ht affects about one - fifth of adult nigerians.[14 ] it is a risk factor for erectile dysfunction ( ed ) in men .
many studies have reported a higher prevalence of ed in hypertensive induviduals compared with normotensive individuals.[57 ] ed is defined as the persistent inability to achieve and/or maintained penile erection sufficient for sexual intercourse .
microalbuminuria ( ma ) is an important predictor of cardiovascular risk and complications in hypertensives.[810 ] ma has been described as a marker of generalized vascular damage .
ht plays an important role in endothelial damage which may affect the nitric oxide production and/or release leading to ed.[1113 ] there are few nigerian studies on male ed and ht .
the primary objective was to determine the prevalence of ma and ed in newly diagnosed hypertensive nigerians .
in addition , we also evaluated the relations between ed and ma and some other cardiovascular risk factors in essential ht .
the study was conducted at the cardiology clinic of a tertiary referral hospital in nigeria .
the study was done in newly diagnosed hypertensive patients who were yet to commence antihypertensive drugs .
the study protocol was approved by the ethics and research committee of the study center .
all the participants gave informed consent and the procedures followed were consistent with institutional guidelines .
individuals with diabetes mellitus , renal disease , endocrine disorder , heart failure , liver disease , prostatic enlargement , psychiatric illness , obesity , and proteinuria were excluded from the study .
a standardized protocol was followed , in which systolic blood pressure ( sbp ) and diastolic blood pressures ( dbp ) were measured on the left arm after the participants had been seated for at least 5 min .
three measurements were done at least 5 min apart and the mean value was used for the study .
ht was defined as sbp  140 mmhg and/or dbp  90 mmhg , or use of antihypertensive drugs .
general as well as specific examination of the external genitals for local abnormalities and digital rectal examination for prostatic enlargement were conducted .
venous blood samples were collected and analyzed for fasting plasma glucose ( fpg ) , serum total cholesterol ( tc ) , and serum triglyceride ( tg ) .
resting 12-lead electrocardiogram ( ecg ) of all the patients and controls were recorded using schiller at-1 machine at a sensitivity of 10 mm / mv and a paper speed of 25 mm / sec .
ecg left ventricular hypertrophy ( lvh ) was diagnosed based on standard ecg criteria.[1416 ] ed was evaluated using a standardized questionnaire of the international index of erectile function ( iief).[17195 ] we used an 
inform - then - probe  approach , whereby the participants were generously assured that their ed ( if present ) was not an uncommon condition .
the iief has been proved to be a reliable and widely used test to define sexual function .
ed is graded as severe ( 6 - 10 points ) , moderate ( 11 - 16 points ) , mild ( 17 - 25 points ) , and none ( 26 - 30 points ) .
ma was determined using the micra test strips ( boehringer mannheim , mannheim , germany ) .
this dipstick has been found to be a fast , accurate , and relatively , the cheapest way to screen patients for the presence of ma .
there are four color blocks on the test strip corresponding to negative ( or 0 ) , 20 , 50 , and 100 mg / l of albumin .
the test was done on three consecutive first morning - voided urine samples collected at 3 weeks intervals .
ma was considered to be present when two of the three urine samples tested produce a reaction color corresponding to 20 mg / l or more .
statistical analyses were done using the student 's t - test and chi?square to compare means and proportions respectively .
statistical analyses were done using the student 's t - test and chi?square to compare means and proportions respectively .
the mean age of the patients and the controls was 53.8  5.6 and 51.2  7.1 respectively .
ed was found in 32.1% of hypertensive patients and 16% of normotensive controls and the difference was statistically significant ( < 0.001 ) . among the hypertensive patients ,
there was a significant difference between the mean age of those with ed and those without ed ( 54.2  8.5 vs. 49.2  6.8 , p = 0.02 ) .
the prevalence of ma was significantly higher in patients with ed ( 65.4% ) than in those without ed ( 23.6% ) ( p < 0.001 ) .
hypertensive patients with ed were significantly more likely to have ecg lvh than their counterparts without ed ( p < 0.001 ) . the other characteristics and features of hypertensive patients with ed compared with hypertensive patients without ed
are shown in table 2 . when hypertensive patients with ed are divided into two subsets based on the presence or otherwise of ma , and then compared , the results obtained are shown in table 3 : the means of sbp ( p = 0.04 ) , dbp ( p = 0.02 ) , ecg lvh ( p <
0.001 ) , serum tc ( p = 0.1 ) , serum ldl - c ( p = 0.001 ) were significantly higher in those with ma than their counterparts without ma .
multiple regression analysis showed that ed was independently associated with ma , ecg lvh , age , dbp , and cigarette smoking .
characteristics of hypertensive patients and the controls characteristics of hypertensive patients with and without erectile dysfunction characteristics of hypertensive patients with erectile dysfunction with and without microalbuminuria
our study demonstrated a higher prevalence of ed in hypertensive patients than in normotensive individuals ( 32.1% vs. 16.0% ) .
for instance , aranda et al . reported a prevalence of ed among hypertensive patients of 46% in spain where patients with diabetes mellitus were included in the study . in this study ,
thus , the difference in prevalence may be due to study methodology including the selection of patients .
hypertensive patients with ed have significantly higher cardiovascular risk factors when compared to their counterparts without ed and to the normotensive controls .
ma was found in 37% of the hypertensive patients as against 6.7% in the controls .
this finding is higher than that of akinsola et al . who reported 17.4% prevalence of ma in ht .
the difference may be attributed to patient selection as we recruited hypertensive patients who had never been treated previously for the study .
treatment of hbp with antihypertensive medications , particularly angiotensin - converting - enzyme ( ace ) inhibitors , has been found to improve ma . in our study , ma , a cardiovascular risk factor and marker of endothelial damage , is also significantly more common in hypertensives with ed than in hypertensives without ed .
that is , patients with ed are more likely to have endothelial damage and dysfunction than their counterparts without ed .
the study also revealed that ed may also be related to cardiac damage as significantly more hypertensive patients with ed have ecg lvh .
ed is often a sentinel manifestation of damage to the vascular endothelium.[2830 ] the main link between ed and cardiovascular disease is the vascular endothelium , which has a fundamental role in the regulation of circulation .
thus , once the ability to generate nitric oxide has been compromised , ed may ensue .
the study shows that mal and ed might represent different variables with a common pathological process such as vascular damage .
this hypothesis is consistent with the finding of pedrinelli et al . who reported that ma was strongly associated with c - reactive protein ( crp ) which is an evidence of subclinical inflammation .
crp is also a cardiovascular risk factor and predicts cardiovascular prognosis independent of conventional risk factors .
thus , vascular damage with possible atherosclerosis and the resultant inadequate blood flow to the erectile tissue might cause ed .
there are conflicting reports on the role of cigarette smoking in the etio - pathogenesis of ed .
moreira et al . showed a 2.5-fold increased risk of ed among smokers in contrast to the study by doumas et al . and
the massachusetts male aging study where smoking was found not to be associated with ed .
this notwithstanding , long - term cigarette smoking is a major risk factor for vasculogenic ed because of its effects on the vascular endothelium .
it also causes nicotine - induced vasoconstriction of the cavernous smooth muscle . in our study , patients with ed were significantly more likely to be cigarette smokers than those without ed .
the effect of alcohol on penile erection depends on the volume and the duration of consumption .
although small quantities of alcohol may improve erection and enhance libido , large amounts result in central sedation , depression of libido , and ed .
however , one of the limitations of the study is that the alcohol ingestion was not quantified .
the study reveals that both ed and ma are common in adult male nigerians with ht .
it also points out that male ed in hypertensive patients is associated with ma and the subsets with either or both have increased risk of cardiovascular disease .
cigarette smoking , a major risk factor for atherosclerosis and cardiovascular disease , is also associated with ed . with a somewhat common pathological process of vascular damage between ed and ma
, it could be expected that antihypertensive drugs , particularly ace - inhibitors and angiotensin - receptor blockers , that improve ma might have some impact on ed .
this hypothesis is yet to be proven and may become a focus of research in the future .
 background : microalbuminuria has been described as a marker of generalized vascular damage.aims:the aim of the present study was to determine the prevalence of erectile dysfunction ( ed ) and microalbuminuria in adult male nigerians with newly diagnosed hypertension . 
 we also evaluated the relations between ed and microalbuminuria , electrocardiographic left ventricular hypertrophy , serum lipids , and cigarette smoking.materials and methods : a total of 81 male adult nigerians with newly diagnosed hypertension were recruited into the study . 
 there were also 75 age- and sex - matched healthy normotensive controls . 
 ed was evaluated using a standardized questionnaire of the international index of erectile function and microalbuminuria was determined using the micra test strips ( boehringer manneheim gmbh , mannheim , germany).results : eighty - one hypertensive patients and 75 normotensive controls were studied . 
 mean age of the patients and the controls was 53.8  5.6 and 51.2  7.1 respectively . 
 ed was found in 32.1% of the hypertensive patients and 16% of normotensive controls 
 ( p < 0.001 ) . 
 the prevalence of microalbuminuria was significantly higher in patients with ed than in those without it ( 65.4% vs. 23.6% , p < 0.0001).conclusion : the study shows that ed and microalbuminuria are common in male adult nigerians with hypertension . 
 it also demonstrates that male ed is associated with an increased risk of cardiovascular disease . 
Introduction
Materials and Methods
Statistical study
Results
Discussion
Conclusion