Sexual dysfunction represents several domains in desire or interest, as well as physical limitations such as erectile dysfunction. In addition, beta blockers, mineralocorticoid receptor antagonists, and other antihypertensive drugs can have negative effects on libido and erectile function. There are emerging data on the association between erectile dys- function and CVD compared with other domains of sexual dysfunction. Experimental and clinical studies describe a role for angiotensin II, endothelin, and hydrogen sulfide on cavernous tissue function.S11.4-1 Many of the signaling path- ways for the increased production of oxidative stress and the subsequent deleterious effects of oxidative stress on vascular tissue have been described. Accordingly, it is rea- sonable to suggest that hypertension might lead to vascu- lar changes that cause erectile dysfunction but, conversely, erectile dysfunction may be part of the causal pathway to Although there is insufficient evidence to rec- ommend screening for CVD risk factors in all men with erectile dysfunction, it has been reported as a sole precur- sor for CVD in men.S11.4-2 S11.4-6 With the introduction of the phosphodiesterase-5 inhibi- tors, which can be coadministered with antihypertensive medications, there is now effective therapy for erectile dysfunction that has implications for systemic vascular These drugs have additive effects on lowering BP and are recommended as a primary therapy for pulmonary Although data are available to suggest that some antihypertensive medications affect erectile dysfunc- tion more than others, the use of phosphodiesterase-5 inhibi- tors make drug class distinctions for erectile dysfunction less The long-term safety and efficacy of chronic administration of phosphodiesterase-5 inhibitors for the mit- igation of CVD has yet to be determined and represents an important knowledge gap. 11.5. Patients Undergoing Surgical Procedures Recommendations for Treatment of Hypertension in Patients Undergoing Surgical Procedures References that support recommendations are summarized in Online Data Supplements 57 and 58. 