Does High Blood Pressure Cause Erectile Dysfunction?

High blood pressure, or hypertension, can cause a wide range of problems if left untreated (via Mayo Clinic). It can weaken your arteries, damage your kidneys, and cause a heart attack or stroke. There can also be more unexpected long-term effects from high blood pressure, including dementia as a result of blocked arteries limiting blood flow to the brain, or blurred vision and even blindness due to damaged blood vessels in the eyes. More than 670,000 deaths in the United States in 2020 were linked to hypertension, and nearly half the country's adults suffer from the condition (via the Centers for Disease Control & Prevention).

In addition to these very serious long-term effects, high blood pressure can also affect your day-to-day life as well. According to the World Health Organization, patients with hypertension can suffer such symptoms as headaches, nosebleeds, and, in severe cases, anxiety, chest pain, and vomiting. However, perhaps most worrying to male hypertension patients is the link between hypertension and sexual dysfunction.

According to a 2012 study published in the International Journal of Hypertension, 68% of men between the ages of 35 and 75 who had high blood pressure also suffered from erectile dysfunction. In addition, the restricted blood flow cause by hypertension can impact the delivery of testosterone, resulting in a lowered sex drive and difficulty achieving and maintaining an erection (via Priority Men's Medical Center).

The penis shaft consists of two side-by-side chambers, called the corpora cavernosa (via WebMD). These two chambers are made up of a number of arteries and veins and smooth muscle fiber. In cases of hypertension, those arteries are unable to dilate correctly, restricting the flow of blood to the penis and preventing erection. Additionally, the smooth muscle of the corpora cavernosa loses its ability to relax, which also impacts blood flow and prevents erections.

While the condition itself can lead to erection problems, there is also a risk that the drugs used to treat hypertension can have sexual side effects. There are many drugs for which erectile dysfunction can be a side effect, but blood pressure drugs are at the high end of the list (via Harvard Medical School). Drugs like diuretics and beta-blockers can cause a reduction in penile blood flow and subsequent erection problems. There are other BP drugs, such as alpha-blockers, antigen-sin-receptor blockers, and ACE inhibitors, for which erectile dysfunction is not a common side effect.

According to WebMD, beta-blockers such as Atenolol or diuretics such as hydrochlorothiazide or are likely the first drugs your doctor will prescribe if you cannot manage your blood pressure through lifestyle changes like diet and exercise, though they carry a high probability for ED. If that is the case, it is recommended that you stay on the medication until your blood pressure is better managed. 

It's also important to note that there are some blood pressure medications that may actually improve sexual performance. A 2001 study published in the American Journal of Hypertension showed that patients who were treated with the drug Valsartan, an angiotensin II receptor blocker, had sex more often after going on the drug than before, increasing to 10 times a month versus four times before going on the medication. Conversely, patients treated with carvedilol, a beta-blocker, showed a decrease in sexual activity, down to four times a month after taking the drug from eight times before.

If your erection problems continue, you can talk to your doctor about taking erectile dysfunction drugs like Viagra or Cialis. However, caution should be used when taking these medications in combination with certain medications, as there can be dangerous side effects (via Mayo Clinic). An open and honest conversation about the right treatment for your blood pressure, as well as your concerns about the possible sexual side effects, is the best course towards a healthy and fulfilling life ahead.