Relation of Postexercise Reduction of Arterial Blood Pressure and Erectile Dysfunction in Patients with Coronary Heart Disease

https://doi.org/10.1016/j.amjcard.2018.03.368Get rights and content

Penile erection is a hemodynamic process consisting of 2 synchronized components in which the first (active) requires proper vascular endothelium functioning, whereas the second one (passive) is based on a veno-occlusive mechanism. Antihypertensive treatment reduces the passive component, often leading to the development of erectile dysfunction (ED), but lifestyle modifications can improve the sexual functioning. The study aimed to evaluate the association between blood pressure (BP) reduction caused by cardiovascular training and the intensity of ED in men with coronary heart disease. A total of 101 men (mean age 59.50 ± 7.93) with ED treated invasively for coronary heart disease and subjected to cardiac rehabilitation were enrolled. Patient characteristics, the International Index of Erectile Function 5 (IIEF-5) questionnaire (IIEF-5), and BP values were collected at baseline and after 6 months of cardiac rehabilitation and were analyzed. Cardiac rehabilitation led to a significant reduction of 5.08 mm Hg in systolic BP (p <0.001) and of 1.60 mm Hg in diastolic BP (p <0.001). The IIEF-5 score (EQ) significantly increased (median 15, interquartile range 11 to 19 vs median 18, interquartile range 12 to 21, p <0.001). Greater improvement in sexual performance was significantly negatively correlated with age, concentration of triglycerides, and high-density lipoprotein, whereas it was positively correlated with the presence of diabetes and baseline IIEF-5 score. After excluding patients with diabetes, a greater decrease in systolic BP was found to be significantly associated with greater improvement in erectile performance. In conclusion, a reduction of arterial BP caused by cardiac training is accompanied by improvement in erectile performance. This effect is the strongest in patients with hypertension and those with dyslipidemia.

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Methods

A total of 101 consecutive men (mean age 59.50 ± 7.93) with ED treated invasively for CHD and subjected to cardiac rehabilitation were enrolled; only those who agreed to participate in the study (written informed consent) and answered the abridged International Index of Erectile Function 5 (IIEF-5) questionnaire twice were enrolled. All patients denied having lung disease, depression, or hormonal disorders requiring chronic pharmacotherapy. No significant abnormalities were found in the initial

Results

As a result of cardiac rehabilitation, the mean value of SBP and DBP decreased significantly, whereas the IIEF-5 score (EQ) increased significantly. The values of SBP and DBP are presented in Figure 1, whereas values of EQ are shown in Figure 2.

The baseline EQ was significantly associated with age (r = −0.560, p = 0.000). Taking into account clinical parameters, it was correlated with triglycerides (r = −0.299, p = 0.002), high-density lipoprotein cholesterol (r = 0.287, p = 0.007), plasma

Discussion

The physiology of erection is a complex phenomenon. The relaxation of the smooth muscular layer of the corpora cavernosa of the penis associated with non-noradrenergic, non-cholinergic activation exerts a direct impact on the increase in blood flow through the corpora cavernosa. Nitric oxide, released in non-noradrenergic, non-cholinergic fiber endings and vascular endothelial cells, is the main neurotransmitter participating in the erection process. The inflow of the blood exceeding its

Disclosures

The authors have no conflicts of interest to disclose.

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