Skip to main content

Thank you for visiting You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

Relation between hypertension and erectile dysfunction: a meta-analysisof cross-section studies


Erectile dysfunction (ED) is a wide spread and troublesome problem in aging men. Many analyses of hypertensive patients suggest that the prevalence of ED in hypertensive populations is even higher. The purpose of this meta-analysis was to evaluate the relation between hypertension and ED. A literature review was performed to identify all cross-section studies about hypertension and erectile dysfunction. Sources included MEDLINE and EMBASE from 1966 to 2015. The reference lists of the retrieved studies were also investigated, and a meta-analysis were conducted. Eighteen cross-section studies involving a total of 41,943 participants and 10,151 cases of ED were used in this analysis. We found that risk of ED was increased with hypertension (summary OR = 1.84, 95% CI: 1.58–2.14, p < 0.000001). Adjusting for obesity, unfavorable lipid levels, alcohol abuse, physical activity, cigarette smoking, educational level and other lifestyle factors, hypertension was also associated with increased risk of ED (summary OR = 1.58, 95% CI: 1.35–1.86, p < 0.00001). The results of this meta-analysis support that hypertension is associated with an increased risk of ED. Further high-quality prospective studies are needed to confirm this observation.

Access options

Rent or Buy article

Get time limited or full article access on ReadCube.


All prices are NET prices.

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6


  1. 1.

    Lue TF, Giuliano F, Montorsi F, Rosen RC. Summary of the recommendations on sexual dysfunctions in men. J Sex Med. 2004;1:6–23.

    Article  Google Scholar 

  2. 2.

    Utiger RD. A pill for impotence (editorial). N Engl J Med. 1998;338:1458–9.

    CAS  Article  Google Scholar 

  3. 3.

    Koskimäki J, Hakama M, Huhtala H, Tammela TL. Effect of erectile dysfunction on frequency of intercourse: a population-based prevalence study in Finland. J Urol. 2000;164:367–70.

    Article  Google Scholar 

  4. 4.

    Boolell M, Gepi-Attee S, Gingell JC, Allen MJ. Sildenafil, a novel effective oral therapy for male erectile dysfunction. Br J Urol. 1996;78:257–61.

    CAS  Article  Google Scholar 

  5. 5.

    Barrett-Connor E. Heart disease risk factors predict erectile dysfunction 25 years later (the Rancho Bernardo Study). Am J Cardiol. 2005;96:3–7.

    Article  Google Scholar 

  6. 6.

    Nunes KP, Labazi H, Webb RC. New insights into hypertension-associated erectile dysfunction. Curr Opin Nephrol Hypertens. 2012;21:163–70.

    Article  Google Scholar 

  7. 7.

    Moreira ED Jr, Abdo CH, Torres EB, Lôbo CF, Fittipaldi JA. Prevalence and correlates of erectile dysfunction: results of the Brazilian study of sexual behavior. Urology. 2001;58:583–8.

    Article  Google Scholar 

  8. 8.

    Moreira ED Jr, Lbo CF, Diament A, Nicolosi A, Glasser DB. Incidence of erectile dysfunction in men 40 to 69 years old: results from a population-based cohort study in Brazil. Urology. 2003;61:431–6.

    Article  Google Scholar 

  9. 9.

    Naya Y, Mizutani Y, Ochiai A, Soh J, Kawauchi A, Fujito A, et al. Preliminary report of association of chronic diseases and erectile dysfunction in middle-aged men in Japan. Urology. 2003;62:532–6.

    Article  Google Scholar 

  10. 10.

    Bal K, Oder M, Sahin AS, Karataş CT, Demir O, Can E, et al. Prevalence of metabolic syndrome and its association with erectile dysfunction among urologic patients: metabolic backgrounds of erectile dysfunction. Urology. 2007;69:356–60.

    Article  Google Scholar 

  11. 11.

    Mirone V, Ricci E, Gentile V, Basile Fasolo C, Parazzini F. Determinants of erectile dysfunction risk in a large series of Italian men attending andrology clinics. Eur Urol. 2004;45:87–91.

    CAS  Article  Google Scholar 

  12. 12.

    Ponholzera A, Temmlb C, Mocka K, Marszalek M, Obermayr R, Madersbacher S. Prevalence and risk factors for erectile dysfunction in 2869 men using a validated questionnaire. Eur Urol. 2005;47:80–6.

    Article  Google Scholar 

  13. 13.

    Skeldon SC, Detsky AS, Goldenberg SL, Law MR. Erectile dysfunction and undiagnosed diabetes, hypertension, and hypercholesterolemia. Ann Fam Med. 2015;13:331–5.

    Article  Google Scholar 

  14. 14.

    Moreira ED Jr, Bestane WJ, Bartolo EB, Fittipaldi JA. Prevalence and determinants of erectile dysfunction in Santos, southeastern Brazil. Sao Paulo Med J. 2002;120:49–54.

    Article  Google Scholar 

  15. 15.

    Fafiolu AS, Adebayo AM, Akande TO, Akinboboye OO. Erectile dysfunction among male hypertensives in a tertiary health facility in South-West Nigeria. Glob J Health Sci. 2014;7:154–60.

    Article  Google Scholar 

  16. 16.

    Morillo LE, Díaz J, Estevez E, Costa A, Méndez H, Dávila H, et al. Prevalence of erectile dysfunction in Colombia, Ecuador, and Venezuela: a population-based study (DENSA). Int J Impot Res. 2002;14:10–8.

    Article  Google Scholar 

  17. 17.

    Safarinejad MR. Prevalence and risk factors for erectile dysfunction in a population-based study in Iran. Int J Impot Res. 2003;15:246–52.

    CAS  Article  Google Scholar 

  18. 18.

    Chao JK, Ma MC, Lin YC, Chiang HS, Hwang TI. Study on alcohol dependence and factors related to erectile dysfunction among aborigines in Taiwan. Am J Mens Health. 2015;9:247–56.

    Article  Google Scholar 

  19. 19.

    Ahn TY, Park JK, Lee SW, Hong JH, Park NC, Kim JJ, et al. Prevalence and risk factors for erectile dysfunction in Korean men: results of an epidemiological study. J Sex Med. 2007;4:1269–76.

    Article  Google Scholar 

  20. 20.

    Elbendary MA, El-Gamal OM, Salem KA. Analysis of risk factors for organic erectile dysfunction in Egyptian patients under the age of 40 years. J Androl. 2009;30:520–4.

    Article  Google Scholar 

  21. 21.

    Kimura M, Shimura S, Tai T, Kobayashi H, Baba S, Kano M, et al. A web-based survey of erection hardness score and its relationship to aging, sexual behavior, confidence, and risk factors in Japan. Sex Med. 2013;1:76–86.

    Article  Google Scholar 

  22. 22.

    Al Naimi A, Majzoub AA, Talib RA, Canguven O, Al Ansari A. Erectile dysfunction in qatar: prevalence and risk factors in 1,052 participants-a pilot study. Sex Med. 2014;2:91–5.

    Article  Google Scholar 

  23. 23.

    Parazzini F, Menchini Fabris F, Bortolotti A, Calabrò A, Chatenoud L, Colli E, et al. Frequency and determinants of erectile dysfunction in Italy. Eur Urol. 2000;37:43–9.

    CAS  Article  Google Scholar 

  24. 24.

    Adebusoye LA, Olapade-Olaopa OE, Ladipo MM, Owoaje ET. Prevalence and correlates of erectile dysfunction among primary care clinic attendees in Nigeria. Glob J Health Sci. 2012;4:107–17.

    Article  Google Scholar 

  25. 25.

    Seftel AD, Sun P, Swindle R. The prevalence of hypertension, hyperlipidemia, diabetes mellitus, and depression in men with erectile dysfunction. J Urol. 2004;171:2341–5.

    Article  Google Scholar 

  26. 26.

    Clavijo RI, Miner MM, Rajfer J. Erectile dysfunction and essential hypertension: the same aging-related disorder? Rev Urol. 2014;16:167–71.

    PubMed  PubMed Central  Google Scholar 

  27. 27.

    Johnson RJ, Feig DI, Nakagawa T, Sanchez-Lozada LG, Rodriguez-Iturbe B. Pathogenesis of essential hypertension: historical paradigms and modern insights. J Hypertens. 2008;26:381–91.

    CAS  Article  Google Scholar 

  28. 28.

    Behr-Roussel D, Gorny D, Mevel K, Compagnie S, Kern P, Sivan V, et al. Erectile dysfunction: an early marker for hypertension? A longitudinal study in spontaneously hypertensive rats. Am J Physiol Regul Integr Comp Physiol. 2005;288:276–83.

    Article  Google Scholar 

  29. 29.

    Jiang R, Chen JH, Jin J, Shen W, Li QM. Ultrastructural comparison of penile cavernous tissue between hypertensive and normotensive rats. Int J Impot Res. 2005;17:417–23.

    CAS  Article  Google Scholar 

  30. 30.

    Burnett AL, Lowenstein CJ, Bredt DS, Chang TS, Snyder SH. Nitric oxide: a physiologic mediator of penile erection. Science. 1992;257:401–3.

    CAS  Article  Google Scholar 

  31. 31.

    Miner M, Seftel AD, Nehra A, Ganz P, Kloner RA, Montorsi P, et al. Prognostic utility of erectile dysfunction for cardiovascular disease in younger men and those with diabetes. Am Heart J. 2012;164:21–8.

    Article  Google Scholar 

  32. 32.

    Hurt KJ, Sezen SF, Lagoda GF, Musicki B, Rameau GA, Snyder SH, et al. Cyclic AMP dependent phosphorylation of neuronal nitric oxide synthase mediates penile erection. Proc Natl Acad Sci USA. 2012;109:16624–9.

    CAS  Article  Google Scholar 

  33. 33.

    Kloner RA. Pharmacology and drug interaction effects of the phosphodiesterase 5 inhibitors: focus on a-blocker interactions. Am J Cardiol. 2005;96:42–6.

    Article  Google Scholar 

  34. 34.

    Grimm RH Jr, Grandits GA, Prineas RJ, McDonald RH, Lewis CE, Flack JM, et al. Long-term effects on sexual function of five antihypertensive drugs and nutritional hygienic treatment in hypertensive men and women. Treatment of Mild Hypertension Study (TOMHS). Hypertension. 1997;29:8–14.

    CAS  Article  Google Scholar 

  35. 35.

    Fogari R, Zoppi A, Poletti L, Marasi G, Mugellini A, Corradi L. Sexual activity in hypertensive men treated with valsartan or carvedilol: a crossover study. Am J Hypertens. 2001;14:27–31.

    CAS  Article  Google Scholar 

  36. 36.

    Bansal S. Sexual dysfunction in hypertensive men: a critical review of the literature. Hypertension. 1988;12:1–10.

    CAS  Article  Google Scholar 

Download references

Author information



Corresponding author

Correspondence to Yong Zhang.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Wang, Xy., Huang, W. & Zhang, Y. Relation between hypertension and erectile dysfunction: a meta-analysisof cross-section studies. Int J Impot Res 30, 141–146 (2018).

Download citation


Quick links