Management of erectile dysfunction in hypertension patients

In hypertensive patients, lifestyle modifications are going to play a vital role in managing erectile dysfunction. These lifestyle modifications include physical exercise, quitting smoke, stop drinking alcohol, a healthy diet, and good sleep. Along with lifestyle modification switching of antihypertensive drugs is also important in managing erectile dysfunction as antihypertensive drugs are the risk factors for erectile dysfunction.

Let’s get deep into how hypertensive patients can manage erectile dysfunction


Hypertension or Arterial hypertension is a major risk factor for cardiovascular diseases and around 30% of population in the world are suffering with hypertention.

We have already seen that cardiovascular diseases are the risk factors for Erectile Dysfunction. As the erection is mainly dependent on the flow of blood to the penis, our cardiovascular system plays a vital role in it. As a result, erectile dysfunction is frequently encountered in patients with hypertension and it greatly affects their quality of life and relationships.

But, Erectile Dysfunction in hypertension patients remains under-reported,under-recognized, and under-treated mainly due to the lack of awareness on the relationship between Erectile Dysfunction and hypertension. Therefore, the management of erectile dysfunction in hypertensive patients is of paramount importance.

Management of Erectile Dysfunction in untreated hypertension patients

Erectile Dysfunction caused by Cardiovascular diseases is seen in untreated hypertension patients.

Patients after diagnosing hypertension should check for Erectile Dysfunction before getting the treatment for hypertension. If they are diagnosed with both Erectile Dysfunction and Hypertension, they should look into their lifestyle and food habits. Adopting an appropriate lifestyle, healthy food habits and healthier attitude can be an initial efficient and cost-effective treatment option for them.

I am stressing on a healthy lifestyle and habits because no physical activity, smoking, improper sleeping activity, and drinking are always the risk factors for hypertension, erectile dysfunction, and cardiovascular diseases.

Some studies have shown that physical activity and exercises can reduce the risk of erectile dysfunction by 30%. And a study from the University of the West in the United Kingdom found that pelvic exercises helped 40 percent of men with ED regain normal erectile function. They also helped an additional 33.5 percent significantly improve erectile function.

Physical activity and exercises are also important in improving cardiovascular health.

Coming to healthy food habits, food is one thing that has effects on every system of the human body and Erectile Dysfunction isn’t an exemption for it. A diet that has less number of calories have shown positive effects on the sexual function.

Physical activity and restricting the intake of calories can also help in weight loss which reduces the risk of erectile dysfunction caused by obesity by 30%.

Lifestyle modification is an important and cost effective step for patients diagnosed with erectile dysfunction and hypertension. Finding an appropriate hypertension medication is a difficult task here as antihypertensive drugs are risk factors for erectile dysfunction.

Management of Erectile Dysfunction in patients taking antihypertensive drugs

Studies have shown that the duration and severity of hypertension are associated with erectile dysfunction. Patients with long-standing(>5-6 years) and severe hypertension are expected to suffer more frequently from severe erectile or sexual dysfunction.

When a patient is undergoing hypertension treatment and diagnosed with Erectile Dysfunction, there are certain issues that need to be addressed. Most of the hypertension patients discontinue the treatment for hypertension after diagnosing with Erectile dysfunction caused by antihypertensive drugs. This could affect their cardiovascular health and health quality in long term.

So the long term hypertensive patients should be first tested for medically induced erectile dysfunction as antihypertensive drugs are associated with medically induced erectile dysfunction.

More effective remedies should be elected paving the way for the introduction of phosphodiesterase-5 inhibitors (PDE-5).

PDE-5 inhibitors

Since their introduction in the therapeutic field, more than a decade ago, PDE-5 inhibitors have revolutionized the treatment of sexual dysfunction. By blocking the activity of PDE-5 isoenzyme, localized throughout the smooth muscle cells of the vasculature (genital vessels included), PDE-5 inhibitors increase the levels of cyclic guanosine monophosphate thus exerting vasodilating properties and facilitating penile erection. Due to these properties, sildenafil was the first drug of its class to receive wide acceptance. Its short half-life, food interactions and the associated visual disturbances however, paved the way for the development of newer PDE-5 inhibitors. As such vardenafil with its more rapid onset of action, and tadalafil with its longer half-life and the lack of food interactions or side effects, have offered significant alternatives to sildenafil.

Due to their vasorelaxant effect, administration of PDE-5 inhibitors in hypertensive individuals was initially confronted with great suspicion. A wealth of clinical data however has proven that PDE-5 inhibitors are associated with few side effects and provoke a small and insignificant reduction in blood pressure with minimal heart rate alterations in both normotensive and hypertensive patients as well. As a matter of fact, they can be safely and effectively administered to hypertensive individuals even when they are already taking multiple antihypertensive agents.

Management beyond PDE-5 inhibitors

Despite remarkable therapeutic efforts, it is evident that a relative proportion of patients with erectile dysfunction will fail to respond to oral drugs including PDE-5 inhibitors. If the patients doesn’t respond to the oral treatment they can try other treatments like penile implantation and injection therapy.

Trimix injections can also be done with the patients who don’t respond to oral medications and there are many treatments available for erectile dysfunction if patients don’t respond for oral medications.

Surgical implantation of a penile prosthesis, either the inflatable (2- and 3-piece) or the malleable device, is a feasible technique that offers a third-line treatment and a more permanent solution to the problem of erectile dysfunction.


The prevalence of erectile dysfunction is approximately 2-fold higher in hypertensive patients compared to normal individuals. However, erectile dysfunction remains under-reported, under-recognized, and under-treated in hypertensive patients.

In patients with untreated hypertension lifestyle modifications can help in treating the erectile dysfunction but whereas in the case of people with treated hypertension oral medications like sildenafil, tadalafil and vardenafil can help with erectile dysfunction.

Consulting a doctor can help in knowing the underlying reason behind your erectile dysfunction.Many men are reluctant to discuss erectile dysfunction with their doctors. But don’t let embarrassment keep you from getting help. Just taking this step will get them on their way to recover not only their sex life but their relationship as well. They need not worry about their privacy as clinics like “The ED Clinic”  take full care to make sure all privacy details are just that- Private.

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