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.
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Lue TF, Giuliano F, Montorsi F, Rosen RC. Summary of the recommendations on sexual dysfunctions in men. J Sex Med. 2004;1:6–23.
Utiger RD. A pill for impotence (editorial). N Engl J Med. 1998;338:1458–9.
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.
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.
Barrett-Connor E. Heart disease risk factors predict erectile dysfunction 25 years later (the Rancho Bernardo Study). Am J Cardiol. 2005;96:3–7.
Nunes KP, Labazi H, Webb RC. New insights into hypertension-associated erectile dysfunction. Curr Opin Nephrol Hypertens. 2012;21:163–70.
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.
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.
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.
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.
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.
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.
Skeldon SC, Detsky AS, Goldenberg SL, Law MR. Erectile dysfunction and undiagnosed diabetes, hypertension, and hypercholesterolemia. Ann Fam Med. 2015;13:331–5.
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.
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.
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.
Safarinejad MR. Prevalence and risk factors for erectile dysfunction in a population-based study in Iran. Int J Impot Res. 2003;15:246–52.
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.
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.
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.
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.
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.
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.
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.
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.
Clavijo RI, Miner MM, Rajfer J. Erectile dysfunction and essential hypertension: the same aging-related disorder? Rev Urol. 2014;16:167–71.
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.
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.
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.
Burnett AL, Lowenstein CJ, Bredt DS, Chang TS, Snyder SH. Nitric oxide: a physiologic mediator of penile erection. Science. 1992;257:401–3.
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.
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.
Kloner RA. Pharmacology and drug interaction effects of the phosphodiesterase 5 inhibitors: focus on a-blocker interactions. Am J Cardiol. 2005;96:42–6.
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.
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.
Bansal S. Sexual dysfunction in hypertensive men: a critical review of the literature. Hypertension. 1988;12:1–10.
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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). https://doi.org/10.1038/s41443-018-0020-z