What blood pressure medications do not cause erectile dysfunction

High blood pressure (hypertension) is a leading cause of erectile dysfunction (ED). High blood pressure puts people at higher risk of ED: Men with high blood pressure are nearly twice as likely to have erectile dysfunction and impaired penile blood flow compared to their peers with normal blood pressure. And it is estimated that one-third of all men with hypertension experience erectile dysfunction. 

Chronically high blood pressure puts a strain on the organs and tissues, slowing blood flow and therefore the ability to maintain an erection. Hypertension alone can lead to erectile dysfunction. Certain high blood pressure drugs can also cause ED, while some other blood pressure medications actually improve ED.

In this article, we will discuss the connection between high blood pressure and erectile dysfunction and explain why some medications may exacerbate erectile dysfunction, and others help in managing erectile dysfunction. 

The Anatomy of an Erection

During sexual arousal, nerves release chemicals that increase blood flow into the penis. Blood flows into two erection chambers in the penis, which are made of spongy muscle tissue called the corpus cavernosum.

During an erection, the corpus cavernosum fills up with blood making the penis firm. After orgasm, the muscles of the penis relax, releasing blood back into the circulation system. As a result, the erection comes down, the penis is soft and limp, and the man’s urogenital system returns to its pre-arousal state.

High blood pressure damages blood vessels, reducing blood flow throughout the body, including the penis. Hardened and narrow blood vessels make it difficult for blood to flow into the penis before intercourse.

Erectile dysfunction can be an early warning sign of damaged blood vessels. When your blood flows naturally, you can have healthy erections. Natural arousal leads to increased blood flow to your penis causing an erection. This process becomes more difficult with high blood pressure. Slowing of blood flow in the pelvic region can make getting or maintaining an erection a challenge. This change in sexual function is sometimes a warning sign of a larger problem, prompting people to seek help. 

If you have isolated high blood pressure, but otherwise a clean bill of health, you are usually safe to take ED drugs. But if you have health complications like severe cardiovascular disease or urinary tract issues, ED drugs are usually not recommended. 

Blood Pressure Medications That May Improve ED

Certain prescription meds have more beneficial effects on erectile function than others. The following drugs have been shown to be helpful:

Angiotensin-Converting Enzyme (ACE) Inhibitors and Erectile Dysfunction

Angiotensin-converting enzyme (ACE) inhibitors are a class of medications that lower blood pressure by relaxing veins and arteries. ACE inhibitors work by blocking the angiotensin-converting enzyme, which converts angiotensin I to angiotensin II. Angiotensin II is a potent hormone that causes smooth muscles around blood vessels to contract, resulting in the narrowing of blood vessels and a rise in blood pressure.

Blocking this effect results in a relaxing of blood vessels and a decrease in blood pressure. It also means that it can help promote blood flow to certain areas of the body like the penis. ACE inhibitors also reduce the workload of the heart which can increase stamina and sexual performance.

 Common ACE inhibitors taken for high blood pressure include:

• Enalapril
• Lisinopril
• Perindopril
• Ramipril
• Captopril
• Benazepril
  

An ACE inhibitor like lisinopril is unlikely to result in ED because the drug increases blood flow. In one study, less than 3% men taking lisinopril reported ED as a side effect.

Vasodilators and Erectile Dysfunction

Arterial vasodilators relax blood vessels and improve blood flow, which helps to lower blood pressure.

Some common arterial vasodilators taken for high blood pressure include: 

• Benazepril (lotensin)
• Captopril (capoten)
• Enalapril (vasotec, epaned)
• Fosinopril (monopril)
• Lisinopril (prinivil, zestril)
• Moexipril (univasc)
• Perindopril (aceon)
• Quinapril (accupril)
• Ramipril (altace)
• Trandolapril (mavik)

Since these medications work by stimulating blood flow, they may have a secondary benefit of improving ED.

There are also vasodilators, like alprostadil, that are specifically prescribed for ED. These drugs are injected directly into the penis or urethra to promote blood flow to the area. You may experience an erection as quickly as 10 minutes after that. Alprostadil is also available as a urethral suppository for those who prefer a non-injectable form of therapy. 

Angiotensin II Receptor Blockers (ARBs) and Erectile Dysfunction

Studies have shown that angiotensin receptor blockers (ARBs) either have no significant negative effects or in some cases, beneficial effects on erectile function.

ARBs are a group of drugs used to treat high blood pressure and heart failure. These medications work by blocking the action of a chemical (angiotensin) which narrows the blood vessels. As a result, blood vessels widen, increasing blood flow and lowering blood pressure. In some people, this effect also improves erectile function.

Some common ARBs taken for high blood pressure include:

• Edarbi (azilsartan)
• Atacand (candesartan)
• Avapro (irbesartan)
• Cozaar (losartan)
• Benicar (olmesartan)
• Micardis (telmisartan)
• Diovan (valsartan)

Alpha-Blockers and Erectile Dysfunction

Alpha-blockers are a class of drugs that block the effects of the hormones adrenaline and noradrenaline on your blood vessels. Adrenaline and noradrenaline cause your blood vessels to narrow so blood has less space to flow through. Alpha-blockers allow your blood vessels to relax and widen, making it easier for blood to flow through.

This effect can help facilitate blood flow to the penis. However, adrenaline and noradrenaline are also important mediators of sexual functioning and the development of an erection, so any decrease in their effect can increase the risk of ED. 

For instance, alpha-blockers such as Hytrin (terazosin) and Cardura (doxazosin) can cause difficulty in maintaining an erection and/or decreased ejaculation. But as a class, alpha-blockers only rarely cause ED.

Alpha-blockers typically are not the first treatment option for high blood pressure, but some common alpha-blockers that may be taken for high blood pressure include:

• Cardura (doxazosin)
• Minipress (prazosin)
• Baratol (indoramin)
• Hytrin (terazosin)

Alpha-blockers shouldn’t be taken alongside PDE5 (phosphodiesterase type 5) inhibitors, like Viagra, and antidepressants, as they can cause a sudden drop in blood pressure if taken together.

Blood Pressure Medications That May Increase the Risk of ED

One reason erectile dysfunction becomes more common with age is that older men are more likely to be on medication, and ED is often a side effect of many common drugs. In fact, it's been estimated that 25% of all ED is caused by medication.

The following drug classes have been linked to increased risk of ED. If you have concerns about medications you are taking, talk with your healthcare provider about other options available to you. You should never start or stop a blood pressure medication without medical supervision.

Diuretics and Erectile Dysfunction

Diuretics, also known as water pills, increase urine output to help release excess water and salt from the blood. This helps lower blood pressure by decreasing the amount of blood the heart has to pump.

It's unknown exactly how diuretics affect erectile function, but some research suggests that diuretics can increase the occurrence of ED. Common diuretics that are taken include:

• Bumex (bumetanide)
• Hygroton (chlorthalidone)
• Diuril (chlorothiazide)
• Edecrin (ethacrynate)
• Lasix (furosemide)
• Esidrix, Hydrodiuril, Microzide (hydrochlorothiazide HCTZ)
• Lozol (indapamide)
• Enduron (methyclothiazide)
• Mykroz, Zaroxolyn (metolazone)
• Demadex (torsemide)

Beta Blockers and Erectile Dysfunction

Beta-blockers work by blocking the effect of adrenaline on tissues. There's some research that suggests beta-blockers may decrease blood flow to the penis, making it difficult to get an erection.

Contrarily, several studies have confirmed that taking the beta-blocker Bystolic (nebivolol) may actually be beneficial to erectile dysfunction.

Some commonly used beta-blockers that may negatively impact penile function include:

• Coreg (carvedilol)
• Lopressor, Toprol XL (metoprolol)
• Tenormin (atenolol)
• Inderal LA (propranolol)
  

Calcium Channel Blockers (CCBs) and Erectile Dysfunction

Calcium channel blockers treat hypertension by blocking calcium from entering the cells of the heart and arteries. This relaxes blood vessels and improves blood flow.

A recent analysis of literature looking at five epidemiological trials evaluating the effect of different cardiovascular drugs on erectile function found that calcium channel blockers had no relevant or even a positive effect on erectile function.

While these findings may be underwhelming, they are contradictory to older studies that have implicated the use of calcium channel blockers in erectile dysfunction. More research is needed to confirm the role of calcium channel blockers in erectile dysfunction.

Common calcium channel blockers prescribed for high blood pressure include:

• Norvasc (alodipine)
• Plendil (felodipine)
• DynaCirc (isradipine)
• Cardene (nicardipine)
• Procardia XL, Adalat (nifedipine)
• Cardizem, Dilacor, Tiazac, Diltia XL (diltiazem)
• Sular (nisoldipine)
• Calan SR, Verelan, Covera-HS (verapamil)

A Word From Verywell 

Despite the debate surrounding the use of high blood pressure medication in ED patients, research shows that people with long withstanding high blood pressure levels are more likely to have significant structural damage in their penile arteries. Treating the condition with antihypertensive drugs is unlikely to further reduce blood flow to the penis, and may prevent additional damage.

In people with normal or high-normal blood pressure, the penile arteries have minimal structural damage, and medications could have a negative impact on penile blood flow, which underscores the importance of having an accurate diagnosis prior to starting high blood pressure treatment. 

If you experience ED shortly after starting treatment with any blood pressure drug, speak with your doctor. They can work with you to substitute for a different one or help troubleshoot your problem. Bear in mind that different drugs have different half-lives which means it may take several days to several weeks for the drug to leave your body, therefore it may take some time for your erections to return after stopping a high blood pressure medication.

Frequently Asked Questions

• Can ED from high blood pressure be reversed?

  ED from high blood pressure can be reversed, especially if you are generally healthy and high blood pressure is the sole culprit. It’s important to note that high blood pressure medications may be helpful to some people and harmful to others, so never start a medication without first speaking with your healthcare provider.

• Does amlodipine cause erectile dysfunction?

  Amlodipine rarely causes erectile dysfunction, although there are some scientists who still debate amlodipine’s role in ED.

• Can you take Viagra if you are on blood pressure medications?

  For many people with hypertension, taking Viagra is safe and effective, but when starting any new prescription, including medications for ED, it is important to discuss it with your doctor or another healthcare professional. They will thoroughly evaluate your health history, current list of medications, and other factors to determine the safest and most appropriate course of treatment for you.

  Viagra can interact with some classes of heart failure or blood pressure medications like alpha-blockers and nitrates, causing an unsafe drop in blood pressure. If you are taking several medications or are unsure if Viagra is contraindicated given your current medication regimen, seek an explanation from a trusted medical professional. 

• Is erectile dysfunction caused by hypertension?

  Erectile dysfunction can be caused by high blood pressure because hypertension damages the small blood vessels that allow blood to flow to the penis during an erection.

Which blood pressure medicine does not cause ED?

What blood pressure medication helps erectile dysfunction?

Which beta blocker does not cause erectile dysfunction?

Does amlodipine help with erectile dysfunction?