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Some blood pressure medications are associated with erectile dysfunction (ED), which is probably the last thing you want to hear if you’ve just been put on a drug to treat your high blood pressure!
But don’t worry, there are only a couple of classes of blood pressure medications (also known as antihypertensives) that might cause ED. Most others do not.
Let’s look at which blood pressure medications shouldn’t cause erectile dysfunction and which ones you might want to avoid if ED is a concern. We’ll also talk about how high blood pressure can cause erectile dysfunction (even without medication). And, finally, we’ll give you some guidance on different ways to treat erectile dysfunction.
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Which blood pressure medications don’t cause erectile dysfunction?
There are quite a few types of medications that are used to treat high blood pressure (also known as hypertension), three of which have no association with erectile dysfunction:
- ACE inhibitors
- Calcium channel blockers
Here’s how these medications work to lower blood pressure and how they impact sexual function.
Angiotensin-converting enzyme inhibitors (known as ACE inhibitors for short) are commonly used to lower blood pressure in patients with hypertension. ACE inhibitors block a key enzyme that is involved in the creation of angiotensin II, a hormone that raises blood pressure. Less angiotensin II in the body means lower blood pressure (Herman, 2020).
Some of the most common examples of ACE inhibitors are (FDA-a, 2015):
- Enalapril/enalaprilat (brand name Vasotec)
- Lisinopril (brand name Zestril and Prinivil)
- Ramipril (brand name Altace)
ACE inhibitors do not seem to be associated with erectile dysfunction (Nicolai, 2014).
ARB stands for angiotensin II receptor blockers. On the surface, that might sound pretty similar to ACE inhibitors, but they work differently. ACE inhibitors decrease the amount of angiotensin II in the body, while ARBs work by blocking angiotensin II from attaching to receptors on cells (Barrerras, 2003). Remember that angiotensin raises blood pressure, so blocking the receptor for that hormone lowers blood pressure.
Here is a list of FDA-approved ARBs (“Common Generic and Brand Names,” 2010):
- Candesartan (brand name Atacand)
- Eprosartan (brand name Tevetan)
- Irbesartan (brand name Avapro)
- Losartan (brand name Cozaar)
- Olmesartan (brand name Benicar)
- Telmisartan (brand name Micardis)
- Valsartan (brand name Diovan)
Just like ACE inhibitors, ARB’s don’t seem to cause any sexual side effects (Fogari, 2002).
What causes erectile dysfunction (ED) in men over 50?
Calcium channel blockers
This class of drugs has been used since the 1970s. Calcium channel blockers lower blood pressure by blocking how much calcium gets into the muscle cells of artery walls. This causes the artery walls to relax and open, lowering blood pressure (Elliott, 2011).
There are a number of calcium channel blockers on the market, including (FDA-b, 2019):
- Amlodipine (brand name Norvasc)
- Clevidipine (brand name Cleviprex)
- Felodipine (brand name Plendil)
- Isradipine (brand name DynaCirc CR)
- Nicardipine (brand name Cardene)
- Nifedipine (brand name Adalat CC and Procardia)
- Nisoldipine (brand name Sular)
Verapamil and diltiazem are also calcium channel blockers, but they are more commonly used for cardiovascular disease, not as often for blood pressure (Godfraind, 2014).
When it comes to erectile function, calcium channel blockers don’t seem to have any impact either way (Fogari, 2002).
Blood pressure drugs that can cause erectile dysfunction
So, we’ve seen the good news—three of the most commonly used antihypertensives have no association with sexual dysfunction. Now for the not-so-good news. Two of the other most common blood pressure medicines—beta blockers and diuretics—do come with an increased risk of erectile dysfunction (Düsing, 2005).
If your healthcare provider is recommending a beta blocker or diuretic and you’re concerned about erectile dysfunction, be sure to discuss your concerns and follow their medical advice.
Let’s look more closely at these other high blood pressure medications.
Beta blockers are used for a wide range of conditions, including high blood pressure, congestive heart failure, hyperthyroidism, and coronary artery disease, to name a few. These are not generally recommended as a first-line treatment for high blood pressure but are used often when other medications have failed to lower blood pressure (Unger, 2020).
The way beta blockers lower blood pressure is by attaching to the beta 1 and beta 2 receptors in the heart, kidneys, and other parts of the body. Without getting too technical, when this happens, one outcome is a decreased amount of blood being pumped from the heart, thereby lowering blood pressure (Farzam, 2020).
Some commonly used examples of beta blockers include (FDA, 2019):
- Metoprolol (brand name Lopressor or Toprol XL)
- Atenolol (brand name Tenormin)
- Bisoprolol (brand name Zebeta)
- Carvedilol (brand name Coreg)
- Propranolol (brand name Inderal and Inderal LA)
Erectile dysfunction is a common side effect of beta blockers. It’s not clear, though, if that’s due to the drug itself or if many patients experience sexual dysfunction because they are aware of the drug’s bad reputation for possibly causing ED (Silvestri, 2003). Either way, there’s definitely an increased chance of ED with beta blockers, except for one specific beta blocker called nebivolol, which does not pose any increased risk of ED (Weiss, 2006).
Erectile dysfunction (ED) and mental health
Diuretics are often called “water pills” because they increase the amount that you urinate. This decreases the levels of sodium and water in the body, which lowers your blood pressure (Arumugham, 2020).
There are a number of different types of diuretics, but thiazide drugs are the ones most commonly used for hypertension. Hydrochlorothiazide (brand names Microzide or Oretic) is generally the drug of choice in this class (Herman, 2020).
Diuretics are safe and effective but do come with a pretty long laundry list of side effects, one of which is sexual dysfunction. If you’re on a diuretic and you’re experiencing bothersome side effects, be sure to talk to your healthcare provider about other options for controlling your blood pressure.
Erectile dysfunction and high blood pressure
Even without medication, there’s a close relationship between hypertension and erectile dysfunction. In fact, ED is sometimes one of the first signs of high blood pressure. Proper blood flow is an essential part of causing the penis to become erect. When a person has high blood pressure, the artery walls are not as relaxed and open as they need to be for enough blood to reach the penis to cause an erection (Hernández-Cerda, 2020).
Patients with hypertension are about twice as likely to experience ED than non-hypertensive patients. It’s a bit hard to parse out how many of those patients are experiencing ED due to the high blood pressure versus medication-induced ED. All we know is that people with high blood pressure have higher rates of ED, whether or not they’re being treated with blood pressure meds (Viigimaa, 2014).
The good news is, no matter what the cause of your ED, there are treatments available.
Management of erectile dysfunction
As we’ve seen, if you’ve got high blood pressure, it’s not uncommon to also experience some level of trouble getting and maintaining an erection. Whether that’s from the high blood pressure itself or from a medication your healthcare provider has prescribed, don’t worry. There are good treatments available.
Before jumping into treating your ED, though, it’s important to first speak with your healthcare provider. If you experience ED after beginning a blood pressure medication, your healthcare provider might recommend switching you to a different medication. If your current medication is still the best choice for you, then you and your healthcare provider might consider one of the following treatments.
This class of drugs includes those ED options almost everyone knows about:
- Sildenafil (brand names Viagra, see Important Safety Information; or Revatio, see Important Safety Information)
- Tadalafil (brand name Cialis; see Important Safety Information)
- Vardenafil (brand names Levitra and Staxyn)
PDE5 inhibitors improve erections by blocking the enzyme PDE5, which breaks down something called cGMP (cyclic guanosine monophosphate), a chemical that causes the penile blood vessels to relax. When PDE5 is blocked, cGMP levels rise, and blood flows more freely into the penis, allowing for better erections.
In general, you can take these medications with most blood pressure medications—just check with your healthcare provider to make sure there aren’t any interactions you need to know about (Viigimaa, 2014).
Erectile dysfunction support sleeve: does it work?
While PDE5 drugs work well for most patients, some people continue having erection problems and turn to other available treatments. These include (Hatzimouratidis, 2010):
- Intracavernous injections—These are medications that get injected into the side of the penis. There’s only one FDA-approved drug on the market for this, called alprostadil (brand names Caverject, Edex, or Viridal). These work well, but about 50% of patients eventually stop this treatment because of pain in the penis.
- Intraurethral medications—These are topical medications that come in the form of a pellet, which is inserted directly into the penis (intraurethral = into the urethra). Available medications include prostaglandin E1 and alprostadil (a synthetic form of prostaglandin). There are also combined medications available (Jain, 2020).
- Surgical implants—Surgery is a last resort for most patients with erectile dysfunction, but if nothing else works, surgical implants are quite effective. The implant is either an inflatable device or a prosthetic that’s semi-rigid.
There are some other, less conventional treatments available, but most patients have success with PDE5s, injectables, intraurethrals, or implants.
Find the right balance of medications for you
Just because you have high blood pressure, that doesn’t mean erectile dysfunction is a given. Even if you need to go on a blood pressure medication, there are many options that don’t increase your risk for ED. And even if you do need to be on a beta blocker or thiazide diuretic and you experience erectile dysfunction, there are treatments available.
Speak with your healthcare provider about any concerns you have so that you can work together to find the treatment that’s best for you.
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