When it comes to high blood pressure (hypertension), this common condition can be a triple-whammy for sexual function. Not only is high blood pressure a key risk factor for erectile dysfunction, but several common medications are known to contribute to ED as a side effect. As if that weren’t bad enough, experts recommended against mixing prescription medications for erectile dysfunction with most blood pressure medications.
For these reasons, it can be beneficial to seek out specific blood pressure medications that don't cause erectile dysfunction. It might not eliminate the chances of experiencing difficulties with erections, but it may dramatically reduce the risk.
What's the Relationship Between Blood Flow and Erections?
Blood pressure and blood flow are two of the most important factors in the erection process. When there's a physical issue with blood flow, such as high blood pressure, constricted arteries, or heart disease, erections can suffer.
Medications for erectile dysfunction work by keeping muscles and blood vessels in the penis open and dilated. This is not so different from the way that most medications treat high blood pressure. For this reason, it can be dangerous to combine two medications that dilate blood vessels, which is why it’s so important to find a blood pressure medication that won’t cause erectile dysfunction – but also won't lead to a dangerous drop in blood pressure.
What Are the Blood Pressure Medications That Don’t Cause Erectile Dysfunction?
Unfortunately, not only is high blood pressure a common risk factor for experiencing erectile dysfunction, but so are some of the medications used to treat it. Not all of the medications cause erectile dysfunction. Research is limited, though some may even be helpful for treating symptoms of erectile dysfunction.
These are the medications that are less likely to result in erectile dysfunction.
Angiotensin Converting Enzyme (ACE) Inhibitors
ACE inhibitors’ primary function is to inhibit the effect of the angiotensin-converting enzyme. This endogenous enzyme is produced by the body and converts angiotensin I to angiotensin II, the latter of which is a vasoconstrictor and contributes to higher blood pressure. It also increases the amount of bradykinin, which is a vasodilator. By blocking the enzyme, less angiotensin II is present in the body. ACE inhibitors prevent this enzyme from being created in the first place.
With less angiotensin II in the body, the veins and arteries in the body remain dilated and more relaxed, lowering blood pressure and reducing heart strain. ACE inhibitors may also be used to prevent or treat conditions such as heart attack, migraines, and diabetes.
Some examples of of ACE inhibitors include:
- Accupril (quinapril)
- Aceon (perindopril)
- Altace (ramipril)
- Capoten (captopril)
- Lotensin (benazepril)
- Mavik (trandolapril)
- Monopril (fosinopril)
- Prinivil (lisinopril)
- Univasc (moexipril)
- Vasotec (enalapril)
ACE inhibitors have been studied as a potential treatment for erectile dysfunction as a result of atherosclerosis (severe clogging and narrowing of the arteries).
One study evaluated 59 men averaging 60 years old who were experiencing atherosclerotic erectile dysfunction. These men were given either an ACE inhibitor or a placebo for a period of between 26 and 46 weeks.
By the end of the trial, the number of sexually active men had increased and the overall severity of the erectile dysfunction decreased; however, the results were not significantly different from those of the placebo group, who experienced similar results.
Calcium Channel Blockers
Calcium is an essential mineral that the body does not produce naturally. Calcium enters the body through the foods that we eat, and when a person gets insufficient calcium it can actually be taken from their bones. Once calcium is in the body, it enters the muscles through tiny pores and eventually into the cells of the heart and arteries. When it reaches the heart and arteries, it causes them to contract more strongly, resulting in more narrow blood vessels and an increase in blood pressure.
Calcium channel blockers work to block calcium from affecting the cardiovascular system and keep arteries/veins relaxed and dilated. Along with high blood pressure, calcium channel blockers are sometimes used to reduce elevated heart rate, restore an irregular heartbeat, and relieve symptoms of angina (severe chest pain).
Some examples of calcium channel blockers include:
- Adalat (nifedipine)
- Calan (verapamil)
- Cardene (nicardipine)
- Cardizem (diltiazem)
- Nimotop (nimodipine)
- Norvasc (amlodipine)
- Plendil (felodipine)
- Sular (nisoldipine)
Calcium channel blockers may be an effective treatment for erectile dysfunction under certain circumstances, though they're not approved for this use. When calcium channel blockers were directly injected into the corpora cavernosa (two columns of spongy tissue running along the shaft of the penis), it led to a severe reduction in muscle contractions. Not only was the corpora cavernosa impacted, but the corpora spongiosum (spongy tissue that surrounds the urethra) was affected as well. Muscle contractions were reduced by 90 percent in the corpora cavernosa and 83 percent in the corpora spongiosum.
While further research is still required, this suggests that calcium channel blockers could serve as an injectable treatment for erectile dysfunction.
Angiotensin II Receptor Blockers (ARBs)
As mentioned earlier, angiotensin II is a chemical enzyme that leads to a narrowing and constricting of blood vessels when it’s released into the bloodstream. While ACE inhibitors aim to prevent its conversion, ARBs work to negate its effects in the body directly.
By blocking the physical response to angiotensin II, blood vessels remain dilated and relaxed regardless of the amount of angiotensin II that has been converted. Along with high blood pressure, ARBs are used to treat various diseases of the kidneys, complications in the kidneys as a result of diabetes, and heart failure.
Some examples of ARBs include:
- Atacand (candesartan)
- Avapro (irbesartan)
- Benicar (olmesartan)
- Cozaar (losartan)
- Diovan (valsartan)
- Edarbi (azilsartan)
- Micardis (telmisartan)
- Teveten (eprosartan)
ARBs were at one point studied as a potential treatment for erectile dysfunction. A total of 2,809 men participated in four clinical trials during which they were given ARBs.
While the men receiving ARBs experienced an improvement in overall sexual activity, their erectile function didn’t increase by a significant enough margin when compared to control groups to be considered efficacious.
Alpha Blockers
Alpha blockers are hardly ever considered as a first-line treatment for high blood pressure, but they are commonly used in combination with other medications. Norepinephrine is a naturally produced chemical that is both a stress hormone and a neurotransmitter. During stressful events it acts as a chemical messenger throughout the body: smaller arteries and veins constrict, leading to an increase in blood pressure. Alpha blockers inhibit norepinephrine from activating certain receptors in the body, helping to keep blood vessels open and relaxed. Alpha blockers are also sometimes used to improve the flow of urine in older men that are experiencing issues relating to an enlarged prostate.
Some examples of alpha blockers include:
- Cardura (doxazosin)
- Flomax (tamsulosin)
- Minipress (prazosin)
During one clinical trial, alpha blockers were used in conjunction with injection therapy for men experiencing severe erectile dysfunction. After the men had undergone injection therapy with no improvements, they were given four milligrams of alpha blockers daily for three weeks. The combination proved to be successful: of the 38 men participating in the trial, 22 of them reported a significant improvement in erectile function after the three-week period ended.
What Are the Blood Pressure Medications That Do Cause Erectile Dysfunction?
A side effect of medication is one of the leading causes of erectile dysfunction among men. Some of the most common medications that headline this list include blood pressure drugs.
If you're experiencing erectile dysfunction and are currently taking one of these medications, it may be the cause of your ED. It’s important to continue taking your medication, but talk with your prescribing doctor about switching to an alternative treatment like those listed above.
The blood pressure medications that have a known history of causing erectile dysfunction include:
- Diuretics. These pills can result in a significant decrease in blood flow to the penis, resulting in issues maintaining erections. Due to their tendency to cause excessive urination, they can also cause a zinc deficiency in the body. Zinc is an essential nutrient that's critical to the production of the male sex hormone testosterone.
- Beta blockers. By reducing the effect that adrenaline has on the body, beta blockers lower heart rate and blood flow. Both of these functions are necessary to get enough blood into the penis to achieve and maintain an erection.
How Rex MD Can Help
Fortunately, there are several medications to lower blood pressure that don’t have a history of causing erectile dysfunction. In fact, some have the potential to treat erectile dysfunction. Using an ACE inhibitor, ARB, alpha blocker, or calcium channel blocker may treat high blood pressure without causing erectile issues.
Treating erectile dysfunction while taking blood pressure medication can be challenging. Due to the potential for negative interactions, it’s not recommended to use prescription medications for erectile dysfunction when taking most medications for blood pressure as they can lead to a dangerous drop in blood pressure.
If you're currently taking medications to lower your blood pressure, talk with a medical professional about the possibility of switching to a different medication. Rex MD may be able to help. Learn more and get started with our free survey by clicking here.
SOURCES
Angiotensin Converting Enzyme Inhibitors (ACEI) - StatPearls - NCBI Bookshelf
Effect of prescription medications on erectile dysfunction
Alpha Blockers - StatPearls - NCBI Bookshelf
New Insights into Hypertension-Associated Erectile Dysfunction.
Effects of some calcium channel blockers on isolated human penile erectile tissues
Angiotensin II Receptor Blockers (ARB) - StatPearls - NCBI Bookshelf
