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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—only a couple of classes of blood pressure medications (also known as antihypertensives) might cause ED. Most others do not.
So, which blood pressure medications cause erectile dysfunction? Two classes of drugs can cause ED: beta blockers and diuretics. Read on to learn more about blood pressure medications that shouldn’t cause erectile dysfunction, how high blood pressure can cause erectile dysfunction (even without medication), and different ways to treat erectile dysfunction.
Blood pressure medication and erectile dysfunction
There are quite a few types of medications 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 involved in creating angiotensin II, a hormone that raises blood pressure. Less angiotensin II in the body means lower blood pressure (Herman, 2022).
Some of the most common examples of ACE inhibitors are (FDA, 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 (Barreras, 2003). Remember that angiotensin raises blood pressure, so blocking the receptor for that hormone lowers blood pressure.
Some FDA-approved ARBs include candesartan (Atacand), eprosartan (Tevetan), and losartan (Cozaar). Just like ACE inhibitors, ARBs don’t seem to cause any sexual side effects (Fogari, 2002; Nicolai, 2014).
Calcium channel blockers
This class of drugs has been used since the 1970s. Calcium channel blockers lower blood pressure by decreasing 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 amlodipine (Norvasc), clevidipine (Cleviprex), nicardipine (Cardene), verapamil (Verelan), and diltiazem (Cardizem) (FDA, 2021).
When it comes to erectile function, calcium channel blockers don’t seem to have any impact either way (Nicolai, 2014).
Which blood pressure medications 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—have an increased risk of erectile dysfunction (Nicolai, 2014; Düsing, 2005).
If your healthcare provider has recommended a beta blocker or diuretic and you’re concerned about erectile dysfunction, be sure to discuss your concerns with your provider. Let’s take a closer look 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 often used when other medications have failed to lower blood pressure (Unger, 2020).
Beta blockers lower blood pressure by attaching to the beta 1 and beta 2 receptors in the heart, kidneys, and other parts of the body. When this happens, your heart rate and the force of the blood being pumped from the heart drop, lowering blood pressure (Farzam, 2022).
Some commonly used examples of beta blockers include metoprolol (Lopressor or Toprol XL), atenolol (Tenormin), and propranolol (Inderal and Inderal LA) (FDA, 2021).
Erectile dysfunction is a common side effect of beta blockers. It’s unclear whether 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 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).
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, 2022).
There are several 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.
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 experiencing bothersome side effects, 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 as non-hypertensive patients. It’s difficult to parse out how many of those patients experience 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 that no matter the cause of your ED, treatments are available.
How to treat ED
As we’ve seen, if you’ve got high blood pressure, it’s not uncommon to also experience some difficulty 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 many 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)
PDE-5 inhibitors improve erections by improving blood flow to the penis. 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 (Sooriyamoorthy, 2022).
While PDE-5 drugs work well for most patients, some people continue having erection problems and turn to other available treatments. These include (Sooriyamoorthy, 2022):
- Intracavernous injections—These medications 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).
- Intraurethral medications—These are topical medications that come in the form of a pellet 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, 2022).
- 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.
Some other, less conventional treatments are available, but most patients have success with PDE-5s, injectables, intraurethrals, or implants.
Find the right balance of medications for you
Having high blood pressure doesn’t mean erectile dysfunction is a given. Even if you need to take blood pressure medication, many options don’t increase your risk for ED. 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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Dr. Chimene Richa is a board-certified Ophthalmologist and Senior Medical Writer/Reviewer at Ro.