Effect of Intensive vs Standard Blood Pressure Treatment Upon Erectile Function in Hypertensive Men: Findings From the Systolic Blood Pressure Intervention Trial |
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| Affiliation: | 1. Division of Public Health Sciences, Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Winston-Salem, NC, USA;2. Division of Public Health Sciences, Department of Biostatistic and Data Science, Wake Forest School of Medicine, Winston-Salem, NC, USA;3. Bedford VA Hospital, Bedford, MA, and Boston University School of Medicine and Boston University School of Public Health, Boston, MA, USA;4. Michael E. DeBakey Veterans’ Administration Medical Center, Houston, TX, USA;5. Division of Nephrology and Hypertension, Department of Medicine, Vanderbilt University, Nashville, TN, USA;6. Division of Internal Medicine, Department of Medicine, Medical College of Georgia, Augusta University, Augusta, GA, USA;7. Division of Nephrology, Department of Medicine, Stanford University, Stanford, CA, USA;8. Second Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, Hippokration Hospital, Thessaloniki, Greece;9. University Hospitals Case Medical Center, Cleveland, OH, USA;10. Robert Wood Johnson Medical School, Rutgers University, University of Medicine and Dentistry of New Jersey, New Brunswick, NJ, USA;11. Department of Internal Medicine, Dallas Veterans’ Administration Medical Center and University of Texas Southwestern Medical Center, Dallas, TX, USA;12. Division of Gerontology, Geriatrics and Palliative Care, Department of Medicine, University of Alabama at Birmingham School of Medicine, Birmingham, AL, USA;1. Department of Psychology and Neuroscience, Dalhousie University, Halifax, Nova Scotia, Canada;2. Department of Obstetrics and Gynaecology, IWK Health Centre, Halifax, Nova Scotia, Canada;3. Department of Psychology, Université de Montréal, Montréal, Québec, Canada;4. Department of Psychology, Queens University, Kingston, Ontario, Canada;1. Department of Psychology, Department of Obstetrics and Gynaecology, Western University, London, Ontario, Canada;2. Department of Psychology, Western University, London, Ontario, Canada;1. Department of Endocrinology, Amsterdam UMC, VU University Medical Center, Amsterdam, the Netherlands;2. Center of Expertise on Gender Dysphoria, Amsterdam UMC, VU University Medical Center, Amsterdam, the Netherlands;3. Department of Internal Medicine, Amsterdam UMC, VU University Medical Center, Amsterdam, the Netherlands;4. Department of Plastic, Reconstructive, and Hand Surgery, Amsterdam UMC, VU University Medical Center, Amsterdam, the Netherlands;1. Institute for Sex Counselling and Sexual Sciences, Zurich, Switzerland;2. Department of Twin Research and Genetic Epidemiology, School of Life Course Sciences, King’s College London, London, United Kingdom;3. School of Psychology, University of Surrey, Guildford, United Kingdom;1. The HIV Center for Clinical and Behavioral Studies at the New York State Psychiatric Institute and Columbia University, New York, NY, USA;2. Department of Psychology, University of Washington, Seattle, WA, USA;3. Department of Anthropology, University of Washington, Seattle, WA, USA;4. School of Social Work, Columbia University, New York, NY, USA;5. Brown University School of Public Health, Providence, RI, USA;6. Department of Epidemiology, Center for Public Health and Human Rights, Johns Hopkins University, Baltimore, MD, USA;7. Division of Epidemiology and Community Health University of Minnesota School of Public Health, Minneapolis, MN, USA |
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| Abstract: | IntroductionThe effect of intensive blood pressure control upon erectile function in men with hypertension, but without diabetes, is largely unknown.AimTo examine the effects of intensive systolic blood pressure (SBP) lowering on erectile function in a multiethnic clinical trial of men with hypertension.MethodsWe performed subgroup analyses from the Systolic Blood Pressure Intervention Trial ([SPRINT]; ClinicalTrials.gov: NCT120602, in a sample of 1255 men aged 50 years or older with hypertension and increased cardiovascular disease risk. Participants were randomly assigned to an intensive treatment group (SBP goal of <120 mmHg) or a standard treatment group (SBP goal of <140 mmHg).Main Outcome MeasureThe main outcome measure was change in erectile function from baseline, using the 5-item International Index of Erectile Function (IIEF-5) total score, and erectile dysfunction ([ED]; defined as IIEF-5 score ≤21) after a median follow-up of 3 years.ResultsAt baseline, roughly two-thirds (66.1%) of the sample had self-reported ED. At 48 months after randomization, we determined that the effects of more intensive blood pressure lowering were significantly moderated by race-ethnicity (p for interaction = 0.0016), prompting separate analyses stratified by race-ethnicity. In non-Hispanic whites, participants in the intensive treatment group reported slightly, but significantly better change in the IIEF-5 score than those in the standard treatment group (mean difference = 0.67; 95% CI = 0.03, 1.32; P = 0.041). In non-Hispanic blacks, participants in the intensive group reported slightly worse change in the IIEF-5 score than those in the standard group (mean difference = −1.17; 95% CI = −1.92, −0.41; P = 0.0025). However, in non-Hispanic whites and non-Hispanic blacks, further adjustment for the baseline IIEF-5 score resulted in nonsignificant differences (P > 0.05) according to the treatment group. In Hispanic/other participants, there were no significant differences in change in the IIEF-5 score between the two treatment groups (P = 0.40). In a subgroup of 280 participants who did not report ED at baseline, the incidence of ED did not differ in the two treatment groups (P = 0.53) and was without interaction by race-ethnicity.Clinical ImplicationsThe effect of intensive treatment of blood pressure on erectile function was very small overall and likely not of great clinical magnitude.Strength & LimitationsAlthough this study included a validated measure of erectile function, testosterone, other androgen, and estrogen levels were not assessed.ConclusionIn a sample of male patients at high risk for cardiovascular events but without diabetes, targeting a SBP of less than 120 mm Hg, as compared with less than 140 mm Hg, resulted in statistically significant effects on erectile function that differed in accordance with race-ethnicity, although the clinical importance of the differences may be of small magnitude.Foy CG, Newman JC, Russell GB, et al. Effect of Intensive vs Standard Blood Pressure Treatment Upon Erectile Function in Hypertensive Men: Findings From the Systolic Blood Pressure Intervention Trial. J Sex Med 2020;17:238–248. |
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| Keywords: | Sexual Function Erectile Function Hypertension Intensive Treatment for Blood Pressure Older Men Race and Ethnicity |
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