Daily tadalafil administration improves cardiac autonomic regulation in men with non-organic erectile dysfunction: a prospective heart rate variability study
Year: 2026
Type: article
Study design: Clinical Trial
Abstract: Background: Non-organic ED patients have cardiac autonomic dysfunction measurable by heart rate variability (HRV). Tadalafil reduces cardiovascular mortality, but exact mechanisms remain unclear. Aim: To evaluate daily tadalafil effects on cardiac autonomic regulation in non-organic ED and identify clinical predictors of HRV response. Methods: In this prospective study, 82 men with non-organic ED (mean age 46.8 ± 5.0 years) received tadalafil 5-10 mg daily. Assessment included International Index of Erectile Function-Erectile Function (IIEF-EF), echocardiography, laboratory tests, and 24-hour Holter ECG. HRV was analyzed via time-domain (standard deviation of NN intervals [SDNN], root mean square of successive differences [RMSSD]) and frequency-domain (low-frequency power [LF], high-frequency power [HF], LF/HF ratio) parameters. Post-treatment recordings were blindly evaluated. Early response to tadalafil was defined as achievement in the severity-adjusted Minimal Clinically Important Difference (MCID) in IIEF-EF or final IIEF-EF score ≥26. Outcomes: Primary: ΔSDNN. Secondary: ΔHF power, ΔLF/HF ratio. Results: > .05), suggesting autonomic modulation independent of erectile response. Multivariable regression: diabetes negatively predicted SDNN improvement; higher testosterone, higher baseline IIEF-EF score, and lower BMI predicted greater HF enhancement. Only 1.1% of patients discontinued the treatment (due to dyspepsia). Clinical Implications: Daily tadalafil treatment may enhance parasympathetic modulation in men with non-organic ED regardless of clinical erectile improvement, suggesting a potential mechanism for its observed cardiovascular benefits. Strengths and Limitations: Strengths include rigorous, blinded Holter assessment. Limitations include the lack of a placebo control, short follow-up (28 days), and a small non-responder subgroup. Conclusion: Daily tadalafil enhanced parasympathetic modulation and reduced sympathovagal imbalance independently of erectile improvement.
Source: Sexual Medicine
Authors: Görkem Yıldız, Tolga Kunak
Institutions: Yüksek İhtisas Üniversitesi, Akdeniz University
Language: English
Subfield: Psychiatry and Mental health
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $2,750
OpenAlex ID: W7160870802