High Blood Pressure Drugs and Erectile Dysfunction

Medically Reviewed by Nazia Q Bandukwala, DO on October 22, 2021
4 min read

To treat erectile dysfunction (ED), you first must lower your blood pressure if it's high. Some people are able to do that through lifestyle changes alone. Others need help from prescription blood pressure drugs.

A problem for many men, however, is that some types of blood pressure medicines can actually causeerectile dysfunction. That may make it difficult to stay on your medication, especially if your high blood pressure never caused any symptoms before. An estimated 70% of men who have side effects from blood pressure medicine stop taking it.

Many drugs used to treat high blood pressure have been linked to erectile dysfunction. But some are much less likely than others to cause problems. Certain blood pressure drugs may even improve erectile dysfunction for some men.

It's known that diuretics or water pills (hydrochlorothiazide, spironolactone) and certain beta-blockers (like Atenolol) can cause erection problems. These are also the first drugs that a doctor is likely to prescribe if you are not able to lower your blood pressure through diet and exercise.

If you're taking a diuretic, you should stay on your medication until your blood pressure is under control. If your erection problem persists, or your blood pressure goes back up, then your doctor might switch you to a drug that's less likely to cause erectile dysfunction. Or, a combination of medications might work better to control your blood pressure and reduce the risk of erectile dysfunction.

If you take a beta-blocker you may also want to ask your doctor if it might cause erectile dysfunction. If so, you might be better off on a different medication.

Some families of high blood pressure drugs rarely cause erectile dysfunction as a side effect. They are:

ACE (angiotensin converting enzyme) inhibitors -- such as captopril (Capoten), benazepril (Lotensin), and lisinopril (Prinivil, Zestril) -- widen blood vessels and increase blood flow. Erectile dysfunction is rarely a side effect, occurring in less than 1% of patients. There are several different drugs in this category. This seems to be true of all of them.

There are also drugs known as calcium channel blockers, such as amlodipine (Norvasc), diltiazem (Cardizem, Tiazac), or verapamil (Calan, Verelan). As a group, they rarely cause erectile dysfunction. But erection problems may be less common with some individual drugs within that group than with others. Your doctor can tell you which.

In general, alpha-blockers do not often cause erection problems either. In one study, a small number of men actually had a 100% improvement in their erectile dysfunction after 2 years on the alpha-blocker doxazosin (Cardura).

Drugs known as ARBs (angiotensin II receptor blockers, like losartan (Cozaar) are not only unlikely to cause erection problems, but they may improve sexual function in men with high blood pressure.

A study published in the American Journal of the Medical Sciences looked at the drug Cozaar, an ARB. At first, just 7% of men and women in the study said they felt sexually satisfied overall. After 12 weeks of Cozaar, about 58% said they were sexually satisfied. The percentage of men who reported having erectile dysfunction dropped from 75% to 12%.

Another study compared the drug valsartan (Diovan), an ARB, with carvedilol (Coreg), a beta-blocker. The study compared the effect of the two drugs on blood pressure and frequency of sexual intercourse. The drugs controlled blood pressure equally well. But people who took the ARB reported having sex more often during the 16 weeks of treatment. They said they had sex about eight times a month before, and 10 times a month after. People taking the beta-blocker had sex much less often: eight times a month before, and four times a month after.

Tell your doctor if you think your blood pressure medication may be causing erectile dysfunction.

If it is your medication, and not just your high blood pressure, switching to another prescription may solve the problem. Never stop taking your medicine without your doctor's OK.

But high blood pressure itself still could be to blame for your erectile dysfunction. In that case, ask about trying an erectile dysfunction drug like avanafil (Stendra), sildenafil (Viagra), tadalafil (Adcirca, Cialis), or vardenafil (Levitra, Staxyn​​​​​​​,).

You should only take these drugs once your blood pressure is under control. They are not safe for men with untreated high blood pressure. They are also not safe for men taking alpha-blockers, or men taking nitrate drugs for heart disease.