ERECTILE DYSFUNCTION IN HYPERTENSIVE SUBJECTS - ASSESSMENT OF POTENTIAL DETERMINANTS

Hypertension is often cited as a risk factor for erectile dysfunction. To clarify the relation between hypertension and erectile dysfunction , we evaluated 32 consecutive hypertensive and 78 normotensive impoten t men with respect to multiple potential determinants and parameters o f erectile function, including medical and sexual history, depression, hormonal profile, penile nocturnal tumescence, penile vascular supply , and pudendal nerve conduction. The hypertensive men were older, had higher body mass index, and used more medications than the normotensiv e men. The groups were not different with respect to the prevalence of smoking and peripheral vascular disease, but the hypertensive men had a marginally higher rate of ischemic heart disease (P = .06). The pre valence of depression, abnormal nocturnal penile tumescence, anomalous pudendal nerve conduction, and impairment in arterial supply as deter mined by penile brachial index were similar in the two groups. Testost erone and bioavailable testosterone levels were lower in the hypertens ive men. After stratification by age and body mass index, hypertensive men younger than 50 years with body mass index less than 30 kg/m(2) h ad significantly lower testosterone levels (12.0 +/- 1.7 versus 21.3 /- 1.4 nmol/L, P < .02) but not bioavailable testosterone levels (3.9 +/- 0.7 versus 6.4 +/- 0.7 nmol/L, P < .17) than the corresponding nor motensive group. Prolactin, follicle-stimulating hormone, and luteiniz ing hormone levels of the two groups were not significantly different. Contrary to common belief and with the exception of lower circulating testosterone levels, the overall analysis showed little difference be tween hypertensive and normotensive men with respect to a wide range o f classic determinants of erectile function. Direct study of the local vascular erectile apparatus appears necessary for further elucidation of the mechanisms underlying erectile dysfunction in hypertensive men .