Effect of sildenafil in patients with erectile dysfunction taking antihypertensive therapy. Sildenafil Study Group

Oral sildenafil is an effective treatment for erectile dysfunction (ED), which is a common complaint for patients with hypertension and those taking antihypertensive agents. This post hoc subanalysis assessed the efficacy and safety of sildenafil in men with ED who were receiving concomitant antihypertensive medication. Efficacy was assessed in 3414 men (1218 of whom were taking antihypertensive medication) who received sildenafil (5 to 200 mg) or placebo for 6 weeks to 6 months in 10 double-blind, placebo-controlled studies. The significant improvements in erectile function demonstrated by sildenafil-treated patients were comparable in patients taking and those not taking antihypertensive medication. Safety was assessed in 3975 men (1094 of whom were taking one or more antihypertensive agent, classified as a diuretic, beta-blocker, alpha1-blocker, angiotensin converting enzyme inhibitor, or calcium channel blocker), who received sildenafil or placebo in 18 double-blind, placebo-controlled studies. For patients taking sildenafil and antihypertensive medication, the incidence of treatment-related adverse events (34%) was similar to that for sildenafil-treated patients not taking any antihypertensive agent (38%). The incidences of the most common adverse events and of adverse events potentially related to blood pressure decreases (eg, hypotension, dizziness, and syncope) were similar in both sildenafil groups. The number of antihypertensive medications taken from among the five classes had no effect on the adverse event profile of sildenafil. Sildenafil is an effective and well-tolerated treatment for ED in patients taking concomitant antihypertensive medication, including those on multidrug regimens.     

高血压及抗高血压药物对勃起功能的影响与研究进展

高血压与抗高血压药物均与血管性勃起功能障碍的发病有密切关系,现就其相互影响及机制作一综述,并对高血压合并勃起功能障碍的防治对策作一简单介绍。     

The effect of antihypertensive drugs on erectile function: a proposed management algorithm

The pharmacologic management of hypertension has long been implicated in the genesis of erectile dysfunction; the latter is considered the main reason of nonadherence to antihypertensive therapy. Older-generation antihypertensive drugs (central-acting, beta blockers, diuretics) negatively affect erectile function, while newer-generation agents (calcium antagonists, angiotensin-converting enzyme inhibitors) seem to have neutral effects. Preliminary data with the latest drugs (angiotensin receptor blockers) point to a beneficial effect on erectile function. Phosphodiesterase-5 inhibitors, used for the treatment of erectile dysfunction, can be safely and effectively administered to hypertensive patients (even when on multiple-agent antihypertensive therapy), with a caution regarding alpha blockers. In the case when erectile dysfunction is considered to result from antihypertensive therapy, the treating physician may either add phosphodiesterase-5 inhibitors or substitute current treatment with angiotensin receptor blockers.     

Sexual dysfunction in patients with hypertension: implications for therapy

Sexual dysfunction associated with hypertension or antihypertensive therapies may impact the ability of patients to stay on therapy and lead to deterioration in patients' quality of life. Therefore, it is important for practitioners to become familiar with the wide variation in sexual side effects produced by antihypertensive agents and to discuss the potential occurrence of these side effects with their patients. In many cases, a change in the patient's drug regimen may help patients overcome specific sexual side effects experienced with certain treatments. Practitioners should consider selecting an antihypertensive therapy that is highly effective in lowering blood pressure but preserves patients quality of life. The effect of medications on sexual function remains controversial. Some blinded trials report little difference between placebo and specific medications, whereas other studies indicate that antihypertensive medications increase sexual dysfunction, which has an impact on quality of life. Recent evidence suggests that losartan, an angiotensin II antagonist, is not typically associated with development of sexual dysfunction and may actually positively impact several indices of sexual function (erectile function, sexual satisfaction, and frequency of sexual activity) as well as perceived quality of life. Thus, angiotensin II antagonists may offer a therapeutic option to prevent or correct erectile dysfunction in patients with hypertension. The favorable effects of these agents on sexual function may be related, in part, to their ability to block angiotensin II, which has recently become recognized as an important mediator of detumescence and possibly erectile dysfunction.     

Sexual Dysfunction in Patients With Hypertension: Implications for Therapy

Sexual dysfunction associated with hypertension or antihypertensive therapies may impact the ability of patients to stay on therapy and lead to deterioration in patients' quality of life. Therefore, it is important for practitioners to become familiar with the wide variation in sexual side effects produced by antihypertensive agents and to discuss the potential occurrence of these side effects with their patients. In many cases, a change in the patient's drug regimen may help patients overcome specific sexual side effects experienced with certain treatments. Practitioners should consider selecting an antihypertensive therapy that is highly effective in lowering blood pressure but preserves patients' quality of life. The effect of medications on sexual function remains controversial. Some blinded trials report little difference between placebo and specific medications, whereas other studies indicate that antihypertensive medications increase sexual dysfunction, which has an impact on quality of life. Recent evidence suggests that losartan, an angiotensin II antagonist, is not typically associated with development of sexual dysfunction and may actually positively impact several indices of sexual function (erectile function, sexual satisfaction, and frequency of sexual activity) as well as perceived quality of life. Thus, angiotensin II antagonists may offer a therapeutic option to prevent or correct erectile dysfunction in patients with hypertension. The favorable effects of these agents on sexual function may be related, in part, to their ability to block angiotensin II, which has recently become recognized as an important mediator of detumescence and possibly erectile dysfunction.     

Overcoming barriers: the role of providers in improving patient adherence to antihypertensive medications

PURPOSE OF REVIEW: To provide an overview of recent research assessing the role of physicians and other healthcare providers in facilitating improvements in patient adherence to antihypertensive medications, to provide a framework for addressing patient adherence to antihypertensive therapy, and to propose future directions for assessing the risk of poor adherence in clinical settings. RECENT FINDINGS: Several recent studies have highlighted the role of the healthcare provider in improving patient adherence to antihypertensive therapy. Opportunities exist for providers to improve communication that enhances patients' understanding of their disease and its treatment, to tailor interventions based on whether patients are intentionally or unintentionally non-adherent, to assess and treat side-effects such as erectile dysfunction, to switch to less costly generic alternatives, and to reduce the complexities of medication regimens. SUMMARY: Poor adherence to prescribed therapies is common in patients with hypertension, and should be considered in the evaluation of the hypertensive patient with poor blood pressure control. When initiating treatment in patients newly diagnosed with hypertension and when monitoring patients with existent disease, providers should identify barriers to medication adherence and actively engage patients in shared decision-making regarding their treatment. These activities will facilitate adherence, which may lead to improved outcomes for patients with hypertension and other chronic cardiovascular diseases.     

Sexual dysfunction in hypertensive men. A critical review of the literature

Sexual dysfunction is common in hypertensive men and often is first reported by patients while receiving hypotensive therapy, leading to a widespread belief by patients and physicians that the sexual dysfunction is caused by a specific antihypertensive medication. However, it is unclear from the literature whether this problem is related to hypertension or to its therapy. Further, whether the erectile failures reported during therapy are a result of 1) reduced penile blood flow secondary to reduction of blood pressure after antihypertensive treatment or to obstructive vascular disease (or both) or 2) specific drug effects has not been well studied. Because of these unresolved issues, this common problem is not well managed and contributes to noncompliance with therapy by hypertensive male patients, which impedes the attainment of satisfactory blood pressure control. The present article reviews the literature related to hypertension and sexual function in men and outlines a management strategy for clinicians that attempts to document normalcy of sexual function before initiating treatment in newly diagnosed hypertensive patients. Further, it does not ascribe causality to specific antihypertensive agents for the sexual dysfunction reported by treated hypertensive patients but attempts instead to delineate the pathogenesis of the dysfunction. Once the pathogenesis is established, treatment plans can be implemented to restore normotension and maintain adequate sexual function among treated hypertensive men. The article also discusses how applied research in this area may be performed.     

Antihypertensive Treatment and Sexual Dysfunction

Sexual dysfunction is frequently encountered in hypertensive patients. Available data indicates that sexual dysfunction is more frequent in treated than in untreated patients, generating the hypothesis that antihypertensive therapy might be associated with sexual dysfunction. Several lines of evidence suggest that differences between antihypertensive drugs exist regarding their effects on sexual function. Older antihypertensive drugs (diuretics, beta blockers) exert detrimental effects on erectile function whereas newer drugs (nebivolol, angiotensin receptor blockers) have neutral or even beneficial effects. Phosphodiesterase (PDE)-5 inhibitors are effective in hypertensive patients and can be safely administered even when multidrug regimes are used. Precautions need to be taken with alpha blockers or patients with uncontrolled high-risk hypertension, while co-administration with nitrates is contraindicated.     

Effect of sildenafil citrate on blood pressure and heart rate in men with erectile dysfunction taking concomitant antihypertensive medication. Sildenafil Study Group

OBJECTIVES: To assess the acute effect of sildenafil citrate on blood pressure and heart rate in men with erectile dysfunction taking concomitant antihypertensive medication. DESIGN: Post-hoc subanalysis of five, 12- or 24-week, prospective, randomized, double-blind, placebo-controlled studies. SETTING: Private-practice and academic urology clinics. PATIENTS: A total of 1685 men with erectile dysfunction of > or = 6 months duration, of whom 667 (sildenafil n = 406, placebo n = 261) were taking antihypertensive medication (diuretic, beta-blocker, alpha-blocker, angiotensin converting enzyme inhibitor, and/or calcium antagonist). Of the patients taking antihypertensive medication, 608 (91%) completed the studies (374 of 406 receiving sildenafil, 234 of 261 receiving placebo). INTERVENTIONS: The last dose of oral sildenafil (25-200 mg) or placebo was taken at home on the morning of the final clinic visit. Patients taking antihypertensive medication maintained usual dosing schedules. MAIN OUTCOME MEASUREMENTS: Sitting systolic (SBP)/diastolic blood pressure (DBP) and heart rate at baseline and after dosing with sildenafil or placebo (end-of-treatment visit). RESULTS: Mean changes from baseline in SBP/DBP for men taking antihypertensive medication were -3.6/-1.9 mmHg for those receiving sildenafil and -0.8/-0.1 mmHg for those receiving placebo compared with -2.2/-2.0 mmHg and -0.1/0.4 mmHg, respectively, for men not taking antihypertensive medication. Mean changes from baseline in heart rate for men taking antihypertensive medication were -0.6 beats/min after sildenafil and 0.9 beats/min after placebo compared with 0.4 beats/min and -0.6 beats/min, respectively, for patients not taking antihypertensive medication. Differences in SBP, DBP, and heart rate between the patients taking and those not taking antihypertensive medication were small. CONCLUSIONS: The acute, short-term effects of oral sildenafil on blood pressure and heart rate in men with erectile dysfunction were small and not likely to be clinically significant in those taking concomitant antihypertensive medication.     

A Comparison of Cognitive and Everyday Functional Performance Among Older Adults With and Without Hypertension

Secondary data analyses examined the differences in cognitive and instrumental activities of daily living (IADL) performance among hypertensive individuals taking one of four classes of antihypertensive medications, hypertensive individuals not taking any antihypertensive medications, and normotensive individuals (N?=?770). After adjusting for covariates, significant group differences were evident on all measures (speed of processing, motor speed, reaction time, p < .05) except memory and timed IADL (p > .05). Follow-up a priori planned comparisons compared hypertensive individuals not on medications to each of the four antihypertensive medication groups. Results indicated that only those on beta-blockers were significantly slower in speed of processing (p < .05). A priori planned comparisons also revealed that normotensive individuals had better cognitive performance on measures of processing speed, motor speed, and reaction time than hypertensive individuals regardless of antihypertensive medication use. Additionally, normotensive individuals performed significantly better on memory (digit and spatial span) than individuals with hypertension on medications. No differences were found between groups on memory (Hopkins Verbal Learning Test) or timed IADL performance. With regard to antihypertensive medications, the use of beta blockers was associated with slowed processing speed. These analyses provide empirical evidence that hypertension primarily impacts speed of processing, but not severe enough to affect IADL performance. Given the contribution of processing speed to memory and executive function performance, this is an important finding. Clinicians need to take into consideration the potential negative impact that beta blockers may have on cognition when determining the best treatment of hypertension among older adult patients.     

Control of hypertension 5 years after stroke in the North East Melbourne Stroke Incidence Study

Control of blood pressure after stroke is important for reducing the risk of recurrent stroke. We examined the control of hypertension in a community-based population of 5-year stroke survivors. Cases of first-ever stroke from the North East Melbourne Stroke Incidence Study were interviewed at 5 years poststroke. Blood pressure, history of hypertension, and antihypertensive medications were recorded. Individuals were classified as normotensive (blood pressure < 140/90 mm Hg, no history of hypertension, and no antihypertensive medications), controlled hypertensive (blood pressure < 140/90 mm Hg, history of hypertension, and/or taking antihypertensive medications), uncontrolled hypertensive (blood pressure > or = 140/90 mm Hg, history of hypertension, and/or taking antihypertensive medications), or uninformed hypertensive (blood pressure > or = 140/90 mm Hg, no known history of hypertension, and no antihypertensive medications). At 5 years poststroke, 441 (45%) of 978 first-ever stroke cases were alive. Of these, 305 (69%) had complete data on blood pressure, antihypertensive medication use, and history of hypertension. No statistical differences existed between those with or without these data. Eight-two percent were hypertensive; 63% had controlled hypertension, 30% had uncontrolled hypertension, and 7% were unaware that they were hypertensive. Overall, 67% of individuals classified as uncontrolled or uninformed hypertensive subjects were receiving treatment that was insufficient to achieve target blood pressure levels. Uncontrolled hypertensive subjects were more likely to recall receiving advice to manage their hypertension with medication (P < 0.02) and diet (P < 0.09). Although the majority of hypertensive individuals had controlled hypertension at 5 years poststroke, considerable improvement can be made in the control of hypertension after stroke.     

Cardiovascular safety update of Tadalafil: retrospective analysis of data from placebo-controlled and open-label clinical trials of Tadalafil with as needed, three times-per-week or once-a-day dosing

Because most men with erectile dysfunction have underlying vascular disease, it is important to update the cardiovascular safety profile of medications used in the treatment of erectile dysfunction. This retrospective analysis evaluated serious cardiovascular treatment-emergent adverse events (CVTEAEs) reported in 36 clinical trials of tadalafil, a phosphodiesterase-5 inhibitor used for the treatment of erectile dysfunction. A serious CVTEAE was defined as myocardial infarction, cardiovascular death, or cerebrovascular death. In the 36 trials, 12,487 men (mean age 55 years) with erectile dysfunction received tadalafil, with 5,771 patient-years (PYs) of exposure, and 2,047 men (mean age 56 years) received placebo, with 460 PYs of exposure. Tadalafil 2 to 50 mg was taken as needed, 3 times/week, or once a day. Co-morbidities at baseline included hypertension (31%), diabetes (21%), hyperlipidemia (17%), and coronary artery disease (5%). Across all trials, the incidence rate of serious CVTEAEs was 0.40/100 PYs in tadalafil-treated patients and 0.43/100 PYs in placebo-treated patients. In patients taking tadalafil as needed, 3 times/week, or once a day, the incidence rates of serious CVTEAEs ranged from 0.17 to 0.54/100 PYs across placebo-controlled and open-label trials. In conclusion, the incidence rates of serious CVTEAEs were comparable among men with erectile dysfunction taking tadalafil as needed, 3 times/week, or once a day, and these rates were also comparable with those in placebo-treated patients. In this clinical trial population of men with erectile dysfunction, tadalafil was not associated with an increased risk for serious cardiovascular adverse events.     

Arterial elasticity and erectile dysfunction in hypertensive men

Erectile dysfunction is a common symptom among hypertensive patients that impairs quality of life and adherence to antihypertensive pharmacologic therapy. It is also associated with cardiovascular risk factors and disease. The Sexual Health Inventory in Men (SHIM) was administered to 105 ambulatory hypertensive patients, and large and small artery elasticity indices were measured. Each variable was examined in a simple linear regression model or 1-way analysis of variance model to determine each variable's relationship with the SHIM score. Variables that were significantly associated with the SHIM score in the univariate models included age, duration of hypertension, peripheral vascular disease, and small artery elasticity. Large artery elasticity was not significantly associated with the SHIM score. In the multivariate model, age, hypertension duration, and peripheral vascular disease were associated with a lower SHIM score. This study demonstrates a relationship between erectile dysfunction and reduced artery elasticity.     

Vascular effects of sildenafil in hypertensive cardiac transplant recipients

BACKGROUND: Sildenafil is commonly used in the treatment of erectile dysfunction in hypertensive male cardiac transplant recipients (CTR); however, little is known about the vascular effects of sildenafil in these patients. METHODS: Central and peripheral arterial blood pressure (BP), heart rate, and brachial artery reactivity were determined in 15 hypertensive male CTR before and after oral sildenafil (50 mg) administration. RESULTS: Sildenafil improved brachial and aortic systolic BP, pulse pressure, aortic augmentation index, left ventricular tension time index, travel time of the reflected aortic pressure wave, and brachial artery reactivity (P <.01 for each comparison). No patient became hypotensive with sildenafil despite continuation of usual antihypertensive medications. CONCLUSIONS: Sildenafil (50 mg) is well tolerated in hypertensive CTR and improves BP, aortic augmentation index, and endothelial function. By decreasing the amplitude of the reflected pressure wave and delaying its return to the heart, sildenafil reduces left ventricular afterload and systolic stress.     

Analysis of integrated clinical safety data of tadalafil in patients receiving concomitant antihypertensive medications

This pooled safety analysis assessed the incidence of hypotension‐related treatment‐emergent adverse events (TEAEs) and major adverse cardiovascular events (MACEs) in patients with concomitant use of tadalafil and antihypertensive medications. Data were pooled from seventy‐two Phase II–IV studies conducted on patients with a diagnosis of erectile dysfunction (ED) and/or benign prostate hyperplasia (BPH). Studies were categorized as either All placebo‐controlled studies or All studies. The incidences of hypotension‐related TEAEs and MACEs were analyzed by indication; by use of concomitant antihypertensive medications; and by the number of concomitant antihypertensive medications. A total of 15 030 and 22 825 patients were included in the analyses for All placebo‐controlled studies and All studies, respectively. In the All placebo‐controlled studies, the incidence of hypotension‐related TEAEs and MACEs was ranging between 0.6–1.5% and 0.0–1.0%, respectively, across all indications. Tadalafil was associated with an increase in hypotension‐related TEAEs only in the ED as‐needed group not receiving any concomitant antihypertensive medications (p‐value = .0070); no significant difference was reported between placebo and tadalafil in the groups of patients receiving ≥1 antihypertensive medication (p‐values ≥ .7386). Similarly, no significant differences (p‐values≥ .2238) were observed in the incidence of MACEs between tadalafil and placebo treatment groups, with or without concomitant use of antihypertensive medications, and across all indication categories. In the All studies group, results were similar. The pooled analysis showed no evidence that taking tadalafil alongside antihypertensive medications increases the risk of hypotension‐related TEAEs or MACEs compared with antihypertensive medications alone.     

Hypertension, obesity, erectile dysfunction. What kind of drug to choose

Hypertension is one of the most common cardiovascular diseases. The development and progression of hypertension is associated with prolonged hyper activation of the renin-angiotensin-aldosterone system. ACE inhibitors and angiotensin receptor blockers (ARBs) are highly effective medicines and are widely used in the treatment of cardiovascular diseases: hypertension, congestive heart failure, coronary heart disease. The main pharmacological effects of ACE inhibitors and ARBs are hypotensive, neurohumoral, antiproliferative, cardio- and nefroprotective functions, as well as constantly improving endothelial function. In accordance with the article, hypertensive effectiveness, tolerability and organ-protective properties of valsartan are noticeable among patients with hypertension, obesity and erectile dysfunction, taking this medicine.     

Blood pressure in children with chronic kidney disease: a report from the Chronic Kidney Disease in Children study

To characterize the distribution of blood pressure (BP), prevalence, and risk factors for hypertension in pediatric chronic kidney disease, we conducted a cross-sectional analysis of baseline BPs in 432 children (mean age 11 years; 60% male; mean glomerular filtration rate 44 mL/min per 1.73 m(2)) enrolled in the Chronic Kidney Disease in Children cohort study. BPs were obtained using an aneroid sphygmomanometer. Glomerular filtration rate was measured by iohexol disappearance. Elevated BP was defined as BP >or=90th percentile for age, gender, and height. Hypertension was defined as BP >or=95th percentile or as self-reported hypertension plus current treatment with antihypertensive medications. For systolic BP, 14% were hypertensive and 11% were prehypertensive (BP 90th to 95th percentile); 68% of subjects with elevated systolic BP were taking antihypertensive medications. For diastolic BP, 14% were hypertensive and 9% were prehypertensive; 53% of subjects with elevated diastolic BP were taking antihypertensive medications. Fifty-four percent of subjects had either systolic or diastolic BP >or=95th percentile or a history of hypertension plus current antihypertensive use. Characteristics associated with elevated BP included black race, shorter duration of chronic kidney disease, absence of antihypertensive medication use, and elevated serum potassium. Among subjects receiving antihypertensive treatment, uncontrolled BP was associated with male sex, shorter chronic kidney disease duration, and absence of angiotensin-converting enzyme inhibitor or angiotensin receptor blocker use. Thirty-seven percent of children with chronic kidney disease had either elevated systolic or diastolic BP, and 39% of these were not receiving antihypertensives, indicating that hypertension in pediatric chronic kidney disease may be frequently under- or even untreated. Treatment with angiotensin-converting enzyme inhibitors or angiotensin receptor blockers may improve BP control in these patients.     

Resistant hypertension, secondary hypertension, and hypertensive crises: diagnostic evaluation and treatment

Hypertension is a very common modifiable risk factor for cardiovascular morbidity and mortality. Patients with hypertension represent a diverse group. In addition to those with primary hypertension, there are patients whose hypertension is attributable to secondary causes, those with resistant hypertension, and patients who present with a hypertensive crisis. Secondary causes of hypertension account for less than 10% of cases of elevated blood pressure (BP), and screening for these causes is warranted if clinically indicated. Patients with resistant hypertension, whose BP remains uncontrolled in spite of use of 3 or more antihypertensive agents, are at increased cardiovascular risk compared with the general hypertensive population. After potentially correctible causes of uncontrolled BP (pseudoresistance, secondary causes, and intake of interfering substances) are eliminated, patients with true resistant hypertension are managed by encouraging therapeutic lifestyle changes and optimizing the antihypertensive regimen, whereby the clinician ensures that the medications are prescribed at optimal doses using drugs with complementary mechanisms of action, while adding an appropriate diuretic if there are no contraindications. Mineralocorticoid receptor antagonists are formidable add-on agents to the antihypertensive regimen, usually as a fourth drug, and are effective in reducing BP even in patients without biochemical evidence of aldosterone excess. In the setting of a hypertensive crisis, the BP has to be reduced within hours in the case of a hypertensive emergency (elevated BP with evidence of target organ damage) using parenteral agents, and within a few days if there is hypertensive urgency, using oral antihypertensive agents.     

Antihypertensive pharmacobezoar

Most antihypertensive drugs have known side effects that are elicited by the careful clinician taking care of hypertensive patients. However, many antihypertensive medications utilize drug delivery systems that prolong the duration of blood pressure reduction. The gastrointestinal therapeutic system that is used with nifedipine, isradipine, and verapamil has a unique side effect. Obstruction may occur at the site of a previous surgical repair (pyloric stenosis or gastroplasty) or stenosis of the esophagus, small intestine, or colon. The same delivery system is used with methylphenidate, oxybutynin, glipizide, and doxazosin. Although this complication is rare, physicians who prescribe and care for hypertensive patients should recognize this potential problem.     

Arterial function and intima-media thickness in hypertensive patients with erectile dysfunction

OBJECTIVE: Erectile dysfunction is a predictor of cardiovascular risk with high prevalence in hypertensive men. We investigated whether erectile dysfunction is related to arterial structure and function in hypertensive patients. METHODS: We evaluated arterial structural and functional characteristics and measured systemic endothelial/inflammatory markers in 52 hypertensive men with vasculogenic erectile dysfunction and in 34 hypertensive men with normal erectile function, matched for age, blood pressure, risk factors and treatment. RESULTS: Hypertensive patients with erectile dysfunction had higher common carotid intima-media thickness (0.95 +/- 0.19 vs. 0.83 +/- 0.18 mm, P = 0.003) and carotid-femoral pulse-wave velocity (8.89 +/- 1.38 vs. 8.11 +/- 1.10 m/s, P = 0.007), lower flow-mediated dilation of the brachial artery (absolute values of 2.96 +/- 1.64 vs. 4.07 +/- 1.68%, P = 0.003) and a higher level of the systemic endothelial dysfunction marker asymmetric dimethylarginine (0.67 +/- 0.13 vs. 0.57 +/- 0.16 mumol/l, P = 0.003), and the inflammatory markers high-sensitivity C-reactive protein [2.03 (1.16-2.89) vs. 1.23 (0.67-1.90) mg/l, P = 0.029] and interleukin-6 (4.13 +/- 2.38 vs. 2.77 +/- 1.92 pg/ml, P = 0.011). Multivariable analysis adjusting for age, mean pressure, other risk factors and treatment showed independent associations between erectile dysfunction and parameters of arterial structure and function. In the erectile dysfunction group, there were no significant relationships between the severity of erectile dysfunction (as expressed by the Sexual Health Inventory for Men score) and the above arterial indices and level of circulating markers (all P = NS). CONCLUSION: In hypertensive men, the presence but not the severity of vasculogenic erectile dysfunction is associated with subclinical atherosclerosis, impairment of arterial function and systemic endothelial and inflammatory activation.