Discussion
In this study, the focus was on understanding the prevalence of ED among hypertensive patients and exploring the relationship between ED and the patients’ personal characteristics. ED is a prevalent health issue that significantly impacts a man’s mental health, relationships, and overall well-being, thereby affecting quality of life ( Mitidieri et al., 2020 ). Therefore, addressing various factors impacting the general health of men with ED is crucial.

Given that erectile physiology is largely influenced by vascular changes, cardiovascular risk factors like hypertension can hasten the onset of ED. Studies have indicated that the prevalence of ED in hypertensive patients increases with age ( Ferrini, Gonzalez-Cadavid & Rajfer, 2017 ; Irfan et al., 2020 ). For instance, Pellegrino et al. (2023) reported that the likelihood of ED in individuals aged 50 to 75 years was between 20% and 68% in healthy men and between 41% and 85% in those with hypertension, obesity, and diabetes. Similarly, Boombhi et al. (2019) highlighted the influence of the duration of hypertension on ED. Consistent with existing literature, age and the duration of hypertension were found to be significant factors affecting ED in this study. As individuals age, their cardiovascular health may deteriorate, leading to the development of chronic diseases and associated complications.

Smoking poses serious risks to all organ systems, with approximately one-third of men worldwide being active smokers ( World Health Organization, 2018 ). Lifestyle habits such as smoking, alcohol consumption, and substance use have been identified as risk factors for ED ( Mazzilli, 2022 ; Sivaratnam et al., 2021 ). Numerous studies have underscored the detrimental effects of smoking on erectile function ( Allen & Tostes, 2023 ; Corona et al., 2020 ). Similarly, in this study, smoking was found to have a significant impact on ED. Cigarette smoke contains nicotine, carbon monoxide, oxidant chemicals and metals that can damage the endothelium and impair erection processes ( Allen & Tostes, 2023 ). Therefore, smoking is an important risk factor for ED and cardiovascular diseases as it causes endothelial dysfunction, oxidative stress and inflammation ( Carella et al., 2023 ). Smoking can lead to vasoconstriction and reduced blood flow, impairing the ability to achieve or sustain an erection. Additionally, smoking can contribute to the buildup of plaque on vessel walls, leading to arteriosclerosis. This, in turn, can affect penile blood flow and result in erection difficulties. Furthermore, smoking can disrupt the nervous system and hormonal balance, further exacerbating erectile dysfunction. The chemicals present in cigarettes are believed to affect the nervous system and hormones, thereby diminishing sexual performance.

The results of this study revealed that the prevalence of ED increased as the educational level of the individuals decreased. Additionally, the analysis showed that the mean age increased as the educational level decreased, with literate individuals having a higher mean age compared to university graduates (mean age 71.33 ± 12.30 for literate individuals and 58.25 ± 4.33 for university graduates). Moreover, it was observed that the prevalence of ED increased as the mean age increased. Although educational level does not directly influence the frequency of ED, it is believed to have an indirect impact.

β -blockers represent one of the primary classes of antihypertensive drugs recommended for hypertension treatment ( Williams et al., 2018 ). In studies investigating the effects of β -blockers on ED, negative effects of this drug class have been reported ( Hernández-Cerda et al., 2020 ; Manolis et al., 2020 ; Terentes-Printzios et al., 2022 ). Consistently, in this study, higher levels of ED were observed in patients using β -blockers. This finding is consistent with existing literature on the subject.