RELATIONSHIP BETWEEN MASKED ARTERIAL HYPERTENSION AND ERECTILE DYSFUNCTION

Background

Erectile dysfunction (ED) has a marked negative effect on quality of life. The association between sustained hypertension (HT) and ED has been clearly shown. However, there is no study evaluating masked HT and ED. We aimed to assess the prevalence of masked HT and the related factors in patients with ED.

Methods

A total of 64 consecutive males with ED (mean age: 50.4 ± 9.8 years) were enrolled in the study. The Sexual Health Inventory for Men (SHIM) questionnaire was used to evaluate the erectile status of the patients. Office and 24-h ambulatory blood pressure (BP) of all patients were measured.

Results

We detected masked HT in 24 of 64 patients with ED (37.5%). The SHIM score was slightly lower in masked HT group compared to true normotensives, but the difference was not statistically significant (10.8 ± 5.2 vs. 11.4 ± 4.6; p=0.65). There was no significant correlation between all-day systolic and diastolic BP with SHIM scores (R=0.076, p=0.55; R=0.079; p=0.53). When the patients with masked HT were classified according to the nocturnal BP reduction, the SHIM scores of patients with the nondipping pattern were lower than the dippers (9.8 ± 5.3 vs. 12.0 ± 5.1; p=0.001).

Conclusions

The prevalence of masked HT is high in patients with ED. Patients with masked HT and nondipping nocturnal BP pattern have more profound ED. The coexistence of masked HT and ED is thought to be a marker of increased cardiovascular risk.

arterial hypertension; circadian blood pressure; dipping; erectile dysfunction; masked hypertension

1. Hackett G, Kirby M, Wylie K, et al. British soci-ety for sexual medicine guidelines on the manage-ment of erectile dysfunction in men—2017. J Sex Med 2018;15(4):430–57. https://doi.org/10.1016/j. jsxm.2018.01.023

2. Sarier M, Soylu A, Baydinc C. Necessity of endo-crine screening in men with erectile dysfunction. Med J SDU 2018;25(4):356–60. https://doi. org/10.17343/sdutfd.368786

3. Martin-Morales A, Sanchez-Cruz JJ, Saenz de Tejada I, Rodriguez-Vela L, Jimenez-Cruz JF, Burgos-Rodriguez R. Prevalence and independent risk factors for erectile dysfunction in SpaIn: Results of the Epidemiologia de la disfuncion erec-til masculina study [Internet]. J Urol 2001;166(2): 569–74; discussion 574–5 [cited 2019 May 21]. Available from: http://www.ncbi.nlm.nih.gov/pubmed/11458070

4. Feldman HA, Goldstein I, Hatzichristou DG, Krane RJ, McKinlay JB. Impotence and its medi-cal and psychosocial correlates: Results of the Massachusetts male aging study [Internet]. J Urol 1994;151(1):54–61 [cited 2019 May 21]. Available from: http://www.ncbi.nlm.nih.gov/pubmed/ 8254833

5. Miner M, Kim ED. Cardiovascular disease and male sexual dysfunction [Internet]. Asian J Androl 17(1):3–4 [cited 2019 May 21]. Available from: http://www.ncbi.nlm.nih.gov/pubmed/25532581

6. Kamenov Z. A comprehensive review of erectile dysfunction in men with diabetes. Exp Clin Endocrinol Diabetes 2014;123(03):141–58. https://doi.org/10.1055/s-0034-1394383

7. Sánchez A, Contreras C, Martínez P, et al. Endothelin A (ET(A)) receptors are involved in augmented adrenergic vasoconstriction and blunted nitric oxide-mediated relaxation of penile arteries from insulin-resistant obese zucker rats. J Sex Med 2014;11(6):1463–74. https://doi. org/10.1111/jsm.12526

8. Jeremy JY, Angelini GD, Khan M, et al. Platelets, oxidant stress and erectile dysfunction: An hypothesis. Cardiovasc Res 2000;46(1):50–4. https://doi.org/10.1016/s0008-6363(00)00009-2

9. Williams B, Mancia G, Spiering W, et al. 2018 ESC/ESH guidelines for the management of arterial hypertension. Eur Heart J. 2018 Sep 1;39(33): 3021–104. https://doi.org/10.1093/eurheartj/ ehy339

 10. Mancia G, Bombelli M, Facchetti R, et al. Increased long-term risk of new-onset diabetes mellitus in white-coat and masked hypertension. J Hypertens 2009;27(8):1672–8. https://doi.org/ 10.1097/HJH.0b013e32832be5f9

 11. Mancia G, Bombelli M, Facchetti R, et al. Long-term risk of sustained hypertension in white-coat or masked hypertension. Hypertens 2009;54(2):226–32. https://doi.org/10.1161/HYPERTENSIONAHA.109.129882

 12. Parati G, Valentini M. Do we need out-of-office blood pressure in every patient? Curr Opin Cardiol 2007;22(4):321–8. https://doi.org/10.1097/HCO. 0b013e3281bd8835

 13. Pierdomenico SD, Cuccurullo F. Prognostic value of white-coat and masked hypertension diag-nosed by ambulatory monitoring in initially untreated subjects: An updated meta analysis. Am J Hypertens 2011;24(1):52–8. https://doi.org/ 10.1038/ajh.2010.203

 14. Aribas A, Kayrak M, Ulucan S, et al. The rela-tionship between uric acid and erectile dysfunc-tion in hypertensive subjects. Blood Press 2014;23(6): 370–6. https://doi.org/10.3109/080370 51.2014.933032

 15. Gareri P, Castagna A, Francomano D, Cerminara G, De Fazio P. Erectile dysfunction in the elderly: An old widespread issue with novel treatment per-spectives. Int J Endocrinol 2014;2014:1–15. https://doi.org/10.1155/2014/878670

 16. Corona G, Mannucci E, Lotti F, et al. Pulse pres-sure, an index of arterial stiffness, is associated with androgen deficiency and impaired penile blood flow in men with ED. J Sex Med 2009;6(1): 285–93. https://doi.org/10.1111/j.1743-6109.2008. 01059.x

 17. Lenfant C, Chobanian AV, Jones DW, Roccella EJ, Joint National Committee on the Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. Seventh report of the Joint National Committee on the Prevention, Detection, Evaluation, and Treatment of high blood pres-sure (JNC 7): Resetting the hypertension sails. Hypertens 2003;41(6):1178–9. https://doi.org/ 10.1161/01.HYP.0000075790.33892.AE

 18. Giuliano F. Neurophysiology of erection and ejaculation. J Sex Med 2011;8 Suppl 4:310–15. https://doi.org/10.1111/j.1743-6109.2011.02450.x

 19. Yao F, Liu L, Zhang Y, et al. Erectile dysfunction may be the first clinical sign of insulin resistance and endothelial dysfunction in young men. Clin Res Cardiol 2013;102(9):645–51. https://doi. org/10.1007/s00392-013-0577-y

 20. Papadopoulos DP, Mourouzis I, Faselis C, et al. Masked hypertension and atherogenesis: The impact of apelin and relaxin plasma levels. J Clin Hypertens 2013 May;15(5):333–6. https://doi. org/10.1111/jch.12075

 21. Kwon MH, Tuvshintur B, Kim WJ, et al. Expression of the apelin-APJ pathway and effects on erectile function in a mouse model of vasculo-genic erectile dysfunction. J Sex Med 2013 Dec;10(12):2928–41. https://doi.org/10.1111/jsm. 12158

 22. Nunes KP, Labazi H, Webb RC. New insights into hypertension-associated erectile dysfunction. Curr Opin Nephrol Hypertens 2012 Mar;21(2):163–70. https://doi.org/10.1097/MNH.0b013e32835021bd

 23. Okutucu S, Kabakci G, Deveci OS, et al. Relationship between exercise heart rate recovery and circadian blood pressure pattern. J Clin Hypertens (Greenwich) 2010;12(6):407–13. https://doi.org/10.1111/j.1751-7176.2010.00279.x

 24. Hermida RC, Ayala DE, Mojón A, Fernández JR. Blunted sleep-time relative blood pressure decline increases cardiovascular risk independent of blood pressure level—The “normotensive non-dipper” paradox. Chronobiol Int 2013;30(1–2):87–98. https://doi.org/10.3109/07420528.2012.701127

 25. Jennersjö PE son, Wijkman M, Wiréhn A-B, et al. Circadian blood pressure variation in patients with type 2 diabetes—Relationship to macro- and microvascular subclinical organ damage. Prim Care Diabetes 2011;5(3):167–73. https://doi.org/ 10.1016/j.pcd.2011.04.001

 26. Okutucu S, Karakulak UN, Kabakçı G. Circadian blood pressure pattern and cardiac autonomic functions: Different aspects of same pathophysiol-ogy. Anadolu Kardiyol Derg 2011;11(2):168–73. https://doi.org/10.5152/akd.2011.031

 27. Okutucu S, Karakulak UN, Sahiner L, et al. The relationship between circadian blood pressure pattern and ventricular repolarization dynamics assessed by QT dynamicity. Blood Press Monit 2012;17(1):14–19. https://doi.org/10.1097/MBP. 0b013e3283502504

 28. Kuo TBJ, Chen C-Y, Wang YP, et al. The role of autonomic and baroreceptor reflex control in blood pressure dipping and nondipping in rats. J Hypertens 2014;32(4):806–16. https://doi.org/ 10.1097/HJH.0000000000000099

 29. Giuliano FA, Leriche A, Jaudinot EO, de Gendre AS. Prevalence of erectile dysfunction among 7689 patients with diabetes or hypertension, or both. Urology 2004;64(6):1196–201. https://doi. org/10.1016/j.urology.2004.08.059

 30. Liu JE, Roman MJ, Pini R, Schwartz JE, Pickering TG, Devereux RB. Cardiac and arterial target organ damage in adults with elevated ambulatory and normal office blood pressure [Internet]. Ann Intern Med 1999;131(8):564–72 [cited 2019 May 21]. Available from: http://www.ncbi.nlm. nih.gov/pubmed/10523216

 31. Tomiyama M, Horio T, Yoshii M, et al. Masked hypertension and target organ damage in treated hypertensive patients. Am J Hypertens 2006;19(9): 880–6. https://doi.org/10.1016/j.amjhyper.2006. 03.006

 32. Papadopoulos DP, Makris TK. Masked hyper-tension definition, impact, outcomes: A critical review [Internet]. J Clin Hypertens (Greenwich) 2007;9(12):956–63 [cited 2019 May 21]. Available from: http://www.ncbi.nlm.nih.gov/pubmed/ 18046102

 33. Harada K, Karube Y, Saruhara H, Takeda K, Kuwajima I. Workplace hypertension is associ-ated with obesity and family history of hyperten-sion. Hypertens Res 2006;29(12):969–76. https://doi.org/10.1291/hypres.29.969

 34. Light KC, Turner JR, Hinderliter AL. Job strain and ambulatory work blood pressure in healthy young men and women [Internet]. Hypertens 1992;20(2):214–18 [cited 2019 May 21]. Available from: http://www.ncbi.nlm.nih.gov/pubmed/ 1639463

 35. Aghighi A, Grigoryan VH, Delavar A. Psychological determinants of erectile dysfunction among middle-aged men. Int J Impot Res 2015; 27(2):63–8. https://doi.org/10.1038/ijir. 2014.34