Hypertension a risk factor for erectile dysfunction?
Hypertensive men appear to be at greater risk of erectile dysfunction (ED) compared with their normotensive counterparts, as shown in a meta-analysis.
“The penis can be considered as a specialized vascular organ and an extension of the vascular system. They are similar to each other both embryologically and physiologically. Therefore, it follows that any disorder that affects the vascular system should also affect the penis and vice versa,” the investigators said.
Pooled data from 18 cross-sectional studies involving 41,943 participants and 10,151 ED patients revealed that hypertension is associated with 84-percent higher odds of ED compared with normal blood pressure (odds ratio [OR], 1.84; 95 percent CI, 1.58–2.14; p<0.000001). [Int J Impot Res 2018;30:141-146]
The association persisted in an analysis controlled for obesity, unfavourable lipid levels, alcohol abuse, physical activity, cigarette smoking, educational level and other lifestyle factors (OR, 1.58; 1.35–1.86; p<0.00001).
There are several potential explanations for why hypertension is a risk factor for ED. According to the investigators, hypertensive patients should also demonstrate the same arteriosclerosis within their penile cavernosal bodies, leading to high vascular resistance and insufficient arterial inflow.
“Another contributing factor may be antihypertensive medicines themselves. Thiazide diuretics and beta blockers are known to worsen ED. The mechanisms have been postulated to be secondary to electrolyte disturbance, volume depletion, inadequate tissue perfusion or damage to smooth muscle cells,” they continued.
Supposing that diuretics are indeed associated with ED, it is said that patients should demonstrate improvement after weeks of discontinuing thiazide. On the other hand, calcium channel blockers and angiotensin converting enzyme inhibitors do not worsen ED compared with placebo.
Despite the presence of limitations, the current meta-analysis points to a possible role for hypertension as an early warning sign for ED, the investigators said. “So it’s a lesson to be learned that hypertension should be more vigorously treated in ageing men with or without ED, in case of ED onset or worsening.”
“On the one hand, for hypertensive patients with ED, it’s a better choice to use the calcium channel blockers, angiotensin converting enzyme inhibitors and angiotensin receptor blockers. On the other hand, for patients with ED who do not have hypertension, it’s necessary to monitor their blood pressure, for early diagnosis and treatment,” they added.