What are the best blood pressure medications for erectile dysfunction?

You might not know that ED (erectile dysfunction) is associated with other health issues—like high blood pressure (also known as hypertension). In a SingleCare survey, high blood pressure was reported or believed to be the most common physical cause of ED. High blood pressure medications can sometimes alleviate erectile dysfunction by reducing stress on the blood vessels and allowing more normal blood flow. However, certain prescriptions, like beta blockers and diuretics, can even make arousal more difficult. Learn which blood pressure medications can help heat things up in the bedroom and which will cool them down.

Best blood pressure medications for erectile dysfunction

Taking blood pressure drugs isn’t the same as taking Viagra (sildenafil citrate) or other medicines used for the management of erectile dysfunction. But if you are prescribed the following blood pressure medicines, you may see improved hypertension as well as improved symptoms of ED.

Angiotensin-converting enzyme (ACE) inhibitors

ACE inhibitors, such as Zestril (lisinopril) and Lotensin (benazepril), are associated with improvement in ED. They work by reducing the heart’s workload and stimulating nitric oxide production, contributing to good erectile function.

Angiotensin II receptor blockers (ARBs)

ARBs, such as Diovan (valsartan), work by reducing the action of the hormone angiotensin II. When angiotensin is activated, it causes blood vessels to contract and increases salt and water retention in the body, both of which can increase blood pressure. Angiotensin II is also present in penile blood vessels, meaning that ARBs can improve erectile function by opening blood vessels and increasing blood flow in the penis.

Alpha blockers

Alpha-1 blockers don’t exacerbate ED as much as other antihypertensives. In other words, they can be a good alternative if you are experiencing ED with your current treatment. In fact, clinical trials demonstrate that alpha-1 blockers can improve erectile function, but not to the point at which they can be used as an ED treatment without hypertension. Cardura (doxazocin) is an example of an alpha-1 blocker used to lower blood pressure and treat benign prostatic hyperplasia, a condition that causes the enlargement of the prostate and contributes to ED.

Vasodilators

Vasodilators widen blood vessels to enhance blood flow to the heart and other body parts, which can improve blood pressure control. However, some vasodilators, such as certain nitrates, like nitroglycerin, can pose risks when combined with ED medications like Viagra or Cialis and may lead to a severe drop in blood pressure. 

Interestingly, other vasodilators have shown potential in treating ED without high blood pressure by improving blood supply to the penis and improving erections. Alprostadil is an injectable vasodilator specifically used for treating erectile dysfunction. It operates by relaxing the muscles and expanding the blood vessels in the penis, which helps to maintain sufficient blood flow and enables an erection. 

PDE-5 inhibitors

Phosphodiesterase-5 (PDE-5) inhibitors such as Viagra (sildenafil) and Cialis (tadalafil) can be used to treat pulmonary hypertension. However, a notable side effect of theirs—which accounts for their use in sexual dysfunction medicine—is harder, longer-lasting erections. 

“PDE-5 inhibitors are first-line pharmacotherapy for ED,” says Raj Dasgupta, MD, a pulmonologist and Associate Program Director of Internal Medicine Residency at Huntington Memorial Hospital. “They enhance blood flow to the penis by increasing the vasodilatory effects of endogenous nitric oxide.”

Blood pressure medications that increase the risk of ED

Erectile dysfunction can stem from various factors, including health conditions, psychological issues, lifestyle habits, and medications. In fact, drug therapy is estimated to cause 25% of all cases of ED—including certain blood pressure medications. Luckily, this effect is reversible when you stop the medication. 

“Certain blood pressure medications, particularly beta blockers and diuretics, can negatively affect erectile function by decreasing blood flow or interfering with nerve impulses to the penis,” explains Steven Malen, Pharm.D., a clinical educator at Town and Country Compounding Pharmacy in Ramsay, New Jersey. If you notice difficulty achieving or maintaining an erection after taking one of the following medications, talk to your healthcare provider.

Beta blockers

Beta blockers are commonly prescribed for cardiovascular conditions, high blood pressure, and sometimes for anxiety disorders. They work by blocking the effects of adrenaline, a stress hormone that slows the heart rate and lowers blood pressure. However, they can also impact erectile function by reducing libido and preventing the muscles in the penis from relaxing sufficiently to allow blood to pass through.

Specific beta blockers linked to a higher risk of ED include bisoprolol, atenolol, metoprolol, and carvedilol. Some newer beta blockers, however, may have less of an effect on ED. “Nebivolol is a beta blocker option recommended to avoid ED because of its lower risk of ED compared with other beta blockers,” Dr. Dasgupta explains.

Diuretics

Thiazide diuretics, often referred to as water pills, are used to treat high blood pressure and edema (swelling). While effective for these conditions, thiazide diuretics can lead to ED, particularly at high doses. 

“Adverse effects of thiazide diuretics on male sexual function, including decreased libido, erectile dysfunction, and difficult ejaculation, have been reported in several studies,” says Dr. Dasgupta. “But the exact mechanisms behind why this happens are still unclear.” 

Can ED from high blood pressure be reversed?

If you’re otherwise healthy, ED caused by high blood pressure can usually be reversed with treatment for hypertension or changing medications if ED is a side effect of your blood pressure treatment. Additionally, you can implement the following lifestyle changes and ED treatments:

• Improve your nitric oxide levels: Nitric oxide plays a crucial role in the erectile process by relaxing the muscles in the penis and allowing blood to flow in. “Treating this deficiency can help with ED and minimize the need for blood pressure medications,” Dr. Malen says. For some patients, eating more nitrate-rich foods and taking dietary supplements may help. However, you should talk to your provider before starting, as these supplements can also interfere with other medications and can also have their own unwanted side effects.
• Quit smoking: Smoking can cause the build-up of plaque in your arteries, which in turn reduces blood flow to the penis. Quitting smoking improves blood flow and, over time, can improve erections.
• Exercise: Regular exercise boosts cardiovascular health and can lead to improvements in erectile function by enhancing blood circulation and reducing stress, which are crucial factors in achieving and maintaining erections. 
• Manage your weight: Managing weight helps reduce the risk of vascular diseases and diabetes, which are associated with erectile dysfunction. Healthy weight levels lead to better blood flow and hormone levels, which are essential for sexual function.

ED is often associated with lifestyle factors that are also common risk factors for high blood pressure, such as smoking and being overweight. Addressing these factors can be a significant step in managing both conditions.

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When to see a healthcare provider

Although it is expected to have performance issues from time to time, any time you experience sustained erectile dysfunction, you should check in with a provider. It can be a sign that your blood pressure is out of control. “Men with ED are more likely to have high blood pressure than those without ED,” Dr. Dasgupta says.

Additionally, if you’ve been diagnosed with hypertension and have started on a blood pressure medication and are just starting to experience erectile dysfunction, be sure to let your provider know. It’s important to let them know about all side effects of your meds as they may be able to help you minimize symptoms or change treatment options. However, you should only stop your blood pressure medications under the guidance of a healthcare provider.

Keep in mind that the effects of changing or stopping blood pressure medications on erectile function will not be immediate. “It can take anywhere from several days to several weeks after stopping a high blood pressure medication for erections to return,” Dr. Dasgupta says. 

If you’re dealing with high blood pressure or erectile dysfunction, it’s important to seek medical advice to explore the range of treatment options available. Not all blood pressure medications cause ED, and with the right approach, it’s possible to manage both conditions effectively.