Erectile dysfunction (ED) and high blood pressure: how are they related?


Key Points

  • Most erectile dysfunction is caused by damage to blood vessels. High blood pressure, smoking, diabetes, obesity, and inactivity can cause this damage.
  • The best thing you can do to improve ED is to eat a healthy diet, exercise and quit smoking.
  • Medications may affect ED, so talk to your doctor about whether you may need to make changes

What is erectile dysfunction and why does it happen?

Erectile dysfunction, or ED, is when someone is not able to develop or keep an erection. ED is very common. One study shows that almost half of men describe some level of sexual dysfunction by age 40. After the age of 40 the percentage of men with ED increases.

Normal male sexual function is complicated. It involves both your body and your mind. Your nerves, blood vessels and hormones are just as important as your mood and focus. These things have to work together to develop and keep an erection.

Many factors can lead to erectile dysfunction. The most common cause is narrowing of the blood vessels in the penis. High blood pressure, high cholesterol, diabetes and cardiovascular disease can cause blood vessels to narrow. When these blood vessels narrow, less blood can flow into the penis. This causes a weak erection which may make you feel anxious about having sex the next time. This anxiety may make having an erection difficult again. Over time this can lead to depression and relationship issues.

So tell me again…….what are the causes of ED?

  • MOST COMMON: Narrowed blood vessels due to diabetes, high cholesterol, high blood pressure, smoking, cardiovascular disease, obesity, obstructive sleep apnea, chronic kidney disease, and lack of physical activity
  • MODERATELY COMMON: some medications (including some for depression and high blood pressure), depression, anxiety
  • LESS COMMON BUT STILL SOMETHING TO THINK ABOUT: pelvic trauma and/or surgery, low testosterone, certain neurologic diseases

How does your blood pressure affect your erections?

High blood pressure damages blood vessel walls. Blood vessels get narrow and blood flow to the penis is decreased. Certain blood pressure medicines can worsen ED. These medications include

  • chlorthalidone
  • hydrochlorothiazide (HCTZ)
  • spironolactone
  • clonidine.

Beta-blockers (atenolol, propranolol, metoprolol or carvedilol) are less likely to make ED worse. ACE inhibitors, angiotensin receptor blockers, and calcium channel blockers are least likely to cause ED. The alpha-blocker, doxazosin, can actually improve sexual function.

What can you do to improve erectile dysfunction?

  1. If you take a medication that is known to contribute to ED it may be possible to change medications. Talk to your doctor to learn more. Keep in mind that changing medication may not resolve your ED.
  2. Talk to your doctor if you think that anxiety, depression or relationship issues may be getting in the way of your sex life.
  3. Your doctor may be able to prescribe medication to help improve your erection. They don’t work for everyone and they don’t reverse the underlying problems causing the ED.
  4. If you have low testosterone levels ask your doctor about testosterone replacement. Keep in mind that this is usually not effective.
  5. The most important thing you can do to improve ED is start reversing the damage to your blood vessels. Do this by focusing on the following:
  6. If you are a smoker, do your best to quit. Stopping smoking has improved ED for many.
  7. Exercise. Forty minutes of moderate to intense physical activity 4 times a week has been proven to improve erectile function!
  8. Evaluate your diet. Eat a lot of vegetables, fruits, nuts, legumes, and fish. Avoid red meat and processed foods. Both are associated with a lower risk of ED.
  9. Lose weight. One study showed that losing 15% of your body weight can cure your ED.
  10. Treat sleep apnea. If you snore and feel tired even after a full night sleep you may have sleep apnea. Check with your doctor.

What if I’ve tried all that and nothing seems to work?

In this case, it’s best to consult with a specialist called a urologist. They may recommend treatments such as vacuum-assisted erection devices or penile self-injection. It’s NOT recommended that you try any over the counter supplements that claim to improve sexual performance. They are usually ineffective and sometimes dangerous.

What you need to know

Erectile dysfunction is common and often treatable. The major cause is blood vessel damage. This can often be reversed by lifestyle changes. Some changes include exercise, diet, or quitting smoking. Sometimes medication changes can help. Check with your doctor if you’ve tried everything and are still experiencing symptoms.


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