Tadalafil在男性性功能障礙治療中引發高血壓併發症之文獻回顧

林大鈞¹、蘇文彬²、陳曉芳¹、蕭亞芝¹、鄭如惠³、蔡蔓綺⁴、黃品叡⁵

1李綜合醫療社團法人大甲李綜合醫院 醫療部 專科護理師小組

2李綜合醫療社團法人苑裡李綜合醫院 醫療部 專科護理師小組

3李綜合醫療社團法人苑裡李綜合醫院 護理部

4疾病管制署中區管制中心 檢疫科

5李綜合醫療社團法人大甲李綜合醫院 外科部 泌尿外科

Tadalafil-Associated Hypertension in the Management of Male Sexual Dysfunction: A literature review

Ta-Chun Lin¹, Wen-Pin Su ², Hsiao-Fang Chen¹, Ya-Chih Hsiao¹, Ru-Hui Cheng³, Man-Chi Tsai⁴,
Pin-Jui Huang⁵

1Division of Nursing Participants, Department of Medical Affairs, Dajia Lee Hospital

2Division of Nursing Participants, Department of Medical Affairs, Yuanli Lee Hospital

3Nursing Department, Yuanli Lee Hospital

4Quarantine Department, Central Regional Center, Centers for Disease Control, Ministry of Health and Welfare

5Division of Urology, Department of Surgery, Dajia Lee Hospital

Background:
Tadalafil, a long-acting phosphodiesterase type 5 (PDE5) inhibitor, is widely used for treating erectile dysfunction (ED), lower urinary tract symptoms (LUTS), and benign prostatic hyperplasia (BPH). Although PDE5 inhibitors are generally considered blood-pressure-lowering agents due to enhanced nitric oxide–mediated vasodilation, recent real-world reports and pharmacovigilance data have indicated that tadalafil may paradoxically induce elevated blood pressure in a subset of patients. This review summarizes current evidence regarding tadalafil-associated hypertension, explores potential mechanisms, and proposes clinical management strategies.

Methods:
A narrative literature review was conducted using PubMed, Embase, and Cochrane Library from inception to 2025. Keywords included “tadalafil,” “hypertension,” “blood pressure,” “PDE5 inhibitor adverse events,” and “erectile dysfunction therapy safety.” Clinical trials, observational studies, pharmacovigilance analyses, and case reports were included. Articles without direct blood-pressure outcomes were excluded.

Results:
Across major clinical trials, tadalafil demonstrates a neutral to mildly hypotensive effect when used in healthy individuals or men with ED and BPH. However, several post-marketing surveillance studies and isolated case reports describe new-onset or worsened hypertension temporally related to tadalafil use, particularly in patients with underlying cardiovascular risk factors or concomitant sympathomimetic medications. Proposed mechanisms include sympathetic overactivation, drug-drug interactions affecting CYP3A4 metabolism, endothelial dysfunction in patients with pre-existing vascular disease, and individual pharmacogenomic variability. Reported cases demonstrate systolic blood-pressure elevation ranging from 10–30 mmHg, typically occurring within hours to days of dosing. Symptoms include headache, flushing, palpitations, and occasionally hypertensive urgency. Discontinuation of tadalafil generally leads to blood-pressure normalization.

Conclusion:
Although tadalafil remains a safe and effective therapy for male sexual dysfunction, clinicians should remain aware of possible paradoxical hypertension, especially in high-risk patients. Baseline cardiovascular assessment and routine blood-pressure monitoring are recommended in elderly men, those with uncontrolled hypertension, and patients receiving interacting medications. If hypertension develops, clinicians should consider dose reduction, temporary discontinuation, switching to alternative PDE5 inhibitors, or initiating appropriate antihypertensive therapy. Further prospective studies are needed to clarify pathophysiology, identify predictive factors, and optimize management strategies.