Hypertension and impotence

In a group of 472 impotent patients who were evaluated with pharmacologic duplex sonography, 117 patient (24.8%) had a history of hypertension, 26 of them (22.2%) for more than 10 years. Objective data about the changes in pulsation, diameter and blood flow velocity of the penile arteries after papaverine injection and the resulting erectile response allowed indirect assessment of the penile venous function. Varying degrees of impaired arterial function were diagnosed in 85% of the patients. The duration of hypertension had less deteriorating effects on the penile arterial system than second risk factors such as diabetes mellitus (n = 31) or smoking (n = 26). Patients on antihypertensive medication (n = 88, 75.2%) demonstrated a worse arterial response to papaverine than those without medication (n = 29, 24.8%). The best vascular response to papaverine injection was found in patients taking a combination of beta-blockers and vasodilators (n = 6), whereas thiazides either taken alone or in combination (n = 51, 60%) seem to have a deteriorating effect on arterial function. However, the arterial response did not correlate with the ability to achieve 'full erection' after intracavernous papaverine injection. Clinical experience confirms that certain antihypertensive drugs affect not only the blood pressure, but also compliance of the erectile tissue resulting in a functional venous leak. This may impair erectile function as much as arteriosclerotic changes of the vascular system secondary to hypertension.