Introduction: Erectile function, an important aspect of quality of life, is gaining increased research and clinical attention in older men with hypertension. Aim: To assess the cross-sectional association between blood pressure measures (systolic blood pressure [SBP]; diastolic blood pressure [DBP]; and pulse pressure [PP]) and (i) sexual activity and (ii) erectile function in hypertensive men. Methods: We performed analyses of 1,255 male participants in a larger randomized clinical trial of 9,361 men and women with hypertension aged ≥50 years. Main Outcome Measures: The main outcome measures were self-reported sexual activity (yes/no) and erectile function using the 5-item International Index of Erectile Function (IIEF-5). Results: 857 participants (68.3%) reported being sexually active during the previous 4 weeks. The mean (SD) IIEF-5 score for sexually active participants was 18.0 (5.8), and 59.9% of the sample reported an IIEF-5 score <21, suggesting erectile dysfunction (ED). In adjusted logistic regression models, neither SBP (adjusted odds ratio = 0.998; P =.707) nor DBP (adjusted odds ratio = 1.001; P =.929) was significantly associated with sexual activity. In multivariable linear regression analyses in sexually active participants, lower SBP (β = −0.04; P =.025) and higher DBP (β = 0.05; P =.029) were associated with better erectile function. In additional multivariable analyses, lower PP pressure was associated with better erectile function (β = −0.04; P =.02). Clinical Implications: Blood pressure is an important consideration in the assessment of erectile function in men with hypertension. Strengths & Limitations: Assessments of blood pressure and clinical and psychosocial variables were performed using rigorous methods in this multi-ethnic and geographically diverse sample. However, these cross-sectional analyses did not include assessment of androgen or testosterone levels. Conclusions: Erectile dysfunction was highly prevalent in this sample of men with hypertension, and SBP, DBP, and PP were associated with erectile function in this sample. Foy CG, Newman JC, Berlowitz DR, et al. Blood Pressure, Sexual Activity, and Erectile Function in Hypertensive Men: Baseline Findings from the Systolic Blood Pressure Intervention Trial (SPRINT). J Sex Med 2019;16:235–247.