| Objective The aim of this study is to assess different of antihypertensive combination therapy on the effect of lowing blood pressure,ED and serum T and SHBG in young-middle-aged male patients with hypertension from urban area.Methods A total of 167(mean age 46.54±11.29 years)male patients aged≤65 of hypertension were enrolled in this prospective randomized,control,parallel assignment and interventional study with 48 weeks follow up. Patients were divided into three groups which including Felodipine combined Irbesartan (group A,n=49,mean age 46.90±12.74 yrs),Felodipine combined Metoprolol (group B,n=46,mean age 46.11±11.26 yrs) and Felodipine combined Hydrochlorothiazide (group C,n=53,mean age 46.70±10.70 yrs) respectively. The dosage of these medicines were initiated with Felodipine 5mg/d combined Irbesartan 150mg/d (group A),Felodipine 5mg/d combined Metoprolol 47.5mg/d (group B) and Felodipine 5mg/d combined Hydrochlorothiazide 12.5mg/d (group C) respectively. Dosage of Felodipine was doubled after 4 weeks if BP was≥140/90 mmHg. Sexual function was assessed by IIEF-5 questionnaire. According to IIEF-5 questionnaire,ED was divided into mild ED,moderate ED and severe ED.Blood samples were taken for assessing of serum T and SHBG. All patients accepted consent form and the research protocol were approved by The Ethic Committee of The Second Hospital of Lanzhou University.Results1. There were effective blood pressure lowering (P<0.01) and no difference (P> 0.05) in these three groups. Antihypertensive target rates in group A, group B and group C were 20.41%,38.60% and 35.85% respectively after treatment for 4 weeks. Similarly antihypertensive effective rates were 79.59%,82.61% and 66.04% respectively. The difference of both rates among these three groups was not statistically significant (P>0.05). Antihypertensive target rates in group A,group B and group C were 48.98%,47.83% and 43.40% respectively after treatment for 24 weeks. Similarly antihypertensive effective rates were 93.88%,91.30% and 83.02% respectively. There was no any statistical difference of both rates among these groups (P>0.05). Antihypertensive target rates in group A,group B and group C were 53.06 %,52.17% and 49.06% respectively after treatment for 48 weeks. Similarly antihypertensive effective rates were 91.84%,91.30% and 88.68% respectively. The difference of both rates among these three groups was no significant difference (P> 0.05).2. Before and after treatment for 24 weeks and 48 weeks the total prevalence of ED were 34.46%,35.81% and 39.86% respectively, the difference among these three groups was not statistically significant (P>0.05). Similarly the difference of mild ED, moderate ED and severe ED among these three groups was no statistical difference (P>0.05),but it can be seen that there was a slight downward trend in prevalence of ED for Felodipine combined Irbesartan after treatment for 24 weeks and 48 weeks, there was also slightly increased in prevalence of ED for Felodipine combined Metoprolol and Felodipine combined Hydrochlorothiazide after treatment for 24 weeks and 48 weeks. Felodipine combined Irbesartan was the most least effect on the mild ED among three groups (P<0.05),and the erectile function was no any statistical difference between Felodipine combined Metoprolol and Felodipine combined Hydrochlorothiazide(P<0.05)3. The serum T in group A,group B and group C were 658.51±395.57ng/dl, 628.71±529.14 ng/dl and 624.59±426.28ng/dl respectively before treatment. Similarly the serum T were 286.10±365.00ng/dl,295.31±357.98ng/dl and 282.34±256.69ng/dl after treatment for 48 weeks. Compared before to after treatment for 48 weeks among these groups,there were statistical difference of the serum T (P<0.05). The serum SHBG in group A,group B and group C were 31.47±17.01ng/dl,33.47±17.63 ng/dl and 23.99±14.29 ng/dl respectively before treatment, Similarly group A, group B and group C were 43.49±28.63ng/dl,43.49±28.63ng/dl and 43.49±28.63ng/dl after treatment for 48 weeks. Compared before to after treatment for 48 weeks among these groups, there were statistical difference of the serum SHBG (P<0.05). This has a tendency of decrease for serum T and increase for SHBG (P<0.05).Conclusion Felodipine combined Irbesartan,Felodipine combined Metoprolol and Felodipine combined Hydrochlorothiazide had similar effection to lowing blood pressure of hypertension. Felodipine combined Irbesartan seems be prior to prevent the ED in male patients with hypertension. Antihypertensive combination therapy decreased serum T and increased serum SHBG.
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