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. 2012 Mar;21(2):163-70.
doi: 10.1097/MNH.0b013e32835021bd.

New Insights Into Hypertension-Associated Erectile Dysfunction

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New Insights Into Hypertension-Associated Erectile Dysfunction

Kenia Pedrosa Nunes et al. Curr Opin Nephrol Hypertens. .
Free PMC article


Purpose of review: Erectile dysfunction is recognized as a quality-of-life disorder that needs to be treated. Currently, it is estimated to affect as many as 30 million American men. Thirty percent of hypertensive patients complain of erectile dysfunction. The understanding of common mechanisms involved in the cause of erectile dysfunction associated with hypertension, and the investigation of antihypertensive drugs that impact erectile dysfunction, will provide important tools toward identifying new therapeutic targets that will improve the quality of life for patients in these conditions.

Recent findings: Hypertension and erectile dysfunction are closely intertwined diseases, which have endothelial dysfunction as a common base. During hypertension and/or erectile dysfunction, disturbance of endothelium-derived factors can lead to an increase in vascular smooth muscle (VSM) contraction. Hypertension can lead to erectile dysfunction as a consequence of high blood pressure (BP) or due to antihypertensive treatment. However, growing evidence suggests erectile dysfunction is an early sign for hypertension. Also, some phosphodiesterase-5 inhibitors used to treat erectile dysfunction can improve BP, but the link between these conditions has not been totally understood.

Summary: This review will discuss the interplay between hypertension and erectile dysfunction, exploring newest insights regarding hypertension-associated erectile dysfunction, as well as the effect of antihypertensive drugs in erectile dysfunction patients.

Conflict of interest statement

The authors declare no conflict of interest.


Figure 1
Figure 1. Pathways involved in erectile function
On the right, signaling pathways involved in mediating cavernosal smooth muscle cell (CSMC) relaxation. On the left, signaling pathway involved in mediating CSMC contraction. During normal conditions, there is a balance between pro-erectile and pro-relaxation signaling pathways resulting in a normal erectile function. During hypertension, there is an increase in pro-contractile signaling and/or decrease in pro-relaxation signaling resulting in increased contractility and decrease relaxation of CSMC, therefore, resulting in ED. Treatment with hypertensive drugs resulting in either increasing CSMC relaxation (i.e. PDEi), or decreasing CSMC contractility (i.e. ACEi), which will result in improvement of CSMC function and improving or restoring erectile function. Ach: acetylcholine, ACE: angiotensin converting enzyme, ACEi: ACE inhibitors, CBS: cystathionine-β-synthase, CSE: cystathionine gamma-lyase, DAG: diacylglycerol, H2S: hydrogen sulfide, IP3: inositol 1,4,5-trisphosphate, PIP2: phosphatidylinositol 4,5-bisphosphate, MLC: myosin light chain, MLCK: myosin light chain kinase, NO: nitric oxide, PLC: phospholipase C, PDE: phosphodiesterase, PDEi: PDE inhibitors.

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