Purpose: Hypertension is the most common comorbidity in patients with erectile dysfunction (ED). Wave reflections (WR) are an important predictor of cardiovascular risk. The association of ED with WR in hypertensive patients has not been investigated.

Methods: 88 consecutive non diabetic treated hypertensive patients (61 ± 8yrs) affected by non-psychogenic and non-hormonal ED for more than 6 months were evaluated for penile vascular disease severity by penile Doppler ultrasound. Augmentation index (AIx) and augmented pressure (AP) were measured as an estimate of WR. Subendocardial-viability ratio (SVR) which is the ratio of diastolic pressure time interval/systolic pressure time interval was evaluated as a sensitive measurement of the adequacy of subendocardial muscle perfusion in response to myocardial oxygen demand.

Results: In univariate analysis, a negative correlation between AIx, AP and mean peak systolic velocity (PSV) of cavernous arteries (r=−0.33, P<0.01 and r=−0.24, P<0.05, respectively) and a positive correlation between SVR and PSV (r=0.28, P<0.05) was observed. Furthermore, in a multiple regression model, AIx was significantly associated with penile vascular disease severity (P<0.01) after controlling for age, heart rate, height, body-mass index, mean pressure, lipid profile, C-reactive protein, intensity of smoking (pack-years), antihypertensive agents and statines, (adjusted R2 of model: 0.42).

Conclusions: Our study shows that in hypertensive patients with ED, WR correlate significantly with increasing severity of penile vascular disease as measured by penile Doppler. This finding provides further insights into the pathophysiology of ED and may have implications for the cardiovascular risk in these patients.