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

SPRINT Study Research Group

Research output: Contribution to journalArticle

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.

Original languageEnglish (US)
Pages (from-to)238-248
Number of pages11
JournalJournal of Sexual Medicine
Volume17
Issue number2
DOIs
StatePublished - Feb 2020

Fingerprint

Blood Pressure
Therapeutics
Hypertension
Gabexate
Hispanic Americans
Androgens
Testosterone
Estrogens
Cardiovascular Diseases
Clinical Trials
Incidence

Keywords

  • Erectile Function
  • Hypertension
  • Intensive Treatment for Blood Pressure
  • Older Men
  • Race and Ethnicity
  • Sexual Function

ASJC Scopus subject areas

  • Reproductive Medicine
  • Obstetrics and Gynecology
  • Urology

Cite this

Effect of Intensive vs Standard Blood Pressure Treatment Upon Erectile Function in Hypertensive Men : Findings From the Systolic Blood Pressure Intervention Trial. / SPRINT Study Research Group.

In: Journal of Sexual Medicine, Vol. 17, No. 2, 02.2020, p. 238-248.

Research output: Contribution to journalArticle

@article{01b06b6f542f474cb29c0770f5ca8b54,
title = "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",
author = "{SPRINT Study Research Group} and Foy, {Capri G.} and Newman, {Jill C.} and Russell, {Greg B.} and Berlowitz, {Dan R.} and Bates, {Jeffrey T.} and Burgner, {Anna M.} and Carson, {Thaddeus Y.} and Chertow, {Glenn M.} and Doumas, {Michael N.} and Hughes, {Robin Y.} and Kostis, {John B.} and Buren, {Peter van} and Wadley, {Virginia G.}",
year = "2020",
month = "2",
doi = "10.1016/j.jsxm.2019.11.256",
language = "English (US)",
volume = "17",
pages = "238--248",
journal = "Journal of Sexual Medicine",
issn = "1743-6095",
publisher = "Wiley-Blackwell",
number = "2",

}

TY - JOUR

T1 - Effect of Intensive vs Standard Blood Pressure Treatment Upon Erectile Function in Hypertensive Men

T2 - Findings From the Systolic Blood Pressure Intervention Trial

AU - SPRINT Study Research Group

AU - Foy, Capri G.

AU - Newman, Jill C.

AU - Russell, Greg B.

AU - Berlowitz, Dan R.

AU - Bates, Jeffrey T.

AU - Burgner, Anna M.

AU - Carson, Thaddeus Y.

AU - Chertow, Glenn M.

AU - Doumas, Michael N.

AU - Hughes, Robin Y.

AU - Kostis, John B.

AU - Buren, Peter van

AU - Wadley, Virginia G.

PY - 2020/2

Y1 - 2020/2

N2 - 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.

AB - 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.

KW - Erectile Function

KW - Hypertension

KW - Intensive Treatment for Blood Pressure

KW - Older Men

KW - Race and Ethnicity

KW - Sexual Function

UR - http://www.scopus.com/inward/record.url?scp=85077151112&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85077151112&partnerID=8YFLogxK

U2 - 10.1016/j.jsxm.2019.11.256

DO - 10.1016/j.jsxm.2019.11.256

M3 - Article

C2 - 31862174

AN - SCOPUS:85077151112

VL - 17

SP - 238

EP - 248

JO - Journal of Sexual Medicine

JF - Journal of Sexual Medicine

SN - 1743-6095

IS - 2

ER -