New research suggests that high blood pressure is a risk factor for erectile dysfunction in men. At least two out of three men with hypertension experience difficulty maintaining an erection, compared with 10% of men in the general population.
Contents Of This Article
Hypertension and erectile dysfunction
In one survey, over two out of three men with high blood pressure (68.3%) admitted to a degree of erectile difficulty, with 7.7% classing their problem as mild, 15.4% as moderate and 45.2% as severe. In another survey, 66.9% of men with hypertension confirmed they experienced erectile dysfunction which was classed as moderate or severe in 73.5%, yet only 5 out of 124 men had previously been asked by their doctor about erectile difficulties.
A recent review of 40 studies involving 121,641 men, showed hypertension was closely related to erectile dysfunction, increasing the risk by 74% overall. There were some interesting regional differences.
Men in Africa were 3.35 times more likely to have erectile dysfunction if they had hypertension, compared with a 97% increased risk in the Americas, a 46% increased risk in Asia and an 83% increased risk in Europe. Interestingly no link was found between hypertension and erectile difficulties amongst Australian men, although this may be because only two small studies from this region were found.
It’s possible that regional differences may relate to the different ways in which hypertension is diagnosed and treated, although more research is needed to confirm whether or not regional differences do exist, and why.
Why does hypertension cause erectile dysfunction?
Both hypertension and erectile dysfunction (ED) are associated with abnormalities of blood vessel linings (endothelium) which affect how they dilate in response to normal triggers. These abnormalities may lead to increased production of blood vessel constrictors (eg endothelin 1), increased sensitivity to angiotensin II (another vasoconstrictor) or reduced production of nitric oxide – a powerful blood vessel dilator.
High blood pressure also leads to thickening of blood vessel walls which reduces blood flow, and these changes also occur in the penis contributing to erection difficulties.
Latest research suggests that low levels of the hormone, melatonin can lead to hypertension. Low levels of melatonin are also linked with erectile dysfunction and could be in underlying cause of both conditions in some men. This understanding came from a recent study involving 62 men with mild, moderate or severe erectile difficulties, all of whom had low blood melatonin levels compared with men who did not have sexual difficulties.
The drugs used to treat hypertension can also affect sexual function.
Blood pressure medication and erectile dysfunction
If you are experiencing erectile difficulties, do see your doctor. Erectile dysfunction is a recognised, common side effect of older antihypertensive medication, especially diuretics and centrally acting beta blockers. Newer drugs, such as nebivolol (a selective beta blocker), calcium antagonists, angiotensin II receptor blockers and ACE inhibitors appear to have neutral or even beneficial effects.
Your doctor can review your medication and switch you to another class of medicine that is not associated with erectile difficulties if you are having problems.
Your doctor can also assess whether or not you have signs of testosterone deficiency as detailed at this link. Low testosterone levels become increasingly common with age, and can have a profound effect on sexual function.
Treatment of hypertension-associated erectile dysfunction
If you are experiencing problems maintaining an erection, don’t put up with it out of embarrassment or a mistaken belief that nothing can be done to help. Seek medical advice – doctors are used to dealing with intimate issues such as this on a daily basis (and may even have experienced the problem themselves at some point).
Phosphodiesterase-5 inhibitors drugs used to treat impotence, such as Viagra (sildenafil), Levitra (vardenafil) and Cialis (tadalafil), can usually be safely prescribed to men with hypertension – even those taking multiple medications, although there is a caution for men taking alpha blockers and those with uncontrolled hypertension, and are contraindicated if you taking nitrates. Your doctor can advise if these treatments are likely to suit you. Viagra is also available over the counter in the UK, after a pharmacist assessment.
Herbal alternatives to Viagra are available, but if you are on prescribed medicines check with a pharmacist for interactions before taking any herbal treatments. There is also information on drug-supplement interaction checkers here.
If you smoke, do your utmost to stop. Smoking cigarettes can lead to both hypertension and erectile dysfunction.
Ensure your alcohol intake is within recommended limits, as high intakes are another potential cause of both hypertension and erection difficulties.