Sexual dysfunction has a high prevalence among hypertensive men, and hypertension per se, regardless of drugs, has been suggested to affect sexual function. The available studies have not clarified which factors play a major role in the pathogenesis of sexual dysfunction in hypertensive men. Neurovascular factors, however, seem to be especially important, (in particular defective nitric oxide activity), although hormonal and psychogenic factors cannot be excluded. Further studies are needed to answer the important question of whether erectile dysfunction seen in hypertension may be one expression of vascular disease and target organ damage. The incidence of sexual dysfunction is exacerbated by antihypertensive drug treatment. There is evidence that some classes of drugs, such as diuretics, centrally acting sympatholitic drugs, and â-blockers have a greater impact on sexual function than other classes, such as calcium antagonists and angiotensin converting enzyme inhibitors. Present evidence on the effects of angiotensin II antagonists is limited, but some data suggest that sexual function in men receiving these drugs not only is not altered, but even improves. Since sexual function is an important aspect of quality of life for the individual, it is important in treating hypertension to ensure that the drugs used have the lowest possible potential for causing sexual problems. This ensures the best balance between therapeutic efficacy and quality of life, which is essential for compliance.