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Erectile dysfunction (ED) can happen for many reasons, from mental health factors to medication side effects and underlying health conditions. Some causes are more severe than others. Among the more serious causes of erectile dysfunction is high blood pressure. Read on to see why and how ED can be one of the earliest signs of high blood pressure—and what you can do about it.
What is ED?
Erectile dysfunction, or ED, is when you have difficulty getting or maintaining an erection firm enough for a satisfying sex life. This can include erections that don’t last as long as you want. ED is a common sexual dysfunction—experts believe that 30–50 million American men have experienced erectile dysfunction (Sooriyamoorthy, 2022).
High blood pressure and ED
ED is often the first sign of high blood pressure (or other cardiovascular issues).
High blood pressure (hypertension) is a condition where the pressure of blood flowing through the arteries is too high. Hypertension can make your arteries more vulnerable to atherosclerosis, a fatty plaque build-up on the walls of blood vessels. This damage can reduce blood flow to the heart or brain, leading to heart disease or stroke. But it can also affect the function of the penis and cause sexual health problems like ED (Hernández-Cerda, 2020).
Studies show that people with high blood pressure may have up to around a 70% increased risk of developing erectile dysfunction (Hernández-Cerda, 2020).
Experts believe this link between erectile dysfunction and hypertension is primarily due to high blood pressure damaging blood vessels. But hypertension can also cause ED even in the absence of atherosclerosis. It can keep the arteries from dilating as they should and prevent smooth muscle tissue from relaxing—two key factors in developing an erection (Hernández-Cerda, 2020).
During an erection, blood vessels in the corpus cavernosum of the penis relax, increasing blood flow into the penis. This blood gets trapped, creating an erect penis. Eventually, this trapped blood gets released, the erection subsides, and blood flow returns to normal. High blood pressure interferes with sexual function by preventing your blood vessels from relaxing as they should, leading to sexual problems (de Oliveira, 2021).
Having erectile dysfunction may indicate that you are at higher risk of having cardiovascular problems (like a heart attack or stroke) if you have high blood pressure (Hernández-Cerda, 2020).
Blood pressure medications and ED
While hypertension can cause erectile dysfunction, some blood pressure drugs (called antihypertensives) can also cause ED—further complicating matters.
Healthcare providers commonly use beta-blockers to treat high blood pressure, especially for people with heart disease or heart failure. However, some studies have shown that erectile dysfunction can be a side effect of the older generation beta-blockers, like propranolol, atenolol, and metoprolol. This effect may be due to their impact on the nerves affecting sex drive and erections (Terentes-Printzios, 2021).
Thiazide diuretics (or water pills) are another popular type of blood pressure treatment that can cause erection problems.
But not all blood pressure meds have this effect. Newer generation beta-blockers, like nebivolol, may treat your blood pressure and improve your erectile dysfunction (Sharp, 2017). So, all is not lost if you have hypertension and ED. There are treatments available to help you achieve a satisfying sex life.
Other causes of erectile dysfunction
A healthy erection requires healthy blood flow. Erectile dysfunction can be related to health conditions that affect blood circulation, like high blood pressure, heart disease, high cholesterol, or diabetes.
The blood vessels in the penis are smaller than in other parts of the body, so ED symptoms sometimes occur before more serious problems like a heart attack or stroke. When an otherwise healthy person in their 20s experiences ED, it could be cause for concern. Talk with a healthcare provider as soon as possible if you’re experiencing ED (Hernández-Cerda, 2020).
ED can also occur as a side effect of medications (other than blood pressure meds), including antidepressants. If you’re experiencing ED, be sure to tell a healthcare provider about all the medicines you’re taking. They might be able to adjust your dose or substitute another medication.
Treatments for ED
Oral medications for ED are highly effective. Several are available, including sildenafil (brand name Viagra; see Important Safety Information), tadalafil (brand name Cialis; see Important Safety Information), and vardenafil (brand name Levitra).
If low testosterone is responsible for your ED, testosterone replacement therapy (TRT) is available. TRT can boost your testosterone levels through an injection, a wearable patch, or gel applied to the skin.
Some people have found natural remedies helpful for their ED. A few studies have shown that certain supplements (e.g., DHEA, ginseng, L-arginine, L-carnitine, and yohimbe) may improve ED (Sooriyamoorthy, 2022). However, use caution when unregulated supplements promise benefits like penis enlargement or “mind-blowing orgasms.” These unregulated substances can be dangerous, and unidentified active ingredients may interact with other medications in harmful ways.
Your erections will be best when you’re healthy. Making simple lifestyle changes, such as getting regular exercise, eating a healthy diet, quitting smoking, and limiting your alcohol consumption, might be enough to improve ED (not to mention your heart health).
If you’re experiencing ED, talk with a healthcare provider. They’ll help you find a solution that’s right for you—and potentially catch other health problems before they become severe.
- de Oliveira, A. A. & Nunes, K. P. (2021). Hypertension and erectile dysfunction: breaking down the challenges. American Journal of Hypertension, 34(2), 134–142. doi:10.1093/ajh/hpaa143. Retrieved from https://pubmed.ncbi.nlm.nih.gov/32866225/
- Hernández-Cerda, J., Bertomeu-González, V., Zuazola, P., & Cordero, A. (2020). Understanding erectile dysfunction in hypertensive patients: the need for good patient management. Vascular Health and Risk Management, 16, 231–239. doi:10.2147/VHRM.S223331. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7297457/
- Nunes, K. P., Labazi, H., & Webb, R. C. (2012). New insights into hypertension-associated erectile dysfunction. Current Opinion in Nephrology and Hypertension, 21(2), 163–170. doi:10.1097/mnh.0b013e32835021bd. Retrieved from https://pubmed.ncbi.nlm.nih.gov/22240443/
- Sharp, R. P. & Gales, B. J. (2017). Nebivolol versus other beta blockers in patients with hypertension and erectile dysfunction. Therapeutic Advances in Urology, 9(2), 59–63. doi:10.1177/1756287216685027. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5298412/
- Sooriyamoorthy, T. & Leslie, S. W. (2022). Erectile dysfunction. StatPearls. Retrieved on Aug. 31, 2022 from https://www.ncbi.nlm.nih.gov/books/NBK562253/
- Terentes-Printzios, D., Ioakeimidis, N., Rokkas, K., & Vlachopoulos, C. (2021). Interactions between erectile dysfunction, cardiovascular disease and cardiovascular drugs. Nature Reviews: Cardiology, Advance online publication. doi:10.1038/s41569-021-00593-6. Retrieved from https://pubmed.ncbi.nlm.nih.gov/34331033/
Dr. Chimene Richa is a board-certified Ophthalmologist and Senior Medical Writer/Reviewer at Ro.