Loyola University Chicago Stritch School of Medicine
Introduction: Cardiovascular disease (CVD) is the leading cause of death in Black men in the U.S. Erectile dysfunction (ED) serves as an indicator of CVD. CVD disproportionately affects Black men, with hypertension being the leading contributor. Several studies have cited ED side effects as a major factor in antihypertensive noncompliance in Black men, further exacerbating hypertension and ED. For decades, guidelines have recommended thiazides and calcium channel blockers as first line therapies for hypertension in Blacks, despite these options being associated with increased rates of ED. A 2022 retrospective study by Holt et al showed that race-based hypertension guidelines yielded no clear benefits in patient outcomes. We aimed to assess the clinical characteristics and treatment patterns of hypertensive men with ED at an academic medical center. Methods: All men presenting for an initial visit for ED (primary ICD-10 code N52.9) between October 2015-July 2022 were included for analysis. The electronic health record was queried for patient demographics, provider type, comorbidities, and major drug classes of antihypertensives. Adjusted odds ratios were estimated from multivariable logistic regression (any CVD and any medications) and ordinal logistic regression (number of CVD comorbidities) analyses. Results: Of 2020 men who presented for ED, the mean age was 55±14, 49.7% were White (n=987, 49.7%), 24.8% Black (n=493), and 18.9% Hispanic (n=375). The most common cardiovascular comorbidity was hypertension (n=960, 47.5%). Underlying cardiovascular disease burden was generally higher among Black men. Black men had higher odds of being prescribed an antihypertensive (aOR vs White: 1.50, 95% CI: 1.16-1.93; aOR vs Hispanic: 1.96, 95% CI: 1.45-2.67). However, Black men were prescribed beta blockers and thiazides significantly more than White and Hispanic men. White men were prescribed angiotensin receptor blockers (ARBs) significantly more than Black and Hispanic men. Conclusions: This study mirrors the effects of race-based hypertension guidelines. ARBs have typically been more favorable antihypertensives when considering sexual function . In this study, we showed that Black men were prescribed ARBs at significantly lower rates compared to White and Hispanic men. Given the significant ED side effects has on hypertension compliance, shifting traditional treatment regimens could lead to improved rates of hypertension control and erectile function. ED sits in a unique position to impact how we solve the CVD crisis. SOURCE OF Funding: none
