Can High Blood Pressure Cause Erectile Dysfunction?

How Is High Blood Pressure Linked To Erectile Dysfunction?

High blood pressure¹ (also known as hypertension) is a condition where a person's blood pressure reading is sustained at a level higher than the ideal or expected level long term. Although there is no single cause, chronic hypertension can lead to arteriolosclerosis (plaque formation in arterioles), causing damaged arteries.

Doctors measure blood pressure with two numbers:

• Systolic pressure

• Diastolic pressure

The 2017 ACC/AHA guidelines² for the prevention, detection, evaluation, and management of high blood pressure in adults define hypertension as a systolic blood pressure measurement equal to or over 130mm Hg or any diastolic blood pressure measurement equal to or over 80mm Hg.

This is compared to the average “normal” reading of around 114/69mm Hg.³

Erectile dysfunction (ED)⁴ involves an ongoing inability to get or maintain an erection. For an erection to occur, there needs to be a normal flow of blood into the penis, and the relevant erectile structures need to work normally.

Many studies⁵ have found a link between high blood pressure and erectile dysfunction. People with hypertension are twice as likely⁶ to have erectile dysfunction than people without this condition.

There are many possible reasons for the link between the two conditions, but improving the risk factors for heart disease can reduce the risk of erectile dysfunction.

Can high blood pressure cause erectile dysfunction?

Experts⁷ believe that high blood pressure can cause or contribute to erectile dysfunction. While it is not known exactly how this process works, there are a few possible reasons.

High blood pressure may be associated with narrowing arteries near the penis due to plaque buildup, or it may be associated with slight damage to the insides of these arteries (endothelial damage).

This can reduce the blood flow to structures of the penis that allow erections to occur. Smooth muscle dysfunction might also have a role to play. Smooth muscle is an important part of the arteries and crucial for erectile function. A poor smooth-muscle function is a hallmark of erectile dysfunction and high blood pressure.

Some medications for high blood pressure are known to cause erectile dysfunction, especially traditional medicines like beta-blockers and thiazide diuretics. Side effects like erectile dysfunction are a very common reason that people stop using their blood pressure medications.

However, there are many different treatment options, not all of which are associated with erectile dysfunction. If you have high blood pressure, a doctor can help you find the right medication for your needs.

How can high blood pressure affect men’s sexual health?

Erectile dysfunction is one of the main sexual health problems facing men with high blood pressure. However, many other potential issues can affect men’s sex lives and overall well-being.

High blood pressure is associated with problems with the structure of arteries due to the buildup of plaques made from cholesterol and other substances. This can affect the blood vessels in the pelvic area, which are essential for an erection.

Hypertension has also been shown to negatively affect semen volume, count, and motility, so men with this problem may have difficulty conceiving a child.

Which blood pressure drugs can cause erectile dysfunction?

There are many different types of drugs that help lower blood pressure. Some of these, especially the older, more traditional options, are known to have the possible side effect of erectile dysfunction.

The main classes of drugs that cause erectile dysfunction are beta-blockers and thiazide diuretics. However, there are many drugs within each class, and not all types cause erectile dysfunction.

Beta-blockers

Beta-blockers⁸ are one type of medication used to lower blood pressure. They work by slowing the heart and reducing myocardial contractility, thus reducing blood pressure.

There are many different types of beta-blockers. Although they all block beta receptors, and their effectiveness in reducing blood pressure is similar, some are more cardioselective (greater effect on heart tissue than other tissue) than others. They also differ in their intrinsic sympathomimetic activity (stimulation of beta-adrenergic receptors) and the ability to cross the blood-brain barrier.

Some beta-blockers can cause erectile dysfunction. These include:

• Propranolol (Inderal)

• Atenolol (Tenormin)

• Carvedilol

• Pindolol

• Metoprolol

Some beta-blockers (cardioselective) work only on the heart and thus are not expected to cause ED, while others (non-selective) work throughout the body, including the penile tissues, and thus are more likely to cause ED.

This means that cardioselective beta-blockers, such as esmolol, bisoprolol, or nebivolol,  should be better from an ED perspective. It's worth noting, though, that some beta-blockers, such as metoprolol or atenolol, have been shown to decrease the levels of testosterone in vivo.

Luckily, some types of beta-blockers are less likely to cause erectile dysfunction. The low incidence and sometimes improvements of ED when nebivolol is used have been attributed to nebivolol-mediated increases in the release of nitric oxide. These include:

• Nebivolol (Nebilet, Bystolic)

• Bisoprolol (Monocor, Zebeta)

Thiazide diuretics

Thiazide diuretics are another type of drug used to treat hypertension. This medication works by reducing plasma volume and vascular (blood vessels) resistance to reduce blood pressure. The most commonly used diuretics are thiazide diuretics. Examples are:

• Chlorthalidone (Hygroton, Thalitone)

• Hydrochlorothiazide (Microzide, HydroDiuril, Oretic)

The effect of diuretics on erectile dysfunction can be worse if they are combined with other medications like beta-blockers.

Types of blood pressure drugs that don’t cause erectile dysfunction

Luckily, beta-blockers and thiazide diuretics aren't the only options. There are many other drugs used to treat high blood pressure that does not cause erectile dysfunction as a common side effect.

Blood pressure drugs that don’t usually cause erectile dysfunction include:

• Angiotensin-converting enzyme (ACE) inhibitors

• Angiotensin II receptor blockers

• Alpha-blockers

• Calcium channel blockers

Angiotensin-converting enzyme (ACE) inhibitors

ACE inhibitors work mainly by interfering with the conversion of angiotensin I to angiotensin II, thereby decreasing peripheral vascular resistance. This effect is the relaxation of the blood vessels, so blood pressure is lowered. Examples of ACE inhibitors include:

• Enalapril (Vasotec)

• Captopril (Capoten)

Experts have found that ACE inhibitors are not associated⁹ with erectile dysfunction. In fact, there is data¹⁰ suggesting that ACE inhibitors may be beneficial in ED.

Angiotensin II receptor blockers (ARBs)

Angiotensin II receptor blockers¹¹ are a type of drug that block angiotensin II receptors and therefore interfere with the renin-angiotensin system (system associated with blood pressure). The result of this is the relaxation of blood vessels and reduced blood pressure. 

Examples of angiotensin II receptor blockers include:

• Losartan (Cozaar)

• Telmisartan (Micardis)

There is clear evidence¹² that angiotensin II receptor blockers do not cause erectile dysfunction. Studies¹³ have shown that angiotensin II receptor blockers might have a positive effect on erectile function. It may be possible for these drugs to undo some of the damage to erectile structures caused by high blood pressure.

Calcium channel blockers (CCBs)

There are two types of CCBs. Dihydropyridines, such as nifedipine and amlodipine, are potent peripheral vasodilators. They lower blood pressure by reducing total peripheral vascular resistance.

On the other hand, nondihydropyridine CCBs decrease AV conduction, slow the heart rate, and decrease myocardial contractility, all leading to a lowering of blood pressure. Examples include:

• Diltiazem

• Nifedipine (Adalat, Procardia)

• Verapamil

There is some unclear evidence¹⁴ about the relationship between calcium channel blockers and erectile dysfunction. However, based on the evidence we do have, it is most likely that calcium channel blockers do not affect erectile function.

How to treat high blood pressure without causing erectile dysfunction

If untreated, high blood pressure can lead to many different health problems, including heart issues. This condition can get worse over time if not properly managed. Therefore, it is important that high blood pressure is treated and managed by a doctor.

Sometimes, blood pressure drugs can cause issues, including erectile dysfunction, which can cause people to want to stop taking their medications. However, modern blood pressure medications do not usually cause erectile dysfunction.

High blood pressure should always be managed by a physician. If you are experiencing any side effects and want to change your medication, consult your doctor first. In particular, if you are concerned that your medication is causing erectile dysfunction or other sexual problems, you could discuss trying one or a combination of the following drugs:

• ACE inhibitors

• Angiotensin II receptor blockers

• Calcium channel blockers

Sometimes, high blood pressure treatment requires a combination of two or more drugs. Speak to your doctor about which combination of these drugs can be safely taken together. Importantly, taking safe combinations does not usually increase the chances of developing erectile dysfunction.

How to prevent high blood pressure without causing erectile dysfunction

Having a healthy lifestyle is the best way to prevent hypertension. This is because hypertension is caused by a complex pathology associated with the hypertensive state, involving structural changes, remodeling, and hypertrophy in resistance arterioles. 

Obesity, a sedentary lifestyle, and a poor diet are all risk factors for different aspects of the development of hypertension. Eating a “heart-healthy” diet is an effective way to prevent high blood pressure. This includes:

• Fruits and vegetables

• Lean protein

• Reduced saturated fat

• Reduced salt intake

• Reduced alcohol intake

Other ways to prevent high blood pressure include quitting smoking and exercising regularly. In addition, a healthy diet and regular exercise can prevent obesity, which is also linked to erectile dysfunction.¹⁵

These lifestyle modifications are likely to improve any existing erectile dysfunction or prevent the condition from developing. Sometimes lifestyle changes are used as part of a treatment plan for erectile dysfunction.

Drug treatments that could cause erectile dysfunction are not usually used for the prevention of high blood pressure, only when people are diagnosed with high blood pressure by their doctor.

When to visit a doctor

Visit your doctor if you have ongoing problems getting or maintaining an erection. Erectile dysfunction can be troublesome and affect your sex life, but it can also be a sign of other underlying problems. It is important that a doctor assesses you to see what kind of management or treatment you might need.

For example, erectile dysfunction could be comorbid with (existing alongside) untreated high blood pressure, heart disease, or diabetes. With treatment, these conditions can be managed, and this management could also help with erectile dysfunction.

High blood pressure does not typically have any symptoms, so it is important to visit your doctor regularly for a check-up, during which they will check your blood pressure.

The lowdown

High blood pressure, also called hypertension, is a condition in which there is too much force on the walls of the arteries.

There are a few different ways blood pressure might be associated with erectile dysfunction. These include narrowing or damage to the arteries near the penis or damage to smooth muscles involved in erection.

Some traditional blood pressure medications are known to cause erectile dysfunction, including beta-blockers and diuretics. However, newer blood pressure medications like ACE inhibitors, angiotensin II receptor blockers, and calcium channel blockers do not usually cause such side effects.

Using newer treatments for the high blood pressure may even reduce the likelihood of getting erectile dysfunction in the first place. However, lifestyle changes are the best way to prevent high blood pressure. These changes, like improved diet and exercise, will also help with erectile function and sexual health.

Visit your doctor regularly for blood pressure checks and if you have had ongoing (not one-off) erectile dysfunction because this could be a sign of other health issues.