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Blood pressure, antihypertensive medication use, and risk of erectile dysfunction in men with type I diabetes

Sarma, Aruna V.a; Hotaling, James M.b; de Boer, Ian H.c; Dunn, Rodney L.a; Oerline, Mary K.a; Singh, Karandeepd; Goldberg, Jacke; Jacobson, Alanf; Braffett, Barbarag; Herman, William H.h; Pop-Busui, Rodicah; Wessells, Hunteri for the DCCT/EDIC Research Group

doi: 10.1097/HJH.0000000000001988

Objective: To gain insight into the effect of blood pressure on the pathophysiology of diabetic erectile dysfunction, we determined the onset, severity and treatment of hypertension and risk of incident erectile dysfunction in men with type I diabetes.

Methods: This prospective cohort study included 692 men without prevalent erectile dysfunction in the Epidemiology of Diabetes Interventions and Complications study. Erectile dysfunction was assessed yearly for 16 years with a single question querying presence of impotence. Multivariable cox proportional hazards models examined associations of hypertension variables with risk for incident erectile dysfunction.

Results: Over 7762 person-years of follow-up, 337 of 692 men reported incident erectile dysfunction representing an unadjusted rate of 43.4 cases per 1000 person-years. Risk of erectile dysfunction significantly increased with each 10 mmHg of SBP elevation for those not taking antihypertensive medications, after adjustment for age, cigarette smoking and HbA1c levels [relative risk (RR) = 1.21, 95% CI = 1.04–1.41]. This relationship disappeared among those reporting antihypertensive medication use (RR = 0.96, 95% CI = 0.84–1.10) and the interaction between SBP and medication use was statistically significant (P = 0.02). Antihypertensive medication did not confer any reduction of erectile dysfunction risk, with similar rates across all measures of blood pressure and hypertension.

Conclusion: Among men with type 1 diabetes not using antihypertensive medications, higher SBP is associated with increased risk of developing erectile dysfunction. These findings provide evidence to support further investigation into the potential benefit of early blood pressure control on risk of erectile dysfunction in men with diabetes regardless of age, blood pressure level, or glycemic control.

aDepartment of Urology, University of Michigan, Ann Arbor, Michigan

bDepartment of Urology, University of Utah, Salt Lake City, Utah

cDepartment of Medicine, University of Washington, Seattle, Washington

dDepartment of Learning Health Sciences, University of Michigan, Ann Arbor, Michigan

eDepartment of Epidemiology, University of Washington, Seattle, Washington

fResearch Institute, NYU Winthrop University Hospital, Mineola, New York

gBiostatistics Center, George Washington University, Rockville, Maryland

hDepartment of Internal Medicine, University of Michigan, Ann Arbor, Michigan

iDepartment of Urology and Diabetes Research Center, University of Washington, Seattle, Washington, USA

Correspondence to Aruna V. Sarma, PhD, Department of Urology, University of Michigan, 2900 Plymouth Road, Room 109E, Ann Arbor, MI 49109, USA. E-mail:

Abbreviations: ACEi, angiotensin-converting enzyme inhibitors; ARB, angiotensin receptor blockers; DCCT, Diabetes Control and Complications Trial; EDIC, Epidemiology of Diabetes, Interventions and Complications; HTN, hypertension; JNC, Joint National Committee; T1DM, type 1 diabetes; T2DM, type 2 diabetes

Received 7 August, 2018

Accepted 10 October, 2018

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