Hypertension mediated organ damage in relation to the severity of erectile dysfunction, the endogenous androgen levels and central vascular stiffness in middle aged men with essential hypertension

Background Hypertension mediated organ damage (HMOD) relates to cardiovascular events. Erectile dysfunction (ED) frequently accompanies the middle aged male population when the endogenous androgen levels typically fall. Purpose To investigate the relation of the severity of ED and the extent of HMOD in middle aged men with essential hypertension independently of the endogenous testosterone levels. Methods 320 hypertensive ED males (mean age: 58 yo) with no history of diabetes mellitus or overt cardiovascular disease enrolled the study. All underwent a 2D echocardiography to estimate the left ventricular mass index (LVMI) by the Devereux formula. Moreover a non-invasive evaluation of the carotid – femoral pulse wave velocity (PWV), estimation of central pulse pressure (cPP) and augmentation index (AIx) a parameter of wave reflection amplification were performed (Sphygmocor device) .They were also screened for the presence of urinary albumin loss (UMALb: 30 – 300 mg /24 h urine volume collection). Finally the intima – media thickness (IMT) of the common carotid artery was estimated by Doppler ultrasound. ED severity was assessed by the SHIM-5 score (range: 0-25) and higher values indicate a better erectile ability. Total testosterone (TT) was measured in morning blood samples taken before 09:00 am. Results The SHIM-5 score was negatively related to the LVMI, IMT, PWV, AIx and UMALb (all P< 0,05) and positively to the TT ( P: 0,04). Moreover SHIM-5 was negatively associated to age and BMI (p<0,05) and there were no connection to cPP. On the contrary LVMI, IMT, PWV, AIx and UMALb were positively related to cPP and negatively to TT (all P<0,05). According to the mean SHIM-5 value (12) we divided our population into high and low SHIM-5 score groups. There was an inverse significant connection between the SHIM-5 score and the LVMI, IMT, PWV, AIx and UMALb. Statistics remained significant after correction for age, BMI and TT levels. Conclusion In middle aged men with essential hypertension, severity of ED correlates with an extensive HMOD independently of cPP and TT levels. Estimating a clinical parameter such as ED with a simple questionnaire may alert the physician and guide further diagnostic algorithms screening for HMOD in this hypertension population group.