High blood pressure and erectile dysfunction

Reviewed by our clinical team

High blood pressure and erectile dysfunction (ED) are both common conditions in males, and while certainly not a ‘normal’ part of growing older, you’re more likely to experience ED if you have high blood pressure.

According to a review of studies by King’s College London, erectile dysfunction affects up to one in five men - or 4.3 million men - in the UK. By 2025, it’s thought that 322 million men worldwide will have experienced ED. Meanwhile, around 31% of men in the UK have been diagnosed with high blood pressure.

In this article, we will take a look at the link between these two conditions, and what you can do if you're experiencing both at the same time.

What is high blood pressure?

High blood pressure, also known as hypertension, is a condition that can lead to heart problems, kidney disease, and stroke, among others. However, it rarely presents with visible or noticeable symptoms, so often goes undiagnosed. 

Blood pressure is how we measure circulating blood against the walls of the arteries, and it’s expressed in two numbers, systolic pressure and diastolic pressure. Systolic pressure measures the pressure of the blood in the arteries when the heart beats to pump blood through the body.

Diastolic pressure, meanwhile, measures the pressure of the blood in the arteries between each heartbeat as the heart refills.

These numbers are presented as a fraction, and you might hear a doctor say your blood pressure is one number ‘over’ another number, for example 120/80 (120 'over' 80).

Risks associated with high blood pressure

High blood pressure can have a serious impact on your health, particularly when left untreated. Risks associated with high blood pressure include:

Stroke

Long term high blood pressure can block or burst the arteries that supply your brain, cutting off blood supply and causing a stroke due to lack of oxygen.

Heart attack 

High blood pressure means your heart has to work harder to pump blood around your body, potentially leading to heart attacks, this is due to the narrowing and stiffening of the arteries around the heart. If the heart muscle has been severely damaged after a major heart attack, this could lead to heart failure.

Peripheral vascular disease

Peripheral vascular disease (PVD), also known as peripheral arterial disease (PAD),  usually affects the legs. It can cause what's called "intermittent claudication" - having to stop frequently whilst walking because of crampy leg pain. It is caused by narrowed and stiff arteries in the leg, restricting blood flow during exercise. High blood pressure is a risk factor for this.

Kidney disease

The constriction and narrowing of the blood vessels in your kidneys due to hypertension can reduce blood flow and stop them from working properly. Your kidneys will then struggle to remove the waste and extra fluid from your body, potentially leading to kidney disease.

Vascular dementia

Vascular dementia is a type of dementia similar to Alzheimer's. It is usually caused by restricted or changed blood flow to the brain. This can mean that certain areas of the brain that  are responsible for memory, thinking, or behaviour may work less efficiently. A risk factor for vascular dementia is high blood pressure. 

Why does high blood pressure cause erectile dysfunction? 

Over time, high blood pressure causes your arteries to narrow and harden. This reduces your blood flow, not only putting you at risk of major health conditions such as heart attacks and strokes, but also means less blood makes it to important areas of your body such as your penis. 

As blood flow to your penis reduces, it gets more difficult to achieve and maintain an erection.

Can high blood pressure treatments cause erectile dysfunction?

While high blood pressure alone can cause erectile dysfunction, the medications designed to treat high blood pressure can also contribute to the problem. 

Common types of blood pressure treatment medications are beta blockers and diuretics. Both types of medication have the potential to trigger or worsen erectile dysfunction, so it’s important that you’re aware of what type you take and their potential impact on ED.

The first type, beta blockers, work by slowing your heartbeat through your nervous system. Although this can reduce high blood pressure, it can also restrict blood flow to your penis and make it difficult to get an erection. Examples of beta blockers are:

• Metoprolol 
• Atenolol
• Propranolol
• Carvedilol

You might know diuretics as ‘water pills’. They work by triggering your kidney to release more sodium into your urine, flushing your body of excess water and decreasing the amount of fluid in your veins and arteries. 

However, they can also weaken the flow of blood to your penis and make erections harder to achieve.

Can blood thinners cause erectile dysfunction?

There’s little to no reliable evidence to say that blood thinners can cause ED. Erectile dysfunction isn’t listed as a side effect either. However, if you’re experiencing ED or find your symptoms worsen speak to your GP.  

How to treat erectile dysfunction when suffering from high blood pressure

Treating high blood pressure in men can be a balancing act between improving the symptoms of the problem without inducing further problems, such as erectile dysfunction. Although beta blockers and diuretics are commonly prescribed, there are other treatments available that are less likely to cause ED.

Which high blood pressure treatments are less likely to cause ED

Diuretics and beta blockers aren’t the only type of blood pressure treatment, but they are the most likely to contribute to erectile dysfunction. Types of blood pressure medication that are less likely to cause, or contribute to, ED are:

• Angiotensin-converting enzyme inhibitors
• Angiotensin II receptor blockers
• Alpha blockers 
• Calcium channel blockers

Often, recommended treatments for high blood pressure will include lifestyle changes, such as eating less processed food, increasing your intake of fruit and veg, and exercising more.

Which ED treatments are high blood pressure friendly? 

The most commonly recommended erectile dysfunction treatments are usually suitable for men who experience high blood pressure, provided they're in otherwise good health. These include popular tablet treatments like sildenafil (Viagra), vardenafil (Levitra) and tadalafil (Cialis).

Your doctor or pharmacist will usually start you on a low dose of these medications. If you also have angina, they might recommend an alternative treatment.

If you don’t want to take oral medication for your ED, other treatments are available including Vitaros cream, devices such as constriction rings and penis pumps, or some people might benefit from therapy. You can learn more about alternative ED treatments here.

Can you take Viagra with blood pressure tablets?

You can usually take Viagra or other PED5 inhibitors alongside commonly prescribed medications for blood pressure. The exception to this, however, are alpha blockers such as doxazosin, prazosin, and terazosin.

Taking Viagra and alpha blockers together can cause you to faint if your blood pressure drops too much. That's why it's best to leave a six-hour gap between the two.

If you take any medication that contains nitrates - often found in medications for heart conditions or anal fissures, you MUST NOT take Viagra or ANY other PED5 inhibitors. This can lead to a fatal reaction.

You should always check with your clinician before starting a new medication.

Conclusion

There’s little doubt that high blood pressure and erectile dysfunction are linked, and can often appear at the same time. Some blood pressure tablets can worsen or trigger ED; so if you have ED and you are taking beta blockers or diuretics, speak to your GP to see if the medication can be changed.

However, it’s important to know that several treatments are available for both conditions - including medication and lifestyle changes, so please speak to your doctor if you have high blood pressure and/or erectile dysfunction.

References

https://www.kcl.ac.uk/news/the-global-prevalence-of-erectile-dysfunction
https://www.bloodpressureuk.org/news/media-centre/blood-pressure-facts-and-figures/
https://pubmed.ncbi.nlm.nih.gov/11464253/
https://www.mayoclinic.org/diseases-conditions/high-blood-pressure/in-depth/high-blood-pressure-and-sex/art-20044209
https://www.bloodpressureuk.org/your-blood-pressure/understanding-your-blood-pressure/why-is-high-blood-pressure-a-problem/erectile-dysfunction-and-high-blood-pressure/
https://pubmed.ncbi.nlm.nih.gov/17011375/
https://www.stroke.org/-/media/Stroke-Files/Lets-Talk-About-Stroke/Risk-Factors/Stroke-and-High-Blood-Pressure-ucm_493407.pdf