Hypertension Erectile dysfunction has a high prevalence among patients with both treated and untreated hypertension. Large studies have confirmed that, not only was ED more prevalent in patients with elevated blood pressure than controls, but also that the degree of ED that experienced by patients with hypertension was also more severe in nature than in the general population.

One study highlighted the specific penile vascular effects of hypertension through the use of rat models.
The study found that hypertensive rats demonstrate impairment in endothelial-mediated relaxation of corporal cavernosal strips in response to acetylcholine. This finding suggested that a defect exists in endothelial-dependent reactivity as well as a reduction in nitric oxide in the presence of hypertension.

It is somewhat more difficult to evaluate the exact effect of hypertension on erectile function in humans. Patients are often being treated for their hypertension with medications that are themselves known to cause ED, such as beta blockers and thiazides. It is likely that the ED experienced in hypertensive men is caused by penile vascular arterial changes including atherosclerosis Obesity Obesity, which is an independent risk factor for cardiovascular disease, is also associated with ED. Esposito et al. showed that intervention with the modification of lifestyle behaviors that led to weight loss and decreased cardiac risk also led to the improvement in erectile function.

A decrease in body mass index may reduce the risk of both ED and endothelial dysfunction in obese men.
If obesity is positively associated with endothelial dysfunction and increased serum concentrations of vascular inflammatory makers, with what has been previously aforementioned, it would appear that a common pathway exists – patients suffer from both increased cardiovascular risk and ED per similar physiologic pathways.

In a more recent publication, Esposito et al. stated that obesity increases ED risk by 30–90% compared to controls. The authors again agreed that lifestyle changes aimed at reducing body mass index improves both erectile and endothelial function in men. In addition, they mentioned that Mediterranean-style diet may aid sexual function.

A separate literature review in 2006 was completely dedicated to the topic of the Mediterranean-style diet and its relation to sexual function. They found that sexual function can improve in as little as 2 years through exercise and adoption of the Mediterranean-style diet. Specifically, men consuming more fruits, vegetables, nuts, whole grain, and olive oil as compared with controls were found to have an improved endothelial function score and improved levels of inflammatory markers.