Erectile dysfunction (ED) is sometimes related to high blood pressure. About 14% of people with high blood pressure have erection problems at some point in their lives, either due to the disease itself (uncontrolled blood pressure) or some prescribed medications.

ED not only affects male erectile function. It also impairs quality of life and relationships by changing oneself perception and leading to irrational thoughts due to anxiety or depression. Although it is not a life-threatening disease, just the fact that it impairs quality of life makes it worthy of urgent attention.

Now, what is the relationship between high blood pressure and erectile dysfunction? And why do medications play an influential role? Let's find out below.

Erectile dysfunction and its relation to blood pressure

Erection is a natural process that requires blood flow and nerve communication to occur. When the penis goes towards erection, sexual stimuli are transformed into nerve signals that travel to the brain and from there to the penis.

The penis receives this nerve information and, in response, dilates its muscles and blood vessels to allow blood inflow. As there is more arousal and stimulation, more nerve information will reach the penis and, therefore, more blood, causing it to lengthen and thicken as an erect penis.

Although erectile dysfunction can affect even healthy young people, it is more common in those over the 40s due to its close relation with high blood pressure. But why? First, high blood pressure is a prevalent disease as you get older, whether it be the consequences of a sedentary lifestyle, obesity, or natural arteries sclerosis.

As we explained in our article on High Blood Pressure and Sex, any disease that impairs small circulation can also alter blood flow to the penis. The penile arteries are very small in size and diameter, so any injury in their walls, no matter how little, makes a significant change in blood flow.

For this reason, erectile dysfunction is considered an early indicator of possible heart disease because when penile circulation fails, the heart arteries may also fail in the future. They just aren't that small or thin to do it that soon.

Can high blood pressure medications cause erectile dysfunction?

Several studies have suggested that certain medications used to improve high blood pressure also cause erectile dysfunction, meaning that even if you lower your blood pressure, you still can suffer from ED.

For some years now, it has been known that drugs such as beta-blockers and diuretics -widely used to lower blood pressure- also cause erectile dysfunction. The explanation is that the first ones that came out were not very selective and therefore acted throughout the body, showing side effects even on sexual function by preventing the penile muscle from relaxing and stopping blood inflow.

So, how is erectile dysfunction treated if I have high blood pressure? Today these clinical challenges have been solved through new therapeutic regimens ranging from lifestyle modifications to better and upgraded drugs. 

Here are some tips you did not know to improve erectile dysfunction.

  1. Know the new generation of beta-blockers

Propranolol (Inderal) was the first beta-blocker launched more than 50 years ago to improve heart function and blood flow. Today it is used for very specific cases, and it is known to be the main cause of drug-induced erectile dysfunction.

Currently, there are novel and improved medications that lower blood pressure without affecting erection, such as Nebivolol

Even some second or third-generation beta-blockers may not affect erectile function as propranolol does. It is best to avoid first-generation beta-blockers when it comes to coping with erectile dysfunction.

  1. Avoid diuretics and opt for angiotensin receptor blockers (ARBs)

Although taking diuretics depends more on your physician's criteria than on you, it is better to change it to another drug if you have erectile dysfunction, such as those from the angiotensin receptor blockers (ARBs) class.

Diuretics also worsen erectile dysfunction, probably as part of their side effect mechanism, as they are unspecific once in the body. According to experts, angiotensin receptor blockers are the first choice because they improve it instead of making the erection worse.

  1. Phosphodiesterase-5 inhibitors (PDE-5i)

If ED persists despite changing the blood pressure medications, it is best to include phosphodiesterase-5 inhibitors. These drugs work by blocking the activity of an enzyme in the smooth muscle of the arteries. This enzyme, when active, prevents the muscles from relaxing and therefore does not allow blood to enter the penis.

Blocking the enzyme then allows for vasodilation and blood inflow to the penis, and hence for erection. PDE-5i are considered the first-line drugs in erectile dysfunction.

From oldest to newest, they are:

  • Sildenafil (Viagra)

  • Tadalafil (Cialis)

  • Vardenafil (Levitra)

  • Avanafil (Stendra/Spedra)

They all work by inhibiting phosphodiesterase-5, the enzyme that prevents an erection. However, there are differences in their action time, how long the effects last, and side effects. 

As you already know, all drugs have side effects. These, in particular, have few, such as sweating, headaches, and colics.

  1. Lifestyle changes are a must.

According to experts, physical inactivity-obesity, smoking, and imbalance in body lipids have been linked to blood vessel damage and sexual dysfunction.

It is not enough to take medications and change doses to improve your sexual function. It is also essential to better lifestyle habits to prevent the blood damage from progressing.

Moderate physical activity has been shown to reduce the risk of erectile dysfunction by up to 30%. Contrary to what a sedentary lifestyle produces.

According to research, the Mediterranean diet also positively influences sexual function, as well as calorie restriction and a diet adapted to your needs. 

Quitting smoking is also a task if you want to achieve better erections in your sex life. Tobacco has been shown to contain substances that progressively damage the penile thin blood vessels, thus reducing erection capacity. 

What can I do if I think I have erectile dysfunction?

The first thing you must do is consult with a professional. Many men fear talking about their sexual problems out of anxiety or fear of judgment.

Do not be afraid. There are many others like you, but only a few take action and overcome their fears to improve their sex life.

Try to make small changes in your day-to-day towards a healthier living. Small changes can turn into habits and, ultimately, a better quality of life.

Remember that the earlier you receive the proper treatment, the better your sex life will be.


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