How High Blood Pressure Leads to Erectile Dysfunction

Medically Reviewed by Nazia Q Bandukwala, DO on February 13, 2024
8 min read

To understand how high blood pressure can lead to erectile dysfunction, you first have to understand how erections work. Getting an erection is really a complicated process.

In the shaft of the penis , there are two side-by-side chambers of spongy tissue called the corpora cavernosa. They're mainly responsible for erections. Just below them is another chamber called the corpus spongiosum. The urethra, which carries semen and urine, runs through the center of it.

The corpora cavernosa are made of small arteries and veins, smooth muscle fiber, and empty spaces. The chambers are wrapped in a sheath of thin tissue.

When you get an erection, signals from the brain or nerve endings in the penis cause the smooth muscle of the chambers to relax and arteries to dilate, or open wider. This allows a rush of blood to fill the empty spaces.

The pressure of blood flow causes the sheath of tissue around the chambers to press on veins that normally drain blood out of the penis. That traps blood in the penis. As more blood flows in, the penis expands and stiffens, and you have an erection.

When the excitement ends, the smooth muscle contracts again, taking pressure off the veins and allowing blood to flow back out of the penis. Then the penis returns to a flaccid state.

For a healthy young man, erectile dysfunction (ED) is typically not a problem. As you age, however, you may notice some changes. Maybe it takes more coaxing for you to get erect than it used to. Sometimes, it may take more direct stimulation of the penis, whereas merely a daydream or the suggestion of sex was once enough. Or maybe your erection isn't quite as firm as it once was, but it's still good enough. These are normal changes.

When should you seek help? Here are a few scenarios:

1. You come home one evening after a long, stressful day at work. Your partner wants to have sex. You think you'd like to also, but you have a problem getting an erection. The next time you try, everything is fine.

In this case, your problem probably doesn't need medical treatment as long as it happens rarely. If it starts to happen more often, you may want to talk to your doctor about it.

2. Sometimes, when you try to have sex, you get only partially erect. Your erection isn't rigid enough to enter your partner.

In the most severe cases of erectile dysfunction, a man isn't able to get even slightly erect. But there are degrees of this condition. Even mild erectile dysfunction is worth discussing with your doctor.

3. You can get a good erection during foreplay, but after you start to have intercourse, you lose it.

This can be very frustrating for you and your partner. Even though you’re able to get an erection, if it doesn't last long enough to complete sexual intercourse, you may have erectile dysfunction.

An estimated 80% of erectile dysfunction is due to physical causes, often high blood pressure

The other 20% is psychological. For a long time, doctors thought that erectile dysfunction was mostly in one's head. Now they know that’s not true. Still, the mind plays a big role in getting an erection. Maybe you're losing your erection due to anxiety or other issues between you and your partner. Your doctor can help you determine the cause.

4. Your doctor prescribes a new medication, and you notice that it's now more difficult to get an erection than it was before you started taking it.

Side effects of drugs cause up to 25% of erectile dysfunction cases.

Blood pressure medicines are lifesavers, but erection problems are sometimes a side effect. Other medications that can cause erectile dysfunction include:

Talk to your doctor about switching to a different drug that's less likely to cause problems. Also ask about treatment options specifically for erectile dysfunction.

5. You typically have several alcoholic drinks every night. It's difficult for you to get an erection when you've been drinking.

A glass of wine may help you and your partner get in the mood, but heavy drinking can really hamper your sexual performance.

Alcohol depresses the nervous system, which may cause erection problems if you've had too much to drink. If it only happens when you drink and the effect is temporary, you should limit your drinking and avoid treating the problem with erectile dysfunction medication.

Keep in mind that alcohol also has long-term toxic effects on the nerves that can cause erectile dysfunction, even at times when you're not drinking.

High blood pressure is a major cause of erection problems. A study in the Journal of the American Geriatrics Society found that about 49% of men ages 40 to 79 with high blood pressure had erectile dysfunction.

Another study of men with high blood pressure, published in the Journal of Urology, found that 68% of them had some degree of erectile dysfunction. For 45% of the men, it was considered severe.

High blood pressure keeps the arteries that carry blood into the penis from dilating the way they're supposed to. It also makes the smooth muscle in the penis lose its ability to relax. As a result, not enough blood flows into the penis to make it erect.

Men with high blood pressure may also have a low testosterone level. Testosterone is the male hormone that plays a big role in sexual arousal.

High blood pressure by itself can lead to erectile dysfunction. But some drugs for treating high blood pressure can actually be the cause as well.

Diuretics -- or water pills -- and beta-blockers are the high blood pressure drugs most commonly linked to erectile dysfunction.

Diuretics may cause erectile dysfunction by decreasing the force of blood flow into the penis. They may also decrease the amount of zinc in the body. Your body needs zinc to make testosterone.

Beta-blockers dampen the response to nerve impulses that lead to an erection. They also make it more difficult for the arteries in the penis to widen and let in blood. What's more, they can make you feel sedated and depressed -- and the mind always plays some part in sexual arousal.

Sometimes, the choices that some men with high blood pressure make can add to the problem. Smoking, especially, is one of those. Smoking increases blood pressure, and damages blood vessels and reduces blood flow all around the body.

The power to take control of your blood pressure and sexual health is in your hands. By living a healthy lifestyle and working with your doctor, there's a chance you'll once again be able to have normal sexual function.

Your doctor will need a lot of information from you before suggesting any treatment. If this doctor had been involved in your care for high blood pressure, you can talk about how well you've been controlling your blood pressure and about how you’re doing with the medications you're taking. If you’re meeting with a new doctor, you’ll share all that, plus information about other health problems you may have, like diabetes or high cholesterol.

The doctor may discuss any of your risk factors for heart disease before recommending treatment, as well as any side effects you could be having from medications.
Telling a doctor that you have difficulty with your erection isn’t the easiest thing to do. But to get the right care, you have to tell your doctor everything, including the truth about things like drinking alcohol, using drugs, or smoking cigarettes. It's in your best interest to be totally honest.

You should also be prepared to discuss some questions about your sex life. They might ask things like:

  • What's your sexual orientation? Do you have sex with men, women, or both?
  • Do you have a steady partner? Multiple partners?
  • How is sex with your partner? Has anything changed recently?
  • Has anything upsetting happened to you lately?
  • In general, are you under a lot of stress?
  • Do you ever feel depressed?

A doctor you’re seeing for the first time may also need to examine your penis, testicles, and prostate gland. Some men also have their testosterone level tested.

There’s another test that is done sometimes to help determine whether you get erections while you are asleep. The doctor may send you home with a special tape that you wrap around your penis before you go to bed. If the tape is broken in the morning, you've had an erection during the night. That means the cause of your erection problem may not be physical.

Erectile function may be related to high blood pressure, vascular disease, medication side effects, and sometimes to stress or depression. After addressing possible medication side effects, your doctor might prescribe a drug such as Cialis, Levitra, or Viagra.

Make an appointment with your doctor afterward to discuss your response to the medication. If it’s not as effective as you’d like, you might need to take a higher dose or switch to a different medication.
It's a good idea to stay in touch with your doctor about your ED. Changes in your health over time may affect your treatment. Since you’ll already have regular checkups for managing your blood pressure, bring up your erectile dysfunction treatment at those visits.

Doctors genuinely want to work with you to solve your health problems. You can help them help you by taking an active role in your care, bringing up your concerns, and asking questions.

You may have much more success treating erection problems if you manage blood pressure first. Eating well and exercising regularly will help prevent and treat high blood pressure.

If you need help managing your blood pressure, try the DASH (Dietary Approaches to Stop Hypertension) diet. This can lower blood pressure in as little as 2 weeks. In general, the DASH diet emphasizes eating whole grains, vegetables, fruit, and low-fat dairy products while limiting salt, fat, and sugar.

You should limit sodium to 1,500 milligrams per day. That's only about two-thirds of a teaspoon of table salt.

That can be a hard target to hit if you eat a lot of processed foods (canned soups, cold cuts, or processed cheese, for example). Your best bet is to favor fresh foods that have no added preservatives or fats. Also, read food labels to check on how much sodium is in a serving, and don't add any extra salt.

Burning calories through exercise helps you tone your body and lose weight. Being overweight makes erectile dysfunction more likely.
Many studies have shown that exercise also fights depression, which has a major impact on sexual function. With a leaner, toned body and a better sense of well-being and self-esteem, you're more likely to feel sexually confident.

When it comes to exercise, you don't have to follow any intense workouts. Just find a way to get your body moving and your heart rate up with 30 minutes of moderate exercise 5 days a week.
If you’re a smoker, look into quit-smoking programs, and get support from your doctor, family, and friends.