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Erectile Dysfunction and Hypertension


Updated October 01, 2007

Erectile dysfunction is a relatively common condition among men of all ages. Studies have shown that that about 70% of men suffer episodes of erectile dysfunction at some time during their lives. The condition is probably more common than these statistics reflect, though, because it is likely that men tend to underreport the disease.

Sometimes the term “impotence” is used interchangeably with erectile dysfunction, though the two terms really describe different conditions –- impotence is used to describe a more chronic form of erectile dysfunction, where at least 75% of sexual encounters fail to produce an erection. Erectile dysfunction becomes more common as men get older, and it is no longer believed to be an unavoidable part of the aging process.

Causes of Erectile Dysfunction

High blood pressure is an important cause of erectile dysfunction and impotence. Other causes include:

  • Blood vessel problems
  • Diabetes
  • Use of certain medications
  • Excessive amounts of certain exercises (bike riding, weight lifting)
A number of studies have shown that erectile dysfunction is both more common and more serious in men with hypertension. For example, while about 30% of men will experience one episode of erectile dysfunction in a given month, that number jumps to almost 70% in men with hypertension. About 45% of men with hypertension have severe erectile dysfunction (more than three episodes in a month), while only about 5% of men with normal blood pressure fit into this category.

These statistics are more interesting when considered from the opposite angle. For example, it’s one thing to say that 40% of men with high blood pressure suffer from erectile dysfunction, but more revealing to note that almost 80% of men who complain of erectile dysfunction are later found to have high blood pressure. The relationship between high blood pressure and erectile dysfunction is so strong that some physicians and researchers have argued in favor of using sexual activity questions as a screening test for high blood pressure and other cardiovascular problems.

How High Blood Pressure Causes Erectile Dysfunction

Nobody knows exactly how high blood pressure causes erectile dysfunction and impotence. One leading theory is that the excess pressure in the blood vessels actually causes damage to small arteries in the penis. Normally, these arteries dilate in response to sexual stimulation, allowing more blood to flow into the spongy tissue of the penis to produce an erection. It is thought that excessive pressure on these arteries may cause tiny tears, which the body then repairs. In response to these tears, the healed arteries become thicker, allowing them to better resist further damage. These thicker arteries, though, aren’t able to respond as fast, or as completely, to demands for extra blood, so they become a sort of dam in the flow of blood to the erectile tissues of the penis.

One problem with this theory is that some studies seem to show that how long a patient has had high blood pressure is not as important for predicting the risk of erectile dysfunction as is the actual severity of the high blood pressure. In other words, someone who has had moderate hypertension for twenty years sometimes appears to be at lower risk for erectile dysfunction than a young man who has had very serious hypertension for only a few months. In light of this, other theories of how high blood pressure contributes to erectile dysfunction have been proposed.

Read More: Theories of High Blood Pressure Induced Erectile Dysfunction

To complicate matters further, it is well established that many popular drugs used to treat high blood pressure can cause or worsen erectile dysfunction. Some of the drugs known to have this side effect are:

Treatment of Erectile Dysfunction and Impotence Caused by High Blood Pressure

Typically, the first step in treating erectile dysfunction and impotence is identifying the ultimate cause of the problem. In patients with high blood pressure, the high blood pressure itself is usually the cause. The primary focus of treatment is to reduce the blood pressure to acceptable levels, if it is not already within the target treatment range.

Popular drugs like Viagra (sildenafil) and Cialis (tadalafil) –- known as phosphodiesterase inhibitors –- are a popular and effective choice for patients who have good blood pressure control. Your doctor may need to avoid giving you these drugs if you are currently taking nitrates (Imdur, Monoket, Isordil, Dilatrate), which are commonly prescribed for angina. More severe, or treatment-resistant cases, are dealt with on a patient-by-patient basis. Treatment in these situations may include options such as surgery, penile injections, or alternate drug therapy.

Sources: Baumhakel, M, Bohm, M. Erectile dysfunction correlates with left ventricular function and precedes cardiovascular events in cardiovascular high-risk patients. International Journal of Clinical Practice 2007; 61:361.

Feldman, HA, et al. Impotence and its Medical and Psychosocial Correlates: Results of the Massachusetts Male Aging Study. Journal of Urology 1994; 151:54.

Fung, MM, Bettencourt, R, Barrett-Connor, E. Heart disease risk factors predict erectile dysfunction 25 years later: the Rancho Bernardo Study. Journal of the American College of Cardiology 2004; 43:1405.

Selvin, E, Burnett, AL, Platz, EA. Prevalence and risk factors for erectile dysfunction in the US. American Journal of Medicine 2007; 120:151.

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