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 .