We appreciate thoughtful and insightful comments of Doumas et al.
The population in the Look AHEAD (Action for Health in Diabetes) trial1 consisted of older, obese men with type 2 diabetes mellitus. In this specific population, a combination of angiotensin-converting enzyme inhibitors, diuretics, and β-blockers is often required to achieve optimal blood pressure control. Although, a third-generation β-blocker such as nebivolol hydrochloride2 is also available, which improves sexual function with an endothelial nitric oxide–generating property. However, a paucity of data on safety and efficacy of nebivolol in combination with other antihypertensive medications limits its use in the elderly diabetic population. Investigators in the Look AHEAD trial analyzed the phosphodiesterase 5 inhibitor user status and demonstrated no significant effects on erectile dysfunction. We also reported that the lifestyle intervention improved erectile dysfunction not responding to phosphodiesterase 5 inhibitors.3