Erectile dysfunction & hypertension: ‘Same disorder, different tissues’

Erectile dysfunction (ED) has been proposed as a harbinger of coronary artery disease (CAD). In the November issue of the Journal of Men’s Health, two physicians suggest that ED and hypertension may be linked as well.

The idea that ED is a vascular disease in some patients is not new. Recognizing that atherosclerotic plaque can affect blood flow in the internal pudendal artery, researchers have tested the use of drug-eluting stents as a treatment for ED. A meta-analysis of studies of patients diagnosed with ED concluded that ED was a predictor of cardiovascular events, too.

Jacob Rajfer, MD, of the University of California Los Angeles Medical School, and Martin M. Miner, MD, of the Men’s Health Center at Miriam Hospital in Providence, R.I., reviewed literature on the etiology of ED with a focus on endothelial dysfunction and aging-related smooth muscle dysfunction. Endothelial dysfunction is considered a precursor and marker of atherosclerosis and possibly a marker of ED, they wrote.

Rajfer and Miner were in the smooth muscle dysfunction camp. “[I]f the majority of cases of ED are associated with a smooth muscle dysfunction due to progressive, genetically predetermined, aging-related apoptosis within the cavernosal tissue as we believe, it follows that these patients should have the same aging-related smooth muscle dysfunction within their peripheral vascular system,” they wrote.

Apoptosis in the peripheral arterial system can lead to atherosclerosis. Peripheral arterial stiffness in the vascular system would prompt an increase in peripheral vascular resistance, which would present as hypertension. That might explain why men with ED often also have hypertension. Aging-related apoptosis of vascular smooth muscle also might reconcile the numerous studies that associated ED with CAD, atherosclerosis and other heart disease, they wrote.

Smooth muscle apoptosis in the penis may cause cavernosal veno-occlusive dysfunction (CVOD). “If the hypertension [in the peripheral vascular system] goes unrecognized and untreated, EnD [endothelial dysfunction] may ensue. Once this occurs within the peripheral vascular system, arterial flow is impacted, which may then exacerbate whatever CVOD is present to make these patients present with symptomatic ED.”

The evidence weighs in favor of the probability that aging-related ED and hypertension are “the same disorder, albeit in two different tissues.” Rajfer and Miner concluded that screening men with ED for hypertension would be a logical step “rather than EnD or even CAD.”