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Can blood pressure medications cause erectile dysfunction?Hypertension and erectile dysfunction -
Professor Vlachopoulos noted that changing hypertensive medications in men with erectile dysfunction must be handled with caution. Alternatives might be considered if patients are at risk of stopping lifesaving therapy because of the detrimental impact of erectile dysfunction on their life.
Patients and doctors need to have open discussions to find the best treatment option. Figure: Penile blood flow velocity across blood pressure categories in treated and untreated men. The hashtag for ESC Congress is ESCCongress. This press release accompanies an abstract at ESC Congress — The Digital Experience.
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Show navigation Hide navigation. Sub menu. How to treat high blood pressure without ruining your sex life 28 Aug Topic s : Rehabilitation and Sports Cardiology.
org The hashtag for ESC Congress is ESCCongress. Follow us on Twitter ESCardioNews This press release accompanies an abstract at ESC Congress — The Digital Experience.
Funding: None. Disclosures : The authors have nothing to disclose. References and notes 1 Abstract title: Association between office blood pressure, antihypertensive medication use and male sexual dysfunction: A penile Doppler study.
About the European Society of Cardiology The European Society of Cardiology brings together health care professionals from more than countries, working to advance cardiovascular medicine and help people lead longer, healthier lives.
As their inner linings become weak and tear, fatty deposits known as plaques can form, narrowing the vessels and reducing flexibility.
Doctors call this process atherosclerosis. All of this results in reduced blood flow. When the process damages the vessels of the reproductive system, it can also lead to sexual dysfunction.
One way high blood pressure can affect a male sexually is through erectile dysfunction ED. Blood flow to the penis is an essential part of sustainable erections.
Proper blood flow ensures the penile arteries can relax, allowing perimeter vessels to expand and fill up with blood. If vascular damage restricts blood flow, the penis may not get enough blood to create an erection — or to sustain one if it occurs.
Males living with hypertension are almost twice as likely to experience ED and impaired blood flow to the penis compared with males without high blood pressure.
According to a study in The Journal of Sexual Medicine , males with higher diastolic blood pressure and lower systolic blood pressure were less likely to experience ED at the same rate as other males with hypertension.
Diastolic blood pressure is the measurement of force inside the arteries between heartbeats. Systolic blood pressure is the measurement of force during a heartbeat, when the organ pumps blood out.
Blood pressure readings consist of both diastolic and systolic measurements. The normal range for an adult is as follows:. Libido is another term for sexual drive and desire. When libido is low , overall interest in sex declines. For males, libido closely links with the hormone testosterone.
According to a study in the Journal of the American Heart Association, males living with hypertension are more likely to have lower levels of testosterone. It is unclear if high blood pressure contributes to testosterone decrease or if both conditions co-occur independently of one another.
Hypertension and low testosterone can share risk factors such as increased body weight, poor diet, and lack of physical activity, explaining why they may regularly occur together. Research shows that the vascular system is essential to proper biological tissue function.
If hormones such as testosterone are not getting where they need to go due to improper blood flow, their effects may diminish. Hypertension is a systemic condition, meaning it can affect the entire body.
If a person does not get treatment, it can lead to :. Kidney damage can cause its own challenges with blood flow and may also occur alongside nerve damage, fatigue , and psychological distress. It is not uncommon for people with any chronic illness to experience symptoms of depression , anxiety , or stress.
Many people with ED become self-conscious. The International Society for Sexual Medicine indicates negative feelings can distract from sexual stimuli and prevent complete arousal. For some people, mental health challenges may also result in premature ejaculation or difficulty reaching orgasm.
Lowering high blood pressure can improve ED but is not a guaranteed fix for sexual dysfunction. ED is more common among males with hypertension, and some medications for high blood pressure may worsen sexual side effects. High blood pressure is not what creates an erection.
Increased blood flow to the penis helps create rigidity through a physiological process of sexual arousal. ED can be an early warning sign of high blood pressure in males.
Other symptoms include :. Like other forms of mild to moderate exertion , sex can increase both heart rate and blood pressure. This effect is temporary, and as long as cardiac health is stable, the risk of adverse reactions is low.
High blood pressure can affect a male sexually in a number of ways. Vascular damage can directly limit blood flow, which can prevent proper erectile function and inhibit libido. Other chronic health conditions with links to hypertension, such as kidney disease, heart disease, and psychological distress, can also cause sexual side effects.
While treating hypertension may improve sexual dysfunction, some high blood pressure medications can worsen sexual symptoms.
Some sexual health problems that affect males include difficulties with erections and ejaculation or low libido. Learn more here. High blood pressure is known as the silent killer as it rarely has symptoms. Read this article to learn how to diagnose it and when to seek help.
Dysfunctionn than half of all American men will No Artificial Flavors ED in their lifetime. Not only can this eretile pump No Artificial Flavors brakes Paleo diet shopping list your sex life, ddysfunction it dysfundtion also be a source of frustration and embarrassment. But many sources fail to explain how high blood pressure, a condition more than half of American adults have, can contribute to your ED. At Urological Associates in Charlottesville, Virginia, our board-certified urologists specialize in helping men overcome ED and reclaim their sex life. Our practice offers personalized ED treatment and a variety of therapeutic modalities.Hypertension and erectile dysfunction -
Sometimes people develop high blood pressure without an identifiable cause. Regardless of why you have hypertension, untreated chronic high blood pressure damages your heart and blood vessels and eventually leads to life-threatening medical conditions like heart disease and stroke.
Erectile dysfunction is the term used to describe a condition in which men cannot maintain an erection, get a full erection, or have an erection at all. While erections may seem simple, the truth is that many different systems must work together for you to get and maintain an erection, including your muscles, cardiovascular system, brain, nerves, emotions, and hormones.
Your blood vessels play one of the main roles in achieving an erection since blood flow is key to penile function. Anything that impacts your vascular health and the way blood flows in your body can cause or contribute to ED, including:.
Sometimes addressing these underlying health issues works to resolve or minimize erectile dysfunction. In fact, men with chronic high blood pressure are twice as likely to have ED. And since ED is underreported, researchers estimate the numbers could be much higher.
This also affects the muscle in the penis by creating an inability to relax. The result? In addition, your risk of having low testosterone is nearly two times higher if you have hypertension. While the relationship between hypertension and low testosterone is still being investigated, having low testosterone can contribute to erectile problems and low libido.
Getting high blood pressure under control is imperative for your overall health. Erectile dysfunction is frequently encountered in hypertensive men, and the co-existence of arterial hypertension and erectile dysfunction increases with age.
There are several clinically meaningful questions that need to be answered regarding the association between arterial hypertension and erectile dysfunction: a is hypertension per se related to erectile dysfunction?
This review aims to highlight the importance of recognizing erectile dysfunction in patients with hypertension and cardiovascular disease, to provide practical information about the management of erectile dysfunction in treated and untreated hypertensive patients, and to summarize the efficacy and safety of PDE5 inhibitors in cardiovascular disease.
The importance of searching for and recognizing erectile dysfunction in patients with hypertension lies in four major parameters: a its frequency, b the negative impact on quality of life, c the tendency towards poor adherence to therapy or even treatment withdrawal, and d its utility as an early diagnostic window for identifying asymptomatic coronary artery disease.
Erectile dysfunction is found almost twice as frequently in hypertensive patients compared to normotensive individuals [3,4]. Moreover, erectile dysfunction is highly prevalent in patients with other concomitant cardiovascular risk factors diabetes mellitus, obesity, metabolic syndrome, dyslipidemia or overt cardiovascular disease coronary artery disease, heart failure.
Overall, more than half of patients with hypertension suffer from erectile dysfunction and the prevalence of the latter increases with advancing age, the severity and the duration of hypertension, and the presence of other cardiovascular risk factors.
Erectile dysfunction exerts a major impact on the quality of life of patients and their sexual partners. It has to been seen that hypertension is mainly an asymptomatic disease. It is therefore not surprising that patients experiencing sexual problems induced by antihypertensive drugs are more likely to withdraw or not adhere to antihypertensive therapy than patients free of sexual problems.
Finally, erectile dysfunction is of vasculogenic origin, in the vast majority of cases due to atherosclerotic lesions in the penile arteries. Due to the smaller diameter of penile arteries as compared to coronary arteries, sexual problems tend to appear earlier than symptoms from the heart.
Indeed, erectile dysfunction is usually experienced 3 to 5 years before the appearance of symptomatic coronary artery disease. Therefore, erectile dysfunction can be used as an early diagnostic sign of otherwise asymptomatic coronary artery disease.
However, despite the importance of the timely recognition and appropriate management of erectile dysfunction, the latter remains remarkably under-reported, under-recognized, and under-treated [5]. Several patient-related and physician-related factors are responsible for this unpleasant reality.
Physicians are also reluctant to initiate a discussion about sexual problems due to lack of familiarity with this issue, mainly due to lack of appropriate training on this topic. In order to address this issue, in , the European Society of Hypertension formed a Working Group on arterial hypertension and sexual dysfunction, aiming to sensitize physicians about the magnitude of this problem, and educate cardiologists, internists, primary care physicians, and other doctors regarding how to approach patients about sexuality, how to recognize erectile dysfunction, and how to manage these patients.
Along with the position statement of the Working Group published in the Journal of Hypertension [6] and a relevant newsletter [7], several other actions have already taken place: educational lectures at the ESH annual meetings and hypertension congresses in many European countries, regional meetings Balkan region, Baltic region , and multinational protocols evaluating factors that contribute to erectile dysfunction in hypertensive patients and the impact of combination antihypertensive therapy on erectile function.
The first step in the management of erectile dysfunction is to recognize its existence, and then to identify whether it is vasculogenic or caused by other factors.
Therefore, specifically structured questionnaires are used in everyday clinical practice to identify erectile dysfunction. The International Index of Erectile Function complete and short version is widely used and represents a validated, reproducible, easy to perform, and accurate tool for the identification of erectile dysfunction.
Several disease conditions are associated with erectile dysfunction and a detailed medical history combined with a meticulous clinical examination is required to exclude urological, neurological, psychological, endocrine, and iatrogenic causes of erectile dysfunction.
Special caution is required in cases of testosterone deficiency especially in the elderly , the discovery of drug-induced erectile dysfunction, and the recognition that a psychologic component is frequently uncovered in patients with vasculogenic erectile dysfunction, especially in patients with chronic pain, depression, and anxiety.
Erectile dysfunction is highly prevalent in hypertensive patients. Several lines of evidence from experimental and clinical studies suggest that blood pressure elevation is associated with structural and functional alterations of the penile arteries which contribute to erectile dysfunction [8].
Despite fears that blood pressure reduction might compromise penile blood supply and worsen erectile function, available data point towards a beneficial effect of blood pressure control on erectile function [3]. Accumulating data indicate that erectile dysfunction is more prevalent in treated than in untreated hypertensive patients and that antihypertensive drugs are associated with the occurrence of erectile dysfunction [9].
However, not all antihypertensive drug classes share the same effects on erectile function. Many experimental and clinical studies observational, small and large studies have strongly indicated that older antihypertensive drugs exert detrimental effects on erectile function while newer agents exert either neutral or even beneficial effects [10].
Finally, data from open studies point towards benefits in erectile function when antihypertensive therapy is changed from a drug with detrimental effects to a drug without such effects on erectile function [11]. The management of erectile function in untreated and treated hypertensive patients has some differences [12,13] which are summarized below.
Once the diagnosis of vasculogenic erectile dysfunction has been established after careful exclusion of other causes as described above , the first step in the management of erectile dysfunction is to encourage lifestyle modification [14].
Lifestyle modification includes weight reduction, salt restriction, smoking cessation, alcohol moderation, and regular exercise, and is strongly recommended in patients with essential hypertension Class I, level A recommendation [15].
Likewise, several studies have shown that lifestyle modification is associated with significant improvements in erectile function [14]. Antihypertensive drug therapy is required in patients with mild-moderate hypertension and low cardiovascular risk who fail to achieve blood pressure control after a reasonable time period of implementing lifestyle modification or immediately in patients with severe hypertension or high cardiovascular risk [15].
According to the European guidelines, the choice of antihypertensive therapy follows an individualized approach and is mainly based on the presence and type of target organ damage, the presence and type of overt cardiovascular disease, special conditions, comorbidities, and concomitant therapy [15].
Therefore, in patients with an active sexual life that is highly appreciated, the choice of antihypertensive therapy has to take into account this important parameter.
Older antihypertensive drugs diuretics and beta-blockers are not ideal candidates for these patients due to their detrimental effects on erectile function, and should be used only if they are absolutely indicated.
In cases where beta-blockers are chosen for an individual patient, the choice of nebivolol should be considered. Moreover, in case more than one class is indicated for an individual patient, the choice of an ARB should be considered.
Four important factors need to be considered in hypertensive patients with erectile dysfunction before any therapeutic changes: a the time sequence of drug administration and erectile dysfunction, b exclusion of other conditions or drugs causing erectile dysfunction, c future consequences on adherence to antihypertensive therapy, and d implementation of lifestyle modification.
The first question that needs to be answered is whether sexual difficulties appeared or deteriorated after antihypertensive therapy initiation or were pre-existing. Although erectile dysfunction may appear at any time after antihypertensive therapy initiation, it usually appears early, within the first months of therapy.
When erectile dysfunction appears years after therapy administration, it is more likely to be the effect of progressive atherosclerosis and less likely to be the effect of antihypertensive therapy.
The second question regards the presence of concomitant diseases or drugs other than antihypertensive agents that might contribute, at least in part, to erectile dysfunction.
The recognition and appropriate management of such comorbidities as well as the replacement of culprit drugs if possible need to be addressed before further therapeutic decisions. The third question regards the impact of erectile dysfunction on adherence to drug therapy.
It is known that the occurrence of sexual problems is associated with drug discontinuation or poor adherence to drug therapy. Therefore, these problems should be discussed in detail with the patient in order to minimize future poor adherence to therapy or even the discontinuation of antihypertensive drugs.
The final question is whether the patient has already implemented lifestyle modification. In case the patient has not followed one or more pieces of advice regarding lifestyle modification, treating physicians need to reinforce relevant advice and persuade the patient about the benefits of lifestyle changes.
After all these factors have been appropriately addressed and erectile dysfunction in the given patient seems to be related to an antihypertensive drug, known to exert negative effects on erectile function, then the therapeutic strategy offers two choices: a switching to another drug with beneficial effects on erectile function, or b the addition of PDE5 inhibitors on top of antihypertensive therapy.
Previous consensus statements negated any benefits from a change in therapeutic class of antihypertensive drugs. However, data from open studies point towards significant benefits when older drugs diuretics, beta-blockers are replaced by newer agents angiotensin receptor blockers, nebivolol [10,11].
The change of antihypertensive drugs, however, needs to be handled with caution. First, in case a concomitant disease dictates the use of a specific drug category for example, beta-blockers for coronary artery disease and heart failure, diuretics for heart failure , then drug switching does not seem wise, although potential alternatives might be considered deltiazem for post-myocardial infarction, nebivolol for heart failure for patients experiencing a significant impact of erectile dysfunction on their quality of life, because these patients might withdraw from essential therapy.
Second, switching to another class does not guarantee either the restoration or the improvement of erectile function. The results were consistent with IVW random and fixed effect OR 3.
Figure 2. The association of hypertension with ED outcomes by MR analysis through different methods random effect and fixed effects inverse variance weighted method, maximum likelihood, weighted median, penalized weighted median, MR-PRESSO.
OR: odds ratio; CI: confidence interval. Figure 3. Association between hypertension and risk of erectile dysfunction. A multiple MR tests showed the SNP effects; B leave-one-out sensitivity analysis; C funnel plot for hypertension risk of ED; D effect size of each SNP.
MR Mendelian Randomization, SNP single nucleotide polymorphism, ED erectile dysfunction. To explore the sensitivity of the analysis, we conducted the Cochren's Q test, which indicated no evidence of heterogeneity.
The horizontal pleiotropy between SNPs and outcome was assessed by MR-Egger regression. No evidence of horizontal pleiotropy was found. The results of the leave-one-out analysis validated that no potentially influential SNP biased the casual link, and our conclusion was stable Figure 3B.
The funnel demonstrated the displayed symmetric pattern of each SNP on ED and indicated no apparent horizontal pleiotropy Figure 3C. The effect size of each SNP is shown in Figure 3D.
In this study, a two-sample MR analysis was performed to investigate the potential causal effect of hypertension on ED outcomes and revealed the suggested association of hypertension with an increased risk of ED.
By employing several Mendelian tools, the results were proved reliable for achieving stability in the sensitivity analysis. In previous MR studies, the casual effects of insomnia 39 , snoring 40 , educational attainment 41 , and COVID 42 on risk of ED have been sufficiently investigated.
Based on the etiology, ED could be categorized as organic, psychogenic, or mixed ED. Noteworthily, the vast majority of patients are actually affected by mixed causes. In other words, organic lesion could be found in most patients.
The pathological classification of ED includes vasculogenic, endocrinologic, neurogenic, anatomical, drug-related, psychogenic, or mixed causes The arterial insufficiency is the primary cause of ED.
The blood supply for penis mainly comes from the iliac and the pudendal artery and flows to the penile arterial system. An impairment in any segment of this arterial system may lead to ED.
Hypertension as a major detrimental factor for vascular impairment could largely damage the blood flow to the penis During the past several years, a few large-scale observational studies on the incidence of ED among hypertensive patients have revealed that hypertension is closely correlated to an elevated risk of ED 18 — Furthermore, ED was found to be more prevalent in patients with long-duration or severe hypertension, which further illustrates the link between hypertension and risk of ED The results of these mentioned studies were consistent with our findings.
Actually, ED shares not only various common risk factors unhealthy lifestyle, obesity, aging, alcohol and tobacco use, etc. A variety of vasoconstrictors angiotensin II, endothelin 1, aldosterone, etc. and vasodilators nitric oxide, hydrogen sulfide, Nrf2, etc. are strongly associated with the pathophysiologic pathways of hypertension and ED.
As a modifiable risk factor, the management of hypertension also significantly interferes with the treatment of ED. According to the recommendations given by the Princeton Consensus Conferences on optimizing sexual dysfunction and preserving cardiovascular health, ED patients with asymptomatic-controlled hypertension can receive treatment for ED in the first place and continue sexual activity without the fear of significant cardiac risk.
Otherwise, ED patients with uncontrolled hypertension are stratified as a high-risk group. For these patients, treatment for ED should always be secondary to the management of hypertension or other cardiovascular diseases.
More importantly, any form of sexual activity is strictly forbidden Noteworthily, although satisfying blood pressure control levels are closely related to erectile function benefits, antihypertensive therapy may independently trigger or worsen ED. According to the results of the MMAS study, one of the most valuable epidemiologic studies on ED, receiving treatment for hypertension strongly elevates the risk of ED 5.
Different antihypertensive drugs have distinct effects on ED Some β -blockers could negatively influence erectile function by blocking β -2 receptors, thus resulting in the constriction of the penile arteries 50 , while nebivolol as a new-generation selective β -BLOCKER has a positive effect on erectile function Diuretics is also considered to exert detrimental effects on ED as a common side effect Angiotensin receptor blockers ARBs and angiotensin-converting enzyme inhibitors ACEIs could be beneficial, or at least neutral, to erectile function and sexual activity In our study, a causal link between hypertension and risk of ED has been established with all confounding factors being excluded.
Arterial hypertension brings more burden than any other diseases globally, which affects more than 1 billion people worldwide 17 , Considering the higher prevalence of ED in hypertensive patients, antihypertensive therapy regardless of side effects on ED no doubt would impair the QoL, cause a heavy mental burden, affect medication compliance, and eventually aggravate the vicious circle of hypertension and ED in a large number of patients and their partners.
Hence, antihypertensive therapy, which is beneficial for erectile function, should be attempted on a large scale on untreated patients. For those patients who receive antihypertensive drugs with detrimental effects on erectile function, a switch in the therapeutic regimen with caution may be a wise decision.
The coadministration of selective phosphodiesterase type 5 inhibitors PDE5I could be an alternative for avoiding the increased risk brought by the change to antihypertensive therapy.
Currently, four potent PDE5I drugs are approved for ED treatment, namely, sildenafil, tadalafil, vardenafil, and avanafil. However, since hypertension is a modifiable risk factor of ED, priority should always be to prevent ED from initiating. The main strength of this study is the merit of the MR design, which could evaluate the independent causal effects of hypertension on ED.
To the best of our knowledge, this is the very first MR study on hypertension and ED based on large-scale consortium data. The application of MR avoids several limitations in retrospective studies. In addition, 67 qualified SNPs in the European population were used as instrumental variables, which constructed a well-powered MR analysis.
Hence, the results were unlikely impacted by population stratification. Inevitably, certain limitations exist in our study.
First, due to the lack of original data in the GWAS data set, we could not fully evaluate the severity of ED and hypertension. Second, the most adaptable inquiry for the epidemiological data of ED is self-reporting and questionnaire survey. Owing to patients' reluctance to disclose their sexual dysfunction problems, the prevalence of ED in hypertensive patients may be underestimated.
Third, our study was mainly based on the genetic data of European ancestry, and the results may be inconsistent in other ethnic populations. Also, each MR method has its own strength and weakness, and we cannot completely rule out potential bias.
Our results suggested that hypertension would increase the risk of ED outcomes. But a definite causal relationship requires conducting more RCTs with high quality and more in-depth studies in the future.
Our results confirmed a positive causal link between the presence of hypertension and the risk of ED in the general population. This MR study could serve as high-level clinical evidence of the impact of hypertension on erectile function, revealing causality and providing reference for clinical diagnosis and treatment, with the aim of improving the treatment effect of ED in the hypertension population, as well as providing certain guidance for the medication regimen of antihypertensive drugs to protect erectile function.
Publicly available data sets were analyzed in this study. Please refer to the supplementary materials for the original code of this study. The authors are accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.
The current analyses are based on publicly available summary data and therefore do not require ethical approval. Original studies have been approved by ethic committees and written informed consent was obtained from study participants or caregivers.
The study was conducted in accordance with the Declaration of Helsinki as revised in LW, DX, and ZL designed and supported the study. ZW, YW, and JX collected and analyzed the data. ZH, YY, and ZW wrote the manuscript. XG, YZ, and YB contributed to manuscript preparation and revision.
WS, YW, and AJ contributed to data visualization and validation. All authors contributed to the article and approved the submitted version. The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.
The reviewer YWe declared a shared parent affiliation with the author YWa to the handling editor at the time of review. All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers.
Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher. NIH Consensus Conference. NIH consensus development panel on impotence.
doi: PubMed Abstract CrossRef Full Text Google Scholar. Rosen RC, Riley A, Wagner G, Osterloh IH, Kirkpatrick J, Mishra A. The international index of erectile function IIEF : a multidimensional scale for assessment of erectile dysfunction. Rosen RC, Cappelleri JC, Smith MD, Lipsky J, Pena BM.
Development and evaluation of an abridged, 5-item version of the international index of erectile function IIEF-5 as a diagnostic tool for erectile dysfunction.
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J Urol. Eardley I. The incidence, prevalence, and natural history of erectile dysfunction. Sex Med Rev. Ayta IA, McKinlay JB, Krane RJ. The likely worldwide increase in erectile dysfunction between and and some possible policy consequences. BJU Int. Wang XY, Huang W, Zhang Y.
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