous, context-dependent effects, with potential cytoprotective actions under specific conditions. In conclusion, hypertension management in men of reproductive age should consider potential reproductive impacts, reinforcing the need for individualized therapy and integrated cardiovascular and reproductive care.
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