Effect of Intensive vs Standard Blood Pressure Treatment Upon Erectile Function in Hypertensive Men: Findings From the Systolic Blood Pressure Intervention Trial

Abstract

Introduction: The effect of intensive blood pressure control upon erectile function in men with hypertension, but without diabetes, is largely unknown.

Aim: To examine the effects of intensive systolic blood pressure (SBP) lowering on erectile function in a multiethnic clinical trial of men with hypertension.

Methods: We 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 measure: The 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.

Results: At 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 implications: The effect of intensive treatment of blood pressure on erectile function was very small overall and likely not of great clinical magnitude.

Strength & limitations: Although this study included a validated measure of erectile function, testosterone, other androgen, and estrogen levels were not assessed.

Conclusion: In 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.

Keywords: Erectile Function; Hypertension; Intensive Treatment for Blood Pressure; Older Men; Race and Ethnicity; Sexual Function.

Figure 1.

Mean Systolic Blood Pressures, and Number of Antihypertensive Medications According to Race/Ethnicity and Treatment Group In Panels A, B, and C, the mean number of medications is the number of blood pressure medications administered at the exit of each visit. The bars represent 95% confidence intervals. Please note that the vertical axis for Panel C has a slightly different range compared to Panels A and B.

Figure 2.

Mean Diastolic Blood Pressures, and Number of Antihypertensive Medications According to Race/Ethnicity and Treatment Group In Panels A, B, and C, the mean number of medications is the number of blood pressure medications administered at the exit of each visit. The vertical bars represent 95% confidence intervals. Please note that the vertical axis for Panel C has a slightly different range compared to Panels A and B.

Figure 3.

Change in International Index of Erectile Function (IIEF-5) Scores over the Course of the Study, by Racial/Ethnic and Treatment Group For Panels A, B and C, the data points represent the estimated mean change in scores from baseline in the two treatment groups over time. The mean number of medications is the number of blood pressure medications administered at the exit of each visit. The vertical bars represent 95% confidence intervals. Scores on the IIEF-5 range from 5 to 25, with lower scores suggesting poorer erectile function.