Prevalence of peripheral arterial disease and erectile dysfunction among ambulant hypertensive males at Kenyatta national hospital investigator

Abstract

Background Hypertension affects 22% of the world‟s population and is a risk factor for cardiovascular disease (CVD) including stroke and coronary artery disease (CAD) partly due to atherosclerosis. The underlying pathophysiological link between hypertension, peripheral arterial disease (PAD) and vasculogenic erectile dysfunction (ED) is endothelial dysfunction. The common risk factors for PAD and ED for atherosclerosis include hypertension, age, cigarette smoking and hazardous alcohol consumption. The worldwide prevalence of PAD is estimated to be up to 29% and is an independent risk factor for cardiovascular morbidity and mortality. The association between ED and PAD has been confirmed in several studies with prevalence of ED reported as high as 68% in hypertensive patients and is associated with a two-to-fivefold increase in mortality. The aim of this study was to investigate the prevalence of PAD and ED, explore their correlation and associated risk factors among male hypertensive patients. Objective Determine the prevalence of peripheral arterial disease and erectile dysfunction, their associations and their correlation among ambulant hypertensive males at the Kenyatta National Hospital. Methods In this hospital-based cross-sectional study 385 ambulant hypertensive male patients at the Kenyatta National Hospital (KNH) on follow up in medical outpatient clinics were enrolled into the study. After giving informed consent to participate in the study were enrolled consecutively by convenience sampling. A targeted clinical history and physical examination was performed and data was entered into standardized questionnaires. PAD was determined using ankle brachial index (ABI) measurement and International Index of Erectile Function (IIEF-5) questionnaire was administered to assess the presence and severity of ED. Results: The prevalence of PAD was 49.9% (95% CI 44.7-55.1%) with an increase in prevalence above age 50 years. The prevalence of ED was 94.5% (95% CI 92.2-96.6%) without a significant change in prevalence due to age. History of smoking had a prevalence of 54.2% and was 14 associated with nearly two-fold risk of PAD (OR 1.8 (95% CI 1.2-2.7), p=0.005) but was not significant in ED. Fourteen percent of patients had hazardous alcohol consumption showing a protective benefit in PAD (OR 0.6) and ED (OR 0.7) but was not statistically significant. The duration of hypertension from diagnosis was not significantly associated with PAD or ED. An elevated waist-hip ratio was noted to be protective with an OR 0.4 (95% CI, p<0.001) in PAD though not significant in ED. There was an agreement on McNemar‟s testing that demonstrated correlation between ED and PAD with 50.8% (p<0.001) patients who had ED likely to have PAD. Conclusion: There is an increased prevalence of PAD and ED among male hypertensive, non-diabetic population. A positive cigarette smoking history was associated with. In this study a significant concordance exists between ED and PAD which may demonstrate the increased population at risk of atherosclerotic disease. These findings may be used justify the use of ED screening to identify patients who may require assessment for PAD in order to have early detection, prevention, and management in order to prevent progression of PAD and improve quality of life. Key words: Peripheral arterial disease, erectile dysfunction, hypertension, cigarette smoking, hazardous alcohol consumption, correlation between Peripheral arterial disease and erectile dysfunction, PAD and ED.