(159) Characteristics and Hypertension Management Trends in Hypertensive Men With and Without Erectile Dysfunction
Authors: Asafu-Adjei D , Mattix-Kramer H , Joyce C , Patel M , Markossian T 
Published: February 2024

Abstract

Introduction
Hypertension, defined as a blood pressure (BP) ≥ 130/80 mmHg and/or use of BP lowering medications, affects 47% of the U.S. population and is the most important modifiable risk factor for cardiovascular disease (CVD) prevention. Prevalence of BP control appears to be decreasing in the U.S. and currently only 1 in 4 adults with hypertension have controlled BP. Erectile dysfunction (ED), an early marker of subclinical CVD, often accompanies hypertension. Most BP lowering medications have been shown to not affect sexual function, but the drug class of angiotensin receptor blockers (ARBs) have generally been found to have favorable effects on erectile function through their inhibition of angiotensin II. Therefore, exploring the relationship between hypertension management and ED is advantageous for the ultimate control and treatment of these two common and highly prevalent diseases.

Objective
Assess the demographics of hypertensive men with and without ED and examine associations of ED with hypertension management and BP control outcomes

Methods
All men presenting for an initial visit for hypertension (ICD-10 codes I10, I11.0, and I11.9) between January 2017-December 2022 at an academic medical center were included for analysis. The electronic health record was queried for patient demographics, the diagnosis of ED, cardiovascular comorbidities, major drug classes of antihypertensives, and major PDE5-inhibitors. Descriptive statistics was used to describe patient characteristics by ED status. Chi-squared, t-test, and Mann-Whitney U tests was used to compare characteristics of patients by presence of ED.

Results
Of 24,723 hypertensive men in our health system during the study period, only 1,119 men (4.5%) were noted to have ED (Table 1). Hypertensive men with ED were younger (56 ± 11), than those without ED (61±15). There was no statistically significant difference in the use of ARBs amongst hypertensive men with and without ED. Initial systolic and diastolic BP was significantly higher amongst men with ED. After pooling all outpatient clinic visits prior to and after the diagnosis of ED, BP control did improve mildly over the study period, but this was coupled with a decrease in BP medication use across all drug classes. Finally, there was a significant increase in hypertensive males who were on a either sildenafil or tadalafil after their ED diagnosis (Table 2).

Conclusions
This study elucidates several key points in conceptualizing the ED and hypertension problem and lays a foundation for the next phase in addressing critical gaps in care. This research further validates the underdiagnoses and thus undertreatment of ED overall, with a significantly lower than expected number of men with ED. Despite the well-established benefits of ARBs in hypertensive men with ED, we observed a trend of underutilization of this beneficial BP medication option. Improvements in BP control over time for hypertensive men with ED emphasize the role ED could play in hypertension management. Leveraging ARBs and education on the interplay of ED and hypertension could lead to improved rates and control of both diseases.

Disclosure
Any of the authors act as a consultant, employee or shareholder of an industry for: Endo Pharmaceuticals, ForHims.