Association between cardiovascular drugs and erectile function quality assessed by nocturnal penile tumescence monitoring

BACKGROUND: In patients with cardiovascular risk factors, erectile dysfunction is an early marker of subclinical generalized vascular damage. Furthermore, cardiovascular drugs may impair erection quality.

AIM: The work aimed to determine the relationship between cardiovascular drugs and erectile function quality assessed by nocturnal penile tumescence monitoring.

METHODS: This retrospective study included 100 male patients who consecutively presented with complaints of erectile dysfunction between 2020 and 2022. All participants underwent nocturnal penile tumescence monitoring, and the results were evaluated using the criteria developed by Academician Kamalov and Professor Chaliy.

RESULTS: Patients with moderate/severe erectile dysfunction were nearly five times more likely to take spironolactone (18.9% vs. 4.8%, p = 0.036) and 2.5 times more likely to use diuretics (24.3% vs. 9.5%, p = 0.087) than those with no/mild erectile dysfunction. The total number of cardiovascular drugs used by patients with moderate/severe erectile dysfunction was twice as high as in those with no/mild erectile dysfunction, according to nocturnal penile tumescence findings. The frequency of β-blocker, statin, metformin, and renin–angiotensin–aldosterone system inhibitor use was comparable between the groups. Spironolactone and diuretics were associated with a 4.7-fold (odds ratio [OR]: 4.667; 95% confidence interval [CI]: 1.126–19.340; p = 0.034) and 3.1-fold (OR: 3.054; 95% CI: 0.989–9.431; p = 0.052) increased risk of moderate/severe erectile dysfunction, respectively. Moreover, the number of cardiovascular drugs taken increased the risk of moderate/severe erectile dysfunction based on nocturnal penile tumescence monitoring. Each additional drug increased the odds of moderate/severe erectile dysfunction by 1.3 times (OR: 1.304; 95% CI: 1.003–1.694; p = 0.047), primarily due to a reduction in nocturnal penile tumescence duration.

CONCLUSION: Spironolactone, known for its antiandrogenic effects, increased the odds of moderate/severe erectile dysfunction by 4.7 times based on nocturnal penile tumescence monitoring. Diuretic therapy was associated with more pronounced erectile dysfunction, whereas other cardiometabolic drugs did not affect erection quality. According to nocturnal penile tumescence monitoring, using more cardiovascular drugs was a significant risk factor for moderate/severe erectile dysfunction. This likely reflects more severe cardiovascular disease, which contributes to the onset and progression of erectile dysfunction.