High blood pressure (hypertension) is a leading cause of erectile dysfunction (ED). Chronically high blood pressure puts a strain on the organs and tissues, slowing blood flow and therefore the ability to maintain an erection. ED from high blood pressure can be reversed, especially if you are generally healthy and high blood pressure is the sole culprit.
Certain high blood pressure drugs can also cause ED, while some other blood pressure medications improve ED.
This article discusses the connection between high blood pressure and erectile dysfunction and explains why some medications may exacerbate erectile dysfunction while others help in managing it.
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How High Blood Pressure Affects ED
High blood pressure puts people at higher risk of ED. Males with high blood pressure are nearly twice as likely to have erectile dysfunction and impaired penile blood flow compared to their peers with normal blood pressure. It is estimated that one-third of all males with hypertension experience erectile dysfunction.
High blood pressure damages blood vessels, reducing blood flow throughout the body, including the penis. Hardened and narrow blood vessels make it difficult for blood to flow into the penis before intercourse.
Erectile dysfunction can be an early warning sign of damaged blood vessels. This change in sexual function is sometimes an indicator of a larger problem, prompting people to seek help.
Can ED from high blood pressure be reversed?
If your ED is caused by high blood pressure and you are otherwise healthy, it is possible to reverse the condition with medication and lifestyle adjustments. It’s important to note that high blood pressure medications may be helpful to some people and harmful to others, so never start a medication without first speaking with your healthcare provider.
Blood Pressure Medications That Improve ED
Certain prescription medications have more beneficial effects on erectile function than others. The following drugs have been shown to be helpful:
Angiotensin-Converting Enzyme (ACE) Inhibitors and Erectile Dysfunction
Angiotensin-converting enzyme (ACE) inhibitors are a class of medications that lower blood pressure by relaxing veins and arteries. ACE inhibitors work by blocking the angiotensin-converting enzyme, which converts angiotensin I to angiotensin II. Angiotensin II is a potent hormone that causes smooth muscles around blood vessels to contract, resulting in the narrowing of blood vessels and a rise in blood pressure.
Blocking this effect results in a relaxing of blood vessels and a decrease in blood pressure. It also means that it can help promote blood flow to certain areas of the body like the penis. ACE inhibitors also reduce the workload of the heart which can increase stamina and sexual performance.
Common ACE inhibitors taken for high blood pressure include:
- Vasotec (enalapril)
- Lisinopril
- Perindopril
- Altace (ramipril)
- Captopril
- Lotensin (benazepril)
An ACE inhibitor like lisinopril is unlikely to result in ED because the drug increases blood flow. Studies have shown that lisinopril has a neutral effect on erectile function.
What to Know About Lisinopril (Zestril)
Vasodilators and Erectile Dysfunction
Arterial vasodilators relax blood vessels and improve blood flow, which helps to lower blood pressure.
Some common arterial vasodilators taken for high blood pressure include:
- Fosinopril
- Lotensin (benazepril)
- Captopril
- Vasotec (enalapril)
- Lisinopril
- Univasc (moexipril)
- Perindopril
- Quinapril
- Altace (ramipril)
- Trandolapril
Since these medications work by stimulating blood flow, they may have a secondary benefit of improving ED.
There are also vasodilators, like alprostadil, that are specifically prescribed for ED. These drugs are injected directly into the penis or urethra to promote blood flow to the area. You may experience an erection as quickly as 10 minutes after that. Alprostadil is also available as a urethral suppository for those who prefer a non-injectable form of therapy.
Erectile Dysfunction Injections: What You Need to Know
Angiotensin II Receptor Blockers (ARBs) and Erectile Dysfunction
Studies have shown that angiotensin receptor blockers (ARBs) either have no significant negative effects or in some cases, beneficial effects on erectile function.
ARBs are a group of drugs used to treat high blood pressure and heart failure. These medications work by blocking the action of a chemical (angiotensin) which narrows the blood vessels. As a result, blood vessels widen, increasing blood flow and lowering blood pressure. In some people, this effect also improves erectile function.
Some common ARBs taken for high blood pressure include:
- Edarbi (azilsartan)
- Atacand (candesartan)
- Avapro (irbesartan)
- Cozaar (losartan)
- Benicar (olmesartan)
- Micardis (telmisartan)
- Diovan (valsartan)
Alpha-Blockers and Erectile Dysfunction
Alpha-blockers are a class of drugs that block the effects of the hormones adrenaline and noradrenaline on your blood vessels.Adrenaline and noradrenaline cause your blood vessels to narrow so blood has less space to flow through. Alpha-blockers allow your blood vessels to relax and widen, making it easier for blood to flow through.
This effect can help facilitate blood flow to the penis. However, adrenaline and noradrenaline are also important mediators of sexual functioning and the development of an erection, so any decrease in their effect can increase the risk of ED.
For instance, alpha-blockers such as Hytrin (terazosin) and Cardura (doxazosin) can cause difficulty in maintaining an erection and/or decreased ejacul*tion. But as a class, alpha-blockers only rarely cause ED.
Alpha-blockers typically are not the first treatment option for high blood pressure, but some common alpha-blockers that may be taken for high blood pressure include:
- Cardura (doxazosin)
- Minipress (prazosin)
- Baratol (indoramin)
- Hytrin (terazosin)
Alpha-blockers shouldn’t be taken alongside PDE5 (phosphodiesterase type 5) inhibitors, like Viagra, and antidepressants, as they can cause a sudden drop in blood pressure if taken together.
Can you take Viagra if you're on blood pressure medication?
For many people with hypertension, taking Viagra is safe and effective, but it is important to discuss any new prescription medication—including medications for ED—with your healthcare provider. They will thoroughly evaluate your health history, current list of medications, and other factors to determine the safest and most appropriate course of treatment for you.
Viagra can interact with some classes of heart failure or blood pressure medications like alpha-blockers and nitrates, causing an unsafe drop in blood pressure. If you are taking several medications or are unsure if Viagra is contraindicated given your current medication regimen, seek information from a trusted medical professional.
Blood Pressure Medications That Increase the Risk of ED
One reason erectile dysfunction becomes more common with age is that older men are more likely to be on medication, and ED is often a side effect of many common drugs. In fact, it's estimated that 25% of all ED is caused by medication.
The following drug classes have been linked to increased risk of ED. If you have concerns about medications you are taking, talk with your healthcare provider about other available options. You should never start or stop a blood pressure medication without medical supervision.
Diuretics and Erectile Dysfunction
Diuretics, also known as water pills, increase urine output to help release excess water and salt from the blood. This helps lower blood pressure by decreasing the amount of blood the heart has to pump.
It's unknown exactly how diuretics affect erectile function, but some research suggests that diuretics can increase the occurrence of ED. Common diuretics that are taken include:
- Bumex (bumetanide)
- Hygroton (chlorthalidone)
- Diuril (chlorothiazide)
- Edecrin (ethacrynate)
- Lasix (furosemide)
- Esidrix, Hydrodiuril, Microzide (hydrochlorothiazide HCTZ)
- Lozol (indapamide)
- Enduron (methyclothiazide)
- Mykroz, Zaroxolyn (metolazone)
- Demadex (torsemide)
Bumex vs. Lasix: Which Is Best for Hypertension Treatment?
Beta Blockers and Erectile Dysfunction
Beta-blockers work by blocking the effect of adrenaline on tissues. Some research suggests beta-blockers may decrease blood flow to the penis, making it difficult to get an erection.
Contrarily, several studies have confirmed that taking the beta-blocker Bystolic (nebivolol) may actually be beneficial for erectile dysfunction.
Some commonly used beta-blockers that may negatively impact penile function include:
- Coreg (carvedilol)
- Lopressor, Toprol XL (metoprolol)
- Tenormin (atenolol)
- Inderal LA (propranolol)
Calcium Channel Blockers (CCBs) and Erectile Dysfunction
Calcium channel blockers treat hypertension by blocking calcium from entering the cells of the heart and arteries. This relaxes blood vessels and improves blood flow.
Calcium channel blockers are thought to have a neutral effect on erectile function, however, some studies have found a relationship between certain calcium channel blockers and ED. More research is needed to confirm the role of calcium channel blockers in erectile dysfunction.
Common calcium channel blockers prescribed for high blood pressure include:
- Norvasc (amlodipine)
- Plendil (felodipine)
- DynaCirc (isradipine)
- Cardene (nicardipine)
- Procardia XL, Adalat (nifedipine)
- Cardizem, Dilacor, Tiazac, Diltia XL (diltiazem)
- Sular (nisoldipine)
- Verelan, Covera-HS (verapamil)
Does amlodipine cause erectile dysfunction?
Amlodipine rarely causes erectile dysfunction, although there are some scientists who still debate amlodipine’s role in ED.
List of Every Calcium Channel Blocker
When to See a Healthcare Provider
If you have erectile problems more than just occasionally, or you are feeling concerned about problems you're experiencing, talk to your healthcare provider. You should also consult your healthcare provider if you experience ED shortly after starting treatment with any blood pressure drug. They can work with you to substitute a different one or help troubleshoot your problem.
Bear in mind that different drugs have different half-lives which means it may take several days to several weeks for the drug to leave your body. Thus, it may take some time for your erections to return after stopping a high blood pressure medication.
Outlook for ED and High Blood Pressure
Despite the debate surrounding the use of high blood pressure medication in ED patients, research shows that people with long-withstanding high blood pressure levels are more likely to have significant structural damage in their penile arteries. Treating the condition with antihypertensive drugs is unlikely to further reduce blood flow to the penis, and may prevent additional damage.
In people with normal or high-normal blood pressure, the penile arteries have minimal structural damage, and medications could have a negative impact on penile blood flow, which underscores the importance of having an accurate diagnosis prior to starting high blood pressure treatment.
Summary
High blood pressure can damage blood vessels, including the blood vessels in your penis. When blood flow to the penis is reduced, you may develop erectile dysfunction.
It is possible to reverse ED when it's caused by high blood pressure and you are otherwise healthy. Certain blood pressure medications can help, but some have been known to raise the risk of ED. Talk to your healthcare provider about your symptoms and whether or not you experience ED after starting a new medication.
