Study (authors – year)
Age of participants (years)
Odds ratio for erectile dysfunction in hypertensives
Derby et al. 2000 [7]
40–70
1.80a
Braun et al. 2000 [8]
30–80
1.58a
Martin-Morales et al. 2001 [9]
25–70
1.58
Marumo et al. 2001 [10]
40–79
2.79
Nicolosi et al. 2003 [11]
40–70
1.45a
Mirone et al. 2004 [12]
17–98
1.30
Ponholzer et al. 2005 [13]
20–80
2.05
Saigal et al. 2006 [14]
≥20
1.56
Laumann et al. 2007 [15]
≥40
1.60
Selvin et al. 2007 [16]
≥20
2.22a
Specifically, Derby et al. [7] reevaluating the results of the Massachusetts Male Aging Study (MMAS) found an 80 % greater risk for erectile dysfunction in hypertensive individuals aged 40–70 years (age-adjusted odds ratio 1.80). In the Cologne Male Survey which was performed by Braun et al. [8] in 4,489 men, 30–80 years of age in the Cologne urban district, an age-adjusted odds ratio 1.58 (95 % confidence intervals 1.29–1.93) was found for erectile dysfunction in the subgroup of hypertensives. Martin-Morales et al. [9] conducted a large cross-sectional study in 2,476 individuals in Spain including 850 hypertensives. The International Index of Erectile Function (IIEF) questionnaire was used for the assessment of erectile dysfunction. The study included both younger and older patients (age range 25–70 years) with a mean ± SD age of 48 ± 12 years. It has to be noted, however, that the majority of study participants was of older age (50–70 years: 68 %). Hypertension was associated with a 58 % increased risk for erectile dysfunction (odds ratio 1.58). Marumo et al. [10] evaluated the significance of several risk factors for erectile dysfunction in 1,014 men aged 40–79 years, according to a univariate logistic regression analysis and found a 48 % prevalence of erectile dysfunction and a 2.79 odds ratio (95 % confidence intervals 2.05–3.80) for erectile dysfunction in the 223 hypertensives included in the study.
Nicolosi et al. [11] assessed the epidemiology of erectile dysfunction in community-based populations in four countries (Brazil, Italy, Japan, and Malaysia). It was a cross-national study performed in a random sample of approximately 600 men in each country aged 40–70 years. An age- and country-adjusted odds ratio for erectile dysfunction 1.45 (95 % confidence intervals 1.15–1.84) was found in the group of 540 hypertensives included in the study. Mirone et al. [12] sought to assess determinants of erectile dysfunction in men aged 17–98 years who asked for a free of charge andrologic consultation during a week focused on andrologic prevention in Italy. They found an increased risk of ED (odds ratio 1.30, 95 % confidence intervals 1.10–1.40) in men with hypertension. Ponholzer et al. [13] assessed the prevalence and risk factors for erectile dysfunction in 2,869 men aged 20–80 years participating in a health-screening project in the area of Vienna. Participants completed the IIEF questionnaire for the evaluation of erectile dysfunction. Risk factors for erectile dysfunction included hypertension with an odds ratio 2.05 (95 % confidence intervals 1.61–2.60). Saigal et al. [14] analyzed data from the 2001–2002 National Health and Nutrition Examination Survey (NHANES) to evaluate predictors and prevalence of erectile dysfunction in a racially diverse population (3,566 men, 20 years and older). They found several modifiable risk factors that were independently associated with erectile dysfunction, including hypertension (odds ratio 1.56). Laumann et al. [15] conducted in the United States the Male Attitudes Regarding Sexual Health (MARSH) study, a cross-sectional, nationally representative probability survey of 1,955 men aged 40 years or older that oversampled blacks and Hispanics. They aimed to estimate, by race/ethnicity, the prevalence of erectile dysfunction and the impact of sociodemographic, health, relationship, psychological, and lifestyle variables. An odds ratio for erectile dysfunction 1.60 (95 % confidence intervals 1.00–2.40) was found in the subgroup of patients with hypertension. Selvin et al. [16] also performed a cross-sectional analysis of data from 2,126 adult male participants in the 2001–2002 National Health and Nutrition Examination Survey (NHANES) to assess the prevalence of erectile dysfunction and to quantify associations between putative risk factors and erectile dysfunction in the US adult male population (20 years and older). Slightly less than half of individuals with treated hypertension (44.1 %) were affected by erectile dysfunction (age-adjusted odds ratio 2.22, 95 % confidence intervals 1.30–3.80).
2.3 Prevalence of Erectile Dysfunction in Hypertensive Patients
The prevalence of erectile dysfunction in patients with essential hypertension, either treated or untreated, has been evaluated in studies dedicated to that purpose and was compared to the prevalence of erectile dysfunction in normotensive individuals in some of these studies [17–23]. According to these studies, some degree of erectile dysfunction is present with a prevalence that ranges from 17 to 79 % in untreated hypertensives, from 25 to 72 % in patients under blood pressure-lowering treatment while from 7 to 24 % in normotensive subjects (Table 2.2).
Study (authors – year) | Prevalence of erectile dysfunction (%) | ||
|---|---|---|---|
Treated hypertensives | Untreated hypertensives | Normotensives | |
Bulpitt et al. 1976 [17] | 25 | 17 | 7 |
Croog et al. 1988 [18] | 58 | 44 | – |
Düsing 2003 [19] | 45 | 65 | – |
Doumas et al. 2006 [20] | 40 | 20 | 14 |
Bener et al. 2007 [21] | 72 | 65 | 24 |
Baumhäkel et al. 2008 [22] | 64 | 79 | – |
Cordero et al. 2010 [23] | 71 | – | – |
Specifically, Bulpitt et al. [17] described a study of 302 patients in which erectile dysfunction was observed in 7 % of normotensive men, 17 % of men with untreated hypertension, and 25 % of men with treated hypertension. The effects of antihypertensive medications on reported distress over sexual symptoms over a 24-week treatment period were examined by Croog et al. [18] as part of a multicenter, randomized, double-blind clinical trial in which 626 men with mild to moderate hypertension participated. On entry into the clinical trial, 58 % of patients taking antihypertensive medications and 44 % of men not receiving antihypertensive drugs reported some degree of erectile dysfunction. Düsing [19] designed an open, prospective study to investigate the effect of the angiotensin II receptor blocker valsartan on sexual function in hypertensive males. The patients’ sexual function was assessed before valsartan and after 6 months of treatment using the IIEF questionnaire. At baseline, 65.0 % of the 952 patients without previous antihypertensive treatment could be diagnosed as having erectile dysfunction, according to the IIEF. Valsartan therapy markedly reduced the prevalence of erectile dysfunction to 45 %. In a sample of 634 Greek young and middle-aged men (31–65 years), erectile dysfunction was at least twice as common in treated hypertensives compared to untreated hypertensives and normotensives (40 % versus 20 % and 14 %, respectively), as reported by Doumas et al. [20].
A matched case-control study was conducted by Bener et al. [21] at primary health-care clinics with 296 Qatari hypertensive participants and 298 normotensive men aged 30–75 years. The mean ± SD age was 54.8 ± 11.5 years for hypertensives as compared to 54.5 ± 12.1 years for non-hypertensives. Sexual function was evaluated with the IIEF questionnaire. Among the 298 non-hypertensive participants, only 71 had erectile dysfunction (24 %), while of the 296 hypertensive patients, 196 participants reported erectile dysfunction (66 %). Moreover, among the 53 treated hypertensives, 38 were found with erectile dysfunction (72 %), while of the remaining 243 untreated hypertensives, 158 reported an erectile dysfunction (65 %). Of the 296 hypertensive participants studied, 25 % had severe, 29 % had moderate, and 12 % had mild erectile dysfunction. Frequency and severity of erectile dysfunction increased with advancing age. Baumhäkel et al. [22] aimed to determine the influence of irbesartan on erectile dysfunction in a total of 1,069 consecutive hypertensive patients with a metabolic syndrome recruited from the documentation of hypertension and metabolic syndrome in patients with irbesartan treatment (DO-IT) survey. Erectile dysfunction was assessed using the IIEF questionnaire. Erectile function increased significantly after 6 months of treatment with irbesartan, irrespective of dosage and independent of additional treatment with hydrochlorothiazide. Prevalence of erectile dysfunction declined to 64 % from 79 % at baseline. Cordero et al. [23] designed a cross-sectional and observational study in 1,007 high-risk hypertensive male subjects treated with any beta-blockade agent for at least 6 months (mean ± SD age of participants 57.9 ± 10.6 years). Erectile dysfunction was assessed by the IIEF questionnaire. The prevalence of any category of erectile dysfunction was 71 % (38.1 % mild, 16.8 % moderate, and 16.1 % severe erectile dysfunction, respectively). Patients with erectile dysfunction had longer time since the diagnosis of hypertension and higher prevalence of risk factors and comorbidities. The prevalence of ED increased linearly with age. ED patients received more medications and were more frequently treated with carvedilol and less frequently with nebivolol.
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