Is High Blood Pressure the Cause of My Erectile Dysfunction?

Hypertension and erectile dysfunction (ED) are common conditions for men, especially older ones. According to the CDC, approximately 116 million adults in the United States suffer from hypertension, while 30 million experience ED.

Given just how commonplace these illnesses have become, it’s imperative for men to be aware of the dangers of hypertension and how they can manifest in conditions like ED.

In this article, we’ll discuss the relationship between hypertension and erectile dysfunction and provide some ways of dealing with both issues.

High Blood Pressure & Erectile Dysfunction

It’s important to understand that the effects of hypertension on the body are pervasive. In this sense, hypertension can lead to ED in both direct and indirect ways.

Around 30% of men with hypertension also experience ED [1]. In fact, hypertensive patients are approximately two times more likely to suffer from ED than normotensive individuals [2] — though this does not necessarily mean that hypertension is the cause of ED. Many factors, including psychological ones, come into play, but ED does exhibit a high degree of co-morbidity with hypertension.

Researchers agree that there’s much to learn about the various aspects and mechanisms of the specific causal relationship between ED and hypertension. However, it is undeniable that many factors leading to hypertension also contribute significantly to the ED process, and the opposite is also true.

Here are a few connections between ED and hypertension.

1. Narrowed Blood Vessels

High blood pressure affects the vessels that carry blood flow into the penis by narrowing them. This decline in blood flow is often a significant contributing factor in ED. Hypertension can also cause the smooth muscle tissue in the penis to lose its ability to relax, another obstacle to proper penile function.

2. Lower Testosterone Levels

A more indirect way high blood pressure can lead to ED is through its effects on testosterone. Achieving successful erections is not only a matter of blood flow — it also involves psychological and hormonal components, and testosterone is quite crucial in this regard. High blood pressure affects the delivery of testosterone throughout the body and leads to overall lowered testosterone levels. This can have adverse effects on erection physiology and manifest in a weakened sex drive, affecting arousal and the will to engage in sexual activity.

We also know that the penis is a particularly sensitive body part when it comes to changes in oxidative stress, systemic nitric oxide levels, and modifications in the vascular system. As such, the incidence of ED is a strong predictor for systemic vascular alterations like the onset of hypertension or atherosclerotic disease [3].

3. Overall Health

A poor diet, being overweight, drinking too much alcohol, smoking, and not exercising can all contribute to cardiovascular problems, but these things are also heavily linked to ED.

Studies show making simple lifestyle changes — losing weight, eating a healthy diet, and working out — can have a big impact on erectile dysfunction and is often the first step to take when treating it [4].

Treating Erectile Dysfunction & High Blood Pressure

Treating hypertension-induced ED mostly likely consists in dealing with hypertension directly and/or using effective and safe pharmacological options like PDE5 inhibitors.

The standard treatment for high blood pressure is simple: diet, exercise, and eliminating things like smoking and drinking alcohol — actions that also significantly help ED.

Besides a healthy lifestyle, there are other ways to treat ED and high blood pressure.

Common Ways to Treat ED

Prescription medications are the go-to for most men, but there are alternative supplements you can try. We’ll cover the most popular options available for ED beyond lifestyle changes.

1. Natural Alternatives

If you want to avoid medications or have trouble with the side effects of PDE-5 inhibitors, natural supplements could help. While results aren’t as consistent and they’re not as potent as prescriptions, they can be a great choice for many men with ED. Here are a few worth checking out, but be aware that many can interact with certain drugs and still come with side effects.

• Vitamin D [5]
• Asian Ginseng [6]
• Yohimbe [7]
• L-arginine [8]

2. Surgical & Non-Surgical Treatments

Drugs and supplements aren’t the only options for treating ED. These are usually used as a last resort, but there are a host of minimally-invasive ways to help the problem, including:

• Vacuum erection device
• Penile implants
• Injection therapy

3. Therapy

Erectile dysfunction can often be the result of stress, depression, performance anxiety, or other conditions.

Getting to the root cause in these cases can take time, but therapy and stress management could do wonders — for ED, your relationship, and your mental health.

However, your doctor will still want to rule out physical causes as well since ED is often caused by more serious health issues. 

4. Prescription Medications

Phosphodiesterase (PDE-5) inhibitors — such as Viagra and Cialis — are the most common way to treat erectile dysfunction.

PDE-5 is an enzyme in the smooth muscle of the corpus cavernosum that breaks down cyclic guanosine monophosphate (cGMP).

Inhibiting this enzyme allows more cGMP, which increases the blood flow to the penis.

These drugs require sexual stimulation to work but are highly effective and used on an as-needed basis.

Common Ways to Treat High Blood Pressure

Many patients can handle lifestyle changes alone, while others need more hands-on guidance on how to implement them.

Here are a few of the ways to treat high blood pressure besides exercising, eating healthy, reducing sodium, and not smoking.

1. Natural Alternatives

You’ll notice that a few of the alternatives for ED are also listed here for high blood pressure. Most of the following suggestions help with HBP because they increase nitric oxide (NO), which widens blood vessels — and plays a crucial role in erections.

Again, never adjust medications or start a supplement without talking to your doctor first.

• L-arginine or L-citrulline [9]
• Ginger [10]
• Beetroot juice [11]
• Potassium [12]

2. Prescription Medications

However, a certain subset of the population cannot improve their blood pressure through natural means alone. Doctors often prescribe these patients blood pressure-lowering agents like statins.

There is a problem with this, though.

Although ED is often a result of hypertension, some studies suggest that ED can result from hypertension treatment. Whereas some research did not find a significant influence, others suggest that anti-hypertension drugs might cause ED — diuretics and β-blockers, in particular [13].

Common blood pressure medications include:

• Angiotensin-converting enzyme (ACE) inhibitors
• Angiotensin II receptor blockers
• Calcium channel blockers
• Beta-blockers
• Diuretics

What Is High Blood Pressure?

In order to understand high blood pressure, it’s necessary to review some basic functions of the cardiovascular system.

We all know the heart pumps blood through a system of blood vessels, delivering oxygen and nutrients that are essential for proper organ function. As the blood pumps, it creates a force against the wall of the blood vessel, known as blood pressure. This pressure rises and falls with every heartbeat and has a noticeable pattern related to how much force the heart exerts while pumping.

Doctors can accurately measure this pressure and have determined that a normal range of systolic blood pressure is 90-120, and normal diastolic blood pressure is 60-80. Systolic pressure is when the heart beats, and diastolic pressure is when the heart relaxes in between beats.

Systolic numbers are written over the diastolic number, so it looks like a fraction. A blood pressure reading above 140/90 is high blood pressure.

What Causes High Blood Pressure?

Before we get into the causes of hypertension, it’s important to note that high blood pressure is not always bad. There are many situations where it’s perfectly normal for the heart to pump faster and thus increase blood pressure. It’s only when high blood pressure becomes a chronic condition that you should be concerned.

Healthy blood vessels have a certain amount of elasticity that allows them to cope with changes in blood pressure. However, certain risk factors reduce this elasticity and increase resistance in the blood vessels, leading to persistently high blood pressure.

These risk factors include:

• Advanced age
• Smoking
• Poor diet
• Alcohol
• Physical inactivity
• Being overweight
• Certain ethnic backgrounds
• Family history
• Other health conditions
• Certain medications

What Are the Effects of High Blood Pressure?

Hypertension is often called a “silent killer.” It is not considered lethal on its own, but consistently high blood pressure can lead to a swathe of other conditions that may become fatal.

Over time, hypertension strains the blood vessels and can lead to small tears within the vessel walls. These tears increase the risk of fatty buildups, known as clots, which can narrow or block the blood vessels.

If left unchecked, clots can become very dangerous, often leading to strokes, heart attacks, and kidney disease. And, since the heart has to work harder, hypertension can also lead to heart failure.

Final Thoughts: Erectile Dysfunction & High Blood Pressure

Correlation does not imply causation, and there’s a lot of research that still must be done to understand the link between hypertension and ED. However, at the moment, we can be relatively sure that there is at least some degree of causation between the two. Although not always, a vast proportion of ED cases are related to the vascular system, and there is simply no way to separate hypertension from negative effects on the body’s vasculature.

One of the most dangerous aspects of ED is the absence of obvious symptoms. In this sense, the incidence of ED can actually serve as a precursor to more serious cardiovascular issues. Patients suffering from ED should make sure to speak to their doctor and review their cardiovascular health.

In terms of treatment, natural solutions like diet and exercise are the most recommended. Even though PDE5 inhibitors like Viagra and Cialis do not interact in a dangerous fashion with hypertension medications and are effective, they will not treat the root of the problem.

As such, patients can use prescriptions for fast relief from ED symptoms, but they should also address the root of the problem by looking for underlying causes and adopting a healthier lifestyle.

---

References

1. 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.
2. Viigimaa, M., Vlachopoulos, C., Lazaridis, A., & Doumas, M. (2014). Management of erectile dysfunction in hypertension: Tips and tricks. World journal of cardiology, 6(9), 908.
3. Chew, K. K., Finn, J., Stuckey, B., Gibson, N., Sanfilippo, F., Bremner, A., … & Jamrozik, K. (2010). Erectile dysfunction as a predictor for subsequent atherosclerotic cardiovascular events: findings from a linked-data study. The journal of sexual medicine, 7(1), 192-202.
4. Krzastek, S. C., Bopp, J., Smith, R. P., & Kovac, J. R. (2019). Recent advances in the understanding and management of erectile dysfunction. F1000Research, 8.
5. Barassi, A., Pezzilli, R., Colpi, G. M., Corsi Romanelli, M. M., & Melzi d’Eril, G. V. (2014). Vitamin D and erectile dysfunction. The journal of sexual medicine, 11(11), 2792-2800.
6. Sin, V. J. E., Anand, G. S., & Koh, H. L. (2021). Botanical medicine and natural products used for erectile dysfunction. Sexual Medicine Reviews, 9(4), 568-592.
7. Wibowo, D. N. S. A., Soebadi, D. M., & Soebadi, M. A. (2021). Yohimbine as a treatment for erectile dysfunction: A systematic review and meta-analysis. Turkish Journal of Urology, 47(6), 482-488.
8. Koolwal, A., Manohar J, S., Rao, T. S., & Koolwal, G. D. (2019). l-arginine and Erectile Dysfunction. Journal of Psychosexual Health, 1(1), 37-43.
9. Khalaf, D., Krüger, M., Wehland, M., Infanger, M., & Grimm, D. (2019). The effects of oral l-arginine and l-citrulline supplementation on blood pressure. Nutrients, 11(7), 1679.
10. Hasani, H., Arab, A., Hadi, A., Pourmasoumi, M., Ghavami, A., & Miraghajani, M. (2019). Does ginger supplementation lower blood pressure? A systematic review and meta‐analysis of clinical trials. Phytotherapy Research, 33(6), 1639-1647.
11. Stanaway, L., Rutherfurd-Markwick, K., Page, R., Wong, M., Jirangrat, W., Teh, K. H., & Ali, A. (2019). Acute supplementation with nitrate-rich beetroot juice causes a greater increase in plasma nitrite and reduction in blood pressure of older compared to younger adults. Nutrients, 11(7), 1683.
12. Iqbal, S., Klammer, N., & Ekmekcioglu, C. (2019). The effect of electrolytes on blood pressure: a brief summary of meta-analyses. Nutrients, 11(6), 1362.
13. de Oliveira, A. A., & Nunes, K. P. (2021). Hypertension and erectile dysfunction: breaking down the challenges. American Journal of Hypertension, 34(2), 134-142.