The inability to detect a statistically significant correlation between BMQ specific-necessity and the 5 IIEF domains suggests that the sexual functioning of men with hypertension is not necessarily related to their antihypertensive medication beliefs. More than 50% agreed or strongly agreed that antihypertensive medications were necessary, but not that life would be impossible without them. Moreover, there was no statistically significant relationship between any of the 5 IIEF domains and the BMQ specific-concern subscale, which suggests that the sexual functioning of men with hypertension may not be related to their concern about their medications.
The findings of this study support HBM and provide a possible explanation for medication nonadherence in men diagnosed with hypertension. The HBM provides a conceptual framework that positions the study variables (eg, beliefs about medicines, illness perception, and erectile function) in terms of health care behaviors that can lead to increased medication adherence among men with hypertension. The HBM also allows the researcher to gain a better understanding about participants’ health behaviors, how these health behaviors are determined by personal beliefs or perceptions about a disease, and strategies available to decrease nonadherence.1
The HBM postulates that patients’ appraisals of disease risk (susceptibility) and severity influence their behavior.9 One study assessed respondents’ perceptions of the seriousness of their hypertension and its relationship to ED and of the consequences of failing to take prescribed blood pressure medications.9 When using the HBM, it is important to consider patients’ perceived barriers to and incentives for engaging in specific behaviors. The same study used the BMQ to address specific questions about respondents’ beliefs and feelings about their prescribed medications and medication adherence. The HBM suggests considering action cues that encourage patients to act by reminding them of the need to change their behavior.
Limitations
This study had several limitations. First, the sample size was small (47), which makes it difficult to generalize findings to a broader population of men with a hypertension diagnosis. In addition, because the study was underpowered, its ability to detect significant differences was compromised. Second, the study used a convenience sample of predominantly African American men. As always, there are concerns of self-selection and failure to represent the overall population. Third, the setting for completing the surveys was only semiprivate, and some respondents may have been uncomfortable, perhaps, working too quickly and not really thinking about the questions or their answers. Fourth, the ED survey was self-administered, so there is a concern about the truthfulness of responses. Fifth, failure to ask respondents whether they were taking a phosphodiesterase 5 inhibitor for ED could have significantly impacted study findings. Sixth, respondents were not asked about other medications, such as antidepressants and nonsteroidal anti-inflammatory drugs, which could have affected erectile function.
Clinical Implications
Despite the study limitations, several findings have important clinical implications. First, the vast majority of participants in this pilot study self-reported moderate or severe sexual dysfunction on all 5 IIEF domains. This finding is important because this was a convenience sample, and many of the IIEF statements are personal. The high rate of reported sexual dysfunction suggests that the incidence of ED may be underreported in the larger population. Second, mean BMQ scores were similar to those reported in other studies involving chronic illness: higher necessity and lower concern. Third, there was no statistically significant relationship between BMQ necessity and concern and IIEF sexual functioning. More research is needed to determine how to interpret these findings. Fourth, there was a significant relationship between length of time with hypertension diagnosis and BMQ specific-necessity score: The longer the diagnosis, the higher the score. However, this relationship did not hold for BMQ specific-concern, though it trended toward significance. Moreover, length of time with hypertension diagnosis did not necessarily predict or influence erectile function as measured with the IIEF. In fact, men with a hypertension diagnosis of ≥ 11 years reported less moderate-to-severe sexual dysfunction in overall satisfaction and sexual desire. Although there are several methodologic concerns about this study, its results offer direction for both clinical practice and future research.
Studies of erectile function and its relationship to hypertension have generated both cause for concern and reason for further research. The present study focused on gaining a better understanding of the relationship between antihypertensive medication beliefs and erectile function. Future clinical studies should explore the effects of antihypertensive medication on erectile function and men’s lack of knowledge and education about the importance of taking medication to prevent complications of hypertension. It is essential that this research be applied to improve the understanding of erectile function in men with hypertension. This will ultimately allow for better patient management and contribute to the overall sexual health and well-being of patients with hypertension.
Although it is important to identify men’s antihypertensive medication beliefs and the relationship of these beliefs to sexual satisfaction, most longitudinal studies suggest that the ED rate is high and that it increases with age.10 Therefore, it is crucial that men differentiate between how antihypertensive medications affect erectile function and changes associated with aging. The present study found no statistically significant relationships between the BMQ specific-necessity and specific-concern subscales and overall satisfaction with sexual functioning (IIEF). In addition, the study found no significant correlations between the BMQ specific and general scales and the 5 IIEF domains.
Conclusion
It was evident from this research that men with chronic health problems, such as hypertension, are often prescribed medications that affect sexual functioning. Unfortunately, the effect on sexual functioning often plays a significant role in the discontinuation of long-term therapy. Many of this study’s participants self-reported moderate or severe sexual dysfunction. Results showed no statistically significant relationships between either BMQ subscale or any of the 5 IIEF domains. Research is needed to further explore the association between ED and antihypertensive medication and men’s lack of knowledge and education about the importance of treatment adherence.