Hypertension (high blood pressure)
People with high blood pressure are more likely than average to develop atherosclerosis (or arteriosclerosis), which is commonly known as ‘hardening of the arteries’. Atherosclerosis causes arteries throughout the body to develop thicker walls and become narrower inside, so reducing the flow of blood through them. If this develops in the arteries going to the penis then it will be more difficult for the penis to fill with blood and so ED may result.
For a detailed explanation of the stages of an erection and the possible complications with each stage, read about the erection process.
Erectile dysfunction (ED) is frequently reported by hypertensive patients. The prevalence increases from 30% at the age of 50 years to 50% or more in patients aged over 70 years, i.e. 2-fold higher than that observed in normotensive subjects of the same age. The conventional view holds that ED is an adverse effect of the antihypertensive treatment, but the results of several controlled trials addressing this issue indicate that the incidence of ED is essentially similar in treated and untreated hypertensive patients, suggesting that ED is due to the elevation in blood pressure rather than to its pharmacological reduction.
A number of psychological, hormonal and vascular alterations associated with hypertension justify the findings of these observational studies and explain why ED should, at present, be considered as an early marker of cardiovascular risk. However, it is still possible that in specific cases some antihypertensive agents (namely the diuretics and the sympatholytic agents) may contribute to ED, but the more modern drugs such as the calcium antagonists and the antagonists of the renin-angiotensin system are neutral with respect to ED; actually, some recent studies carried out with the sartans suggest that these compounds may ameliorate ED.
Finally, there is no evidence that antihypertensive treatment increases the adverse effects of the phosphodiesterase inhibitors recently introduced for the treatment of ED; thus, the use of these drugs is not contraindicated in hypertensive patients.
Hypertension is associated with severe erectile dysfunction
The prevalence and severity of erectile dysfunction in patients with hypertension need to be further evaluated. We evaluate medical and hypertension status, and erectile function in patients with hypertension.
The International Index of Erectile Function, which is a detailed questionnaire, including well established components to evaluate patient medical history, hypertension status and erectile dysfunction, was mailed to 476 male patients of the outpatient Hypertension Center of Columbia Presbyterian Medical Center.
The questionnaire was completed by 104 (22.3%) patients, and mean age was 62.2 years (range 34 to 75). Of the patients 84.8% were sexually active and 68. 3% had various degrees of erectile dysfunction, which was mild in 7. 7%, moderate in 15.4% and severe in 45.2%. Compared to the general population of erectile dysfunction cases in the literature our study population with hypertension had a higher incidence of severe erectile dysfunction. Although correlations of antihypertensive medications with incidence of erectile dysfunction did not reach statistical significance, there was a clear trend with patients treated with diuretics and beta-blockers having the highest incidence and those treated with alpha-blockers having the lowest incidence of erectile dysfunction.
In addition to the observation that erectile dysfunction is more prevalent in patients with hypertension than in an age matched general population, our study shows that it is more severe in those with hypertension than in the general population.
Smoking increases the chances of developing high blood pressure
Smoking is the other major factor that increases the chance of atherosclerosis developing; therefore smokers have an increased risk of developing erectile dysfunction. There are many other adverse implications with smoking, so we wish to encourage smokers to seek help with quitting.
Many of the medicines used to treat high blood pressure might also cause erectile difficulties as a side effect, particularly those called diuretics (water pills) and beta-blockers. High blood pressure is however a very important problem that needs to be treated too; and it is essential never to stop taking prescribed medication for it (or any other condition) without discussing the matter with your doctor. Many men who think that they have erectile dysfunction as a side effect of the drugs they are taking do not mention the problem to their doctor, who in turn may omit to ask if ED is happening.
It is therefore important to mention ED either before your start taking treatment for high blood pressure, or if it develops after you have been given medication for it, as quite often a medication change will be possible and cause fewer side effects.