There are many organic and psychological factors that affect sexual life in men. One of these organic causes is hypertension, that is, high blood pressure. Hypertension seriously affects both libido (sexual desire) and erection (hardening) in men. These adverse events are more common in patients with chronic and irregular hypertension. Most of the patients who go to cardiology outpatient clinics due to cardiovascular diseases also have erection problems.

One of the reasons why erection problems are common in hypertensive patients is the common risk factors. Causes of hypertension are also causes of erectile dysfunction. Or vice versa, cardiovascular problems are detected in patients who apply to a urologist due to erectile dysfunction (ED, erection problem).

In this article, I will talk about the negative effects of hypertension on erection, its causes and treatment methods.

What is hypertension (high blood pressure)?

Hypertension means high blood pressure. Normally, systolic blood pressure should be around 120 mmHg and diastolic blood pressure should be around 80 mmHg. Hypertension is defined as systolic blood pressure above 140 mmHg and diastolic blood pressure over 90 mmHg on repeated measurements (two days in a row).

Patients with high blood pressure should be followed and treated regularly by a cardiologist. The doctor following the hypertension patients should question the sexual functions of male patients and adjust their medications accordingly.

How does hypertension cause erectile dysfunction?

About 30% of patients with hypertension develop ED. This is a disease that occurs as a result of the direct and indirect effects of hypertension. High blood pressure causes erection problems by some mechanisms. These mechanisms are:

Vascular damage: Impairment of penile blood flow and erectile dysfunction occur in patients with hypertension. This is twice as common in hypertensive patients. Depending on the high blood pressure, the penile vessel walls are damaged, hardening of the arteries and narrowing of the vessel diameter occur. As a result, the blood flow of the penis decreases and erection problem is seen.

Low testosterone: Serum testosterone hormone levels also decrease in hypertensive patients. Testosterone hormone is important in sexual desire and erection in men. This should be taken into account in male patients during the treatment of hypertension.

Low libido (decreased sexual desire): High blood pressure negatively affects libido (sexual desire), which causes erection problems.

Hypertension drugs: Hypertension itself can cause erection problems, and drugs used in the treatment of hypertension adversely affect sexual life. In other words, blood pressure medications are like a double-edged sword. While this group of drugs lowers blood pressure, they cause erectile dysfunction. There are two groups of drugs that are given to treat blood pressure in patients with high blood pressure and cause erectile dysfunction;

• Diuretics (diuretic drugs): This group of drugs used in the treatment of blood pressure provide the excretion of excess fluid in the body with urine and thus lower blood pressure. Excess electrolytes and trace elements will be excreted at the same time as urine, resulting in erectile dysfunction. Among diuretic drugs, thiazide diuretics cause erectile dysfunction. This should be taken into account during the treatment of hypertension.
• Beta-blocker drugs: Drugs called beta-blockers, which are used to reduce the heartbeat, adversely affect the erection. Especially in older generation drugs, this side effect is more common. Today, beta-blockers with less side effects on erection have been developed. “Nebivolol” is a new generation beta-blocker drug. It helps erection by increasing nitric oxide (NO) production in the corpus cavernosum in the penis. In other words, Nebivolol has no erectile dysfunction side effects. Doctors prefer these new generation drugs, taking into account the sexual life of the patients.

What are the negative effects of high blood pressure on women’s sexual life?

Hypertension also negatively affects sexual life in women. The negative effects of hypertension on women’s sexual life are as follows:

• Decreases sexual arousal or alert threshold
• Causes orgasm problems (difficult or prolongs reaching orgasm)
• Causes vaginal dryness, which causes painful intercourse

What should hypertension patients tell when they go to the urologist?

In the diagnosis of the disease, the anamnesis, that is, the questioning of the patients about their disease, is very important. When patients with hypertension go to a urologist due to ED, the following information should be told:

• How long the erection problem has been
• Previous operations, medications taken
• List of blood pressure medications he is using
• Lifestyle: Alcohol, smoking habits, diet, etc…
• Whether there is a stress situation with the work environment and partner
• Whether there is diabetes
• Erectile dysfunction drugs used

Can erection problem due to hypertension be reversed?

Erectile dysfunction due to hypertension is a condition that can be corrected. If there is no serious cause other than blood pressure that may cause erectile dysfunction, erectile dysfunction will improve by controlling blood pressure.

For this, it is important to use regular blood pressure medication, a proper diet, regular exercise and a stress-free life. Oral erectile dysfunction drugs can be started at the same time in these patients. Combined treatments are recommended when necessary.

Does erectile dysfunction due to beta blockers and diuretics improve?

As a side effect of these drugs, ED is a frequently encountered condition in patients taking beta-blockers and diuretic group drugs due to cardiovascular diseases. If these drugs are stopped and more appropriate drugs are started, the ED problem can also be improved. If high blood pressure has existed for a long time and has followed an irregular course, the damage to the vessels will be that much. For this reason, in patients with chronic and uncontrolled hypertension, the desired improvement in erection may not be achieved despite discontinuation of drugs.

Ideally, during the treatment of hypertension, the patient’s erection status should be considered and appropriate diuretics and beta-blockers should be prescribed.

Can patients with high blood pressure take medication for ED treatment?

Erectile dysfunction is common in patients with high blood pressure. These patients need to be very careful while taking medication because of their erection problem. Drugs used in the treatment of erectile dysfunction are known as PDE5i group drugs. If patients who take medication for hypertension also take medication for erection treatment, blood pressure may drop further and there may be situations such as fainting and dizziness.

Drugs used in the treatment of erectile dysfunction should not be used together with nitrite-nitrate-containing drugs. Nitrite-nitrate-containing drugs are used in the treatment of heart-induced chest pain. If erectile dysfunction drugs are taken together with these drugs, it leads to serious decreases in blood pressure.

Recommendations for patients with hypertension and ED problems

A healthy life will both help control high blood pressure and reduce or eliminate the erection problem. The points that hypertensive patients should pay attention to for a healthy sexual life:

• Healthy diet: A Mediterranean diet (a diet mainly based on seafood and fruits and vegetables).
• Not smoking and not using alcohol
• A diet low in salt
• A regular exercise program
• Losing weight (to achieve ideal weight)
• A life free from stress
• If there is diabetes, appropriate diet and treatment

What are the treatment options in hypertensive patients with erectile dysfunction?

In patients with hypertension problems, if there is erectile dysfunction, it should be treated. In these patients, ED treatment is done gradually according to the degree of the disease. Steps to be followed in ED treatment in ED patients with hypertension:

• Lifestyle changes of the patient: If there is a weight problem, patients should reach their ideal weight with a suitable diet.
• Alcohol-cigarettes: If they use alcohol-cigarettes, they should be stopped.
• Sugar control: If the patient also has diabetes mellitus (diabetes mellitus, diabetes), treatment and diet should be applied, and sugar should be controlled.
• Blood pressure medications should be checked: If there are drugs that cause ED, they should be changed. It is important to keep the blood pressure under control.
• Hormonal therapy: If patients have Testosterone deficiency, this needs to be corrected.
• Oral erectile dysfunction drugs (PDE5i): Oral medications can be started as the first step. Their dosage is adjusted according to the patient.
• Injection treatments into the penis: There are various drugs that provide an erection by injecting into the penis. Suitable patients can be started on one of these.
• Urethral gel application: Gel-shaped and erection-providing drugs from the inside of the urethra are also an option. It is absorbed from the urethra and causes erection in the penis.
• Vacuum therapy: Vacuum-pump therapy for the penis is an effective method. Suitable patients can be offered this treatment.
• ESWT-shock wave therapy to the penis: There are scientific studies showing that ESWT is effective in the treatment of erectile dysfunction in hypertensive patients. We also apply it to our patients and get successful results.
• PRP, stem cell therapy: Such treatments are still in the experimental stage. It is not a routine treatment method.
• Combined treatments: The treatment methods mentioned above can be applied in combination to suitable patients. We apply such combinations to our patients.
• Penile prosthesis surgery: Penile prosthesis is the last option in the treatment of ED. If patients do not respond to current treatments, then the only option is to surgically insert a penile prosthesis. Depending on the patient’s condition, either malleable or inflatable prosthesis is preferred.

In summary: Hypertension negatively affects sexual life in men. It causes serious erection problems. Erectile dysfunction due to hypertension results from both the direct negative effects of high blood pressure and the side effects of drugs used in the treatment of blood pressure. Erectile function improves significantly by controlling blood pressure. These patients can use drugs used in the treatment of erectile dysfunction. If there is no response to current treatments, the last option is penile prosthesis insertion. The type of prosthesis to be fitted is decided according to the patient’s condition.

Prof. Dr. Emin ÖZBEK

Urology Specialist

İstanbul/ Turkey