Low testosterone and high c-reactive protein are complementary determinants of global arterial function and early structural changes in hypertensive males with erectile dysfunction

Objective: Arterial functional and structural characteristics are important determinants of cardiovascular performance and predictors of risk in hypertensive patients with erectile dysfunction (ED). Low androgen level and low-grade inflammation may be contributing factors to atherosclerosis process and cardiovascular disease. We investigated whether low testosterone and high C-reactive protein (CRP) levels are complementary determinants of global arterial function and early structural changes in hypertensive ED patients. Methods: We evaluated arterial structural and functional characteristics (carotid-femoral pulse wave velocity (PWV), augmentation index (AIx), flow-mediated dilation (FMD) of the brachial artery and penile peak systolic velocity (PSV) and we measured high sensitivity CRP and total testosterone (TT) levels in 167 hypertensive ED patients (mean age 56± 7 years) without manifest cardiovascular/atherosclerotic disease. Results: In multivariable models, both CRP and TT are significantly correlated with brachial FMD, penile PSV, carotid-femoral PWV and AIx. The distribution of CRP was split by the median (1.85 mg/l) and accordingly subjects were stratified into those with high and low level. All patients were then categorized by CRP level and further subdivided according to presence/absence of testosterone deficiency (TT< 3.5 ng/ml). The subgroup of hypertensive patients with high CRP/low TT (n= 41) exhibited significantly lower age and systolic blood pressure-adjusted brachial FMD and penile PSV (figures A-B) and higher PWV, AIx (figures C-D) as compared with the subgroups of high CRP/high TT, low CRP/low TT and low CRP/high TT (overall P < 0.01, by ANCOVA). Conclusion: In hypertensive males with ED pronounced subclinical inflammation in conjunction with low androgen level exert an additive unfavourable effect on arterial function and structure. This finding underlines the important role of TT and CRP as markers of arterial damage, and implies a synergistic role of these compounds to the pathophysiology of cardiovascular disease in hypertensive ED patients.