Can High Blood Pressure Cause Erectile Dysfunction?

What is Blood Pressure?

Blood pressure is a measurement of the force exerted by the heart as it circulates blood throughout the body. High blood pressure, also commonly referred to as hypertension, is often associated with harmful lifestyle behaviours, such as smoking, excessive alcohol use, being overweight, and not exercising enough. If left untreated, it can increase your risk of developing a variety of significant long-term health disorders, including coronary heart and renal disease. Low blood pressure, although less frequent, can be caused by several different factors, including certain medicines (it is a common side effect) and a variety of underlying illnesses (e.g. heart failure or dehydration).

How is Blood Pressure Measured?

The suggested protocol for checking blood pressure:

1. There should be no eating or drinking for 30 minutes before measuring blood pressure
2. Before the reading starts, the bladder should be empty and the person being measured should be seated in a comfortable chair with back support, for at least 5 minutes
3. Keep legs uncrossed and both feet flat on the ground
4. Place the arm, cuff up, on a table at chest height
5. The blood pressure cuff should be snug but not too tight and should be worn on bare skin 
6. There should be no speaking whiles blood pressure is being taken

Blood pressure is measured in millimetres of mercury (mmHg) and is represented by two numbers: 

• systolic pressure, which is the pressure created by the heart as it pumps blood out
• diastolic pressure, which is the pressure in the heart while it is at rest between beats

How High is “High” Blood Pressure?

As a general rule, optimal blood pressure is between 90/60mmHg and 120/80mmHg. Elevated blood pressure is characterised as having a systolic pressure between 120 to 129 mmHg and diastolic pressure less than 80 mmHg. High blood pressure is defined as a reading around 140/90mmHg or higher, whereas low blood pressure is defined as 90/60mmHg or below.

Is Erectile Dysfunction a Symptom of High Blood Pressure?

When sexually stimulated, the brain sends messages to the nerves in and around the penis. These nerves induce more blood to flow into the penis, as well as tissue and blood vessels to relax and open up, enabling blood to flow into the penis and making it erect. Men with high blood pressure may have difficulty obtaining or maintaining an erection strong enough for intercourse, because high blood pressure may harm blood vessels in or leading to the penis. Problems with having an erection may potentially indicate excessive blood pressure, damaged blood vessels, or heart disease. They may grow excessively narrow (atherosclerosis), preventing adequate blood from flowing through them. Depending on the individual, leading a healthier lifestyle may be all that is needed to enhance erections.

How Does Hypertension Lead to Erectile Dysfunction?

Erection issues are often caused by high blood pressure. High blood pressure prevents the arteries that transport blood into the penis from dilating as they should. It also impairs the capacity of the smooth muscle in the penis to relax. As a consequence, there is not enough blood flowing into the penis to keep it erect. 

According to recent research, erectile dysfunction (ED) has an organic cause in more than 90% of men over the age of 40 with this condition. For example, muscular disorders are a common risk factor.¹ One study (by Bener and colleagues) shows  that 21.2% of hypertensive male patients have reported severe ED, 20.7% moderate ED and 16.4% mild ED.² Additionally, the Massachusetts Male Ageing Study suggests that the prevalence of ED in males aged 40 to 70 years is 52%.^{3, 4} Despite the fact that the majority of the patients in the study by Bener and colleagues saw their doctors on a regular basis, only 18% sought medical treatment for ED.² 

Men who have high blood pressure may also have low testosterone levels. Testosterone is a male hormone that is important in sexual arousal. High blood pressure may cause ED on its own. However, certain blood pressure medications might also be the source of the problem. In general, pharmaceutical side effects were responsible for up to 25% of ED visits, with antihypertensive medicines being the most common cause.²

Antihypertensive medications, diuretics and beta-blockers are often associated with ED. Diuretics can reduce the force of blood flow into the penis, and thus may induce erectile dysfunction. They may also reduce zinc levels in the body. Zinc is required by the body to produce testosterone. Beta-blockers reduce the body's reaction to nerve signals that are necessary for erections. They also make it more difficult for the arteries in the penis to expand and allow blood to enter. 

Furthermore, they might cause feelings of drowsiness and sadness. The decisions that some men with high blood pressure make might sometimes exacerbate the situation. Smoking, in particular, is one of them. Smoking raises blood pressure, destroys blood vessels, and decreases blood flow throughout the body. 

What Else Can Cause Erectile Dysfunction?

ED may be caused or contributed to by a variety of conditions impacting the vascular, neurological, and/or endocrine system. Although men are more prone to experience ED as they get older, ED is not caused by ageing. However, some known causes include:

Certain illnesses and medical conditions: 

• type 2 diabetes
  • may lead to small vessel disease and nerve damage in the penis
  • men with diabetes are 2 to 3 times more likely to develop ED
• blood vascular disease 
• atherosclerosis 
• high blood pressure 
• chronic renal disease 
• multiple sclerosis 
• Peyronie's disease 
• harm from prostate cancer therapies, like radiation therapy 
• prostate surgery, involving injury to the penis, spinal cord, prostate, bladder
• pelvic surgery for bladder, colon-rectal or prostate cancer 

Taking certain medications: 

• blood pressure medications 
• antiandrogens
• drugs used to treat prostate cancer 
• antidepressants 
• tranquilisers or prescription sedatives
  • medications causing calmer or drowsy feelings
• appetite suppressants and/or other medications that help with feeling less hungry 
• ulcer medications 

* for more information, visit the National Library of Medicine’s list of particular medications that may cause ED

Psychological or emotional variables may aggravate ED. These include:

• dread of sexual failure 
• anxiety 
• depression 
• shame over sexual performance or specific sexual activities 
• poor self-esteem 
• stress (either sexual performance or in general) 
• certain health-related issues and behaviours 

Physical causes: 

• insufficient blood flow to the penis
  • This could be due to several health conditions (E.g., blocked arteries, heart disease, diabetes) 
• during erection, the penis cannot hold blood
  • erection cannot be maintained if blood does not remain in the penis (may occur at any age)
• the penis does not receive nerve impulses from the brain or spinal cord
  • certain illnesses, injuries, and surgeries in the pelvic region may cause penis nerve damage
• cancer therapies near the pelvis may impair penis function
  • surgery or radiation for malignancies of the lower abdomen or pelvis

The following health-related conditions and behaviours also play a role in ED: 

• smoking 
• consuming excessive amounts of alcohol and engaging in illicit drug use 
• being overweight and not engaging in physical activity

Treatment, Management and Prevention of Erectile Dysfunction

Treatment and Management

• Non-invasive therapies are often attempted initially. The majority of the most well-known ED therapies are not dangerous. Some examples include

Oral Medications (PDE5 inhibitors): 

PDE type-5 inhibitors are medications that enhance penile blood flow. The only oral medications authorised by the FDA for the treatment of ED include: 

• viagra (sildenafil citrate) 
• levitra (vardenafil HCl) 
• cialis (tadalafil) 
• stendra (avanafil) 

Taking tablets approximately an hour or two before having sex allows for the greatest effects. Normal nerve function in the penis is encouraged by these medications. Approximately 7 out of 10 men have better erections. However, diabetes and cancer patients may experience decreased response rates. Additionally, Patients should not use any PDE5 inhibitors if taking nitrates for the heart. Before taking a PDE5 inhibitor, always consult with your doctor.

PDE5 inhibitors do however have modest adverse effects persisting for short durations. The most prevalent ones include: 

• Headache 
• Nose congestion 
• Flushing of the face 
• Muscle pain 
• Indigestion 

In rare situations, the medicine viagra might cause temporary blue-green darkening of vision. Cialis, in rare situations, may cause or worsen back discomfort or pain. Most adverse effects are related to PDE5 inhibitor effects on other tissues in the body, because they don’t only enhance blood flow to the penis, but also affect other vascular tissues throughout the body.

Testosterone Replacement Therapy: 

In the rare circumstances when a lack of sexual desire (libido) and low blood levels of testosterone are to blame for ED, Testosterone Therapy may restore normal erections and aid in the treatment of ED when paired with medications (e.g. PDE5 inhibitors). 

Erection Device Using a Vacuum:

A vacuum erection device is a plastic tube that slides over the penis and forms a seal with the body's skin. At the opposite end of the tube, a pump creates a low-pressure vacuum surrounding the erectile tissue, resulting in an erection. After that, an elastic ring is slipped around the penis base. This may help maintain the blood in the penis for up to 30 minutes. By using a vacuum erection gadget, 75 out of 100 men achieve a functioning erection.

Urethra (IU) and Intracavernosal (ICI) Therapies: 

When oral medications, such as oral PDE5 inhibitors, are ineffective for men with ED, alprostadil can be administered through treatment. This medication is available in two forms, depending on how it will be administered: 

Intracavernosal injection (ICI): this is administered through Self-Injection. 

With a very small needle, alprostadil is injected into the side of the penis. It is beneficial to receive the initial shot at the doctor's office before doing this alone. With this procedure, the success rate for obtaining a strong enough erection to have intercourse is as high as 85%. 

ICI Alprostadil can also be used alongside two additional medications. This combination, known as "bimix or trimix", is more potent than administering alprostadil alone, and has become the standard treatment for ED. ICI treatment often results in a consistent erection that lasts for 20-30 minutes or until the climax. 

Since ICI erection is not controlled by penile nerves, one should not worry if the erection lasts beyond orgasm. A prolonged erection is the most typical adverse effect of ICI treatment. Prolonged erections (>1 hour) may be reversed with a second injection (antidote). Men who experience priapism (penis erections that persist for more than two to four hours) should go to the ER. Failure to treat priapism can result in irreversible damage to the penis and incurable ED.

Intraurethral administration (IU therapy)

A little medicated pellet of the medication Alprostadil is inserted into the urethra for IU treatment. There is no need to give yourself a shot if using the medicine this way, but it may not function as effectively as the injected method (ICI treatment).

Similarly, with ICI treatment, IU Alprostadil should be tried with your doctor before being self-administered at home. The most typical IU alprostadil side effects include a burning sensation in the penis. If an erection lasts more than four hours, it will need medical care to be relieved.

Surgical Intervention: 

The primary surgical therapy for ED is the implantation of a penile implant (also called penile prosthesis). Penile implants are devices that are completely implanted into the body. They produce a rigid penis allowing for regular intercourse. Although the insertion of a penile implant is a surgical procedure with risks, it has the best success and satisfaction rates among ED therapy methods. Penile implants are classified into two categories: 

• Bendable:(A semi-stiff implant): This consists of two easy-to-bend rods that are usually made of silicone. Those rods provide the hardness required for sexual penetration in a man's penis. The implant may be bent downward to urinate or upward to have intercourse. 
• Inflatable implant: Fluid-filled cylinders are implanted longitudinally in the penis using an inflatable implant. Tubing connects these cylinders to a pump located inside the scrotum. When the pump is turned on, the pressure in the cylinders inflates and stiffens the penis. Inflatable implants provide a natural sensation for companions while producing a normal-looking erection. Surgeons may also advise you to use lubricant during intercourse. Men can manage the hardness and, in some cases, the size of their erections using the implant. In general, the implant doesn’t influence the man’s ability to feel aroused or orgasm. 

Supplements

are popular and generally less expensive than prescription medicines for ED. Conversely, they have not been evaluated to determine their effectiveness or whether they are a safe therapy for ED. 

Clinical Research

Several restorative or regenerative methods are being researched for the treatment of ED in the future, including: 

• extracorporeal shock wave treatment (ESWT), which consists of low-intensity shock waves that attempt to repair erectile tissues and aid in the restoration of natural erections 
• intracavernosal injection of stem cells, to aid in the cavernous tissue regeneration  
• autologous platelet-rich plasma intracavernosal injection, which  aids cavernous tissue renewal 

These are not yet FDA-approved for ED control, however, they may be made available via clinical trials. Before beginning any clinical trials, patients who are interested should examine the risks and benefits of each, as well as the expenses, since they are covered by government or commercial insurance policies. 

Prevention

1. Quit smoking as tobacco use has been associated with heart and blood vessel disorders. Additionally, on its own, smoking also increases the risk of developing ED. 
2. Adhere to a healthy eating plan by choosing whole grains, low-fat dairy products, fruits and vegetables, and lean meats. Avoid foods that are heavy in fat, particularly saturated fat, and salt. Additionally, not consuming too much alcohol is beneficial. If having problems quitting alcohol, consult with a counsellor who specialises in treating those who drink excessively. 
3. Maintaining a healthy weight may also assist to postpone the onset of diabetes and lower blood pressure. If there is a need to reduce weight, consult with a doctor about how to do it safely. Requesting a referral to a dietician could also be useful. Losing weight may help decrease inflammation, boost testosterone levels, and boost self-esteem, all of which can help avoid ED. 
4. Physical exercise improves blood flow throughout the body, including the penis. Before beginning new activities, consult with a health care practitioner. Beginners should begin slowly, with simpler activities such as normal-pace walking or gardening. You may progressively progress to more difficult sports, such as brisk walking or swimming. Attempt to engage in at least 30 minutes of physical exercise on most weekdays. 
5. Using illicit substances may make it difficult to get or maintain an erection as some can hinder an individual’s ability to experience arousal. It could also be more difficult to detect the actual root cause of someone’s ED if they use illicit substances because these mask underlying psychological, emotional, or physical issues.

Other Signs and Symptoms of High Blood Pressure 

Even when blood pressure measurements reach dangerously high levels, most patients have no indications or symptoms. However, some people may experience headaches, shortness of breath, or nosebleeds, but these signs are not specific and typically do not appear until high blood pressure has progressed to be life-threatening.

If blood pressure is exceptionally high, being aware of the following symptoms is helpful: 

• extensive headaches 
• nosebleed 
• tiredness or perplexity 
• issues with vision 
• chest ache 
• breathing difficulties 
• heartbeat irregularity 
• urine with blood
• pounding sensation around the chest, neck, or ears

Treatment, Management and Prevention of High Blood Pressure

Limiting sodium (found in salt) consumption of less than 1,500 milligrammes per day will help lower high blood pressure because sodium stores extra fluid in the body, putting a strain on the heart. 

Excessive drinking raises blood pressure. It is suggested that males have no more than two alcoholic drinks per day and women consume no more than one. 

Exercise strengthens the heart, enabling it to pump blood with less effort. A healthy heart decreases the strain on the arterial walls, avoiding plaque development and the risk of cardiac problems. It is advised that you do forty minutes of moderate-intensity aerobic activity three to four times each week. 

Losing weight reduces the amount of pressure required to circulate blood throughout the body. Certain lipids in the body promote artery thickening, which makes blood flow more difficult. 

Tobacco smoke contains chemicals that can increase the risk of plaque buildup in the arteries, limiting blood flow to the body. These chemicals cause an increase in blood pressure and heart rate, increasing the risk of a heart attack or stroke. 

When to Call a Doctor

Doctors may be able to alter high blood pressure therapies to lower the risk of ED. For some males, the change may be as simple as adjusting their dose. Others may need an entirely different sort of medicine. Discussions about the side effects, as well as any other drugs or supplements the patient takes, are required to assist healthcare workers in determining the cause of someone’s ED.

Summary

Controlling high blood pressure is critical for overall health. Every year, high blood pressure contributes to approximately 500,000 fatalities, yet only one in every four people with hypertension have it under control. It is crucial to take efforts to decrease blood pressure, both via lifestyle modifications and medicines, if necessary. Unfortunately, many of the drugs prescribed to  reduce blood pressure might worsen erectile dysfunction because they also affect the blood flow of the penis.