Viagra and Heart Disease: Is There a Risk?

Erectile dysfunction medications such as sildenafil (the active ingredient in Pfizer’s Viagra^®), tadalafil (Cialis^®) and other ED drugs are thoroughly tested and viewed as safe to use for prescribing. 

For most men in good health, these drugs are viewed as safe.  If you have cardiovascular disease, hypertension or other heart health issues, however, it may not be safe to use ED medication. Maybe you've searched "high blood pressure Viagra" hoping for clarification. Unfortunately, it is a complicated topic; while Viagra may help some aspects of heart health, it can increase other risks.

Below, we’ve explained how ED medications like sildenafil work and their effects on the cardiovascular system. We’ve also looked into what you can do to treat erectile dysfunction if you have a cardiovascular health issue, or if you’ve previously suffered from a heart attack or other cardiovascular event.

All oral erectile dysfunction medications belong to a class of drugs called PDE5 inhibitors. They work by inhibiting the enzyme phosphodiesterase type 5, which is responsible for controlling blood flow to the erectile tissues inside the penis.

Viagra is no different, and it affects the flow of blood through parts of the body.

Erections are all about blood flow. When you’re sexually aroused, more blood begins to flow to your penis, creating a firm, enlarged erection that allows you to have sex.

By inhibiting PDE5, ED medications make it easier for blood to flow to your penis, allowing you to get hard and stay hard during sex. 

Most oral ED medications start working quickly and produce a noticeable change in sexual function within one hour. 

One common misconception is that ED medications make your penis hard all the time, even if you aren’t sexually aroused.

This isn’t accurate. While ED medications do make it easier to get an erection when you feel in the mood for sex, they don’t have any known effect on the psychological side of sexual arousal and won’t cause you to get an erection if you aren’t sexually stimulated. 

Most ED medications, including Viagra, are safe for men with heart disease when used under the guidance of a healthcare professional. If you have heart disease, hypertension or another cardiovascular health issue, however, there are some complications worth knowing about; one risk of Viagra use along with other medications is causing sudden low blood pressure. 

By targeting PDE5, ED medications relax the blood vessels that supply blood to your penis and make it easier to get and maintain an erection. They can also cause blood vessels in other parts of your body to relax. For example, a similar effect can occur in your lungs, where the pulmonary arteries — the blood vessels that are responsible for transporting blood from the heart to the lung capillaries — also dilate.

This increase in blood vessel diameter can cause a reduction in blood pressure. For this reason, some PDE5 inhibitors are used to treat pulmonary arterial hypertension — a form of high blood pressure that affects the blood vessels in the lungs.

So, how does all this affect your heart health? Although PDE5 inhibitors are safe for most men, when they’re used with medications called nitrates and certain other medications, they can cause a severe drop in blood pressure that may be dangerous. So the best answer to “is sildenafil bad for your heart” is simply: it can be if used incorrectly.

Nitrates are commonly prescribed to treat chest pain. Your healthcare provider may prescribe a nitrate if you have angina (chest pain) or if you have reduced blood flow caused by coronary heart disease. 

Medications That Can Interact With ED Drugs

Nitrates and related medications that can interact with ED drugs include nitroglycerin, isosorbide dinitrate and ​​isosorbide mononitrate.

Other medications that can interact with ED drugs include alpha-blockers and non-nitrate drugs used to control high blood pressure. Some recreational “poppers,” which contain nitrites, can also interact with ED medications.

To put this potential drop in blood pressure into perspective, consider that Viagra can cause a temporary maximum reduction in blood pressure of around 8.4/5.5 mmHg.

When the ED medication Viagra is combined with nitroglycerin, this decrease in blood pressure can be much greater.

In short, if you use nitrates to treat angina or other heart health issues, you cannot and should not take ED medication. 

If you have heart disease and erectile dysfunction and wish to learn more about treatment options, you should speak to your healthcare provider about safe treatments.

Even if you don’t use nitrates, you should be extremely cautious about taking ED medication if you’re affected by heart disease. 

The FDA recommends caution in men who’ve suffered from cardiovascular events in the past six months. These include myocardial infarction (heart attack), stroke and other disturbances of the heart’s rhythm and function. 

Men with uncontrolled hypertension, clinically low blood pressure or a history of congestive heart disease and/or angina should also be cautious and speak to their healthcare provider before taking ED medications.

Your healthcare provider will be able to assess your cardiovascular function and, if appropriate, prescribe a medication that’s suitable for you. If ED medication isn’t appropriate, they may also be able to suggest an alternative treatment. 

If you’ve had a heart attack, it’s important to talk to your healthcare provider before you use any type of medication to treat ED, including oral PDE5 inhibitors.

Most of the time, you should be able to resume your usual sex life after successfully recovering from a heart attack. If your healthcare provider clears it, all oral ED medications, including sildenafil, tadalafil, vardenafil and avanafil, should be safe to use as prescribed.

Interestingly, some research suggests that using ED medication after a heart attack may reduce your risk of being hospitalized for heart failure in the future.

There’s no “best” ED medication for use after a heart attack. As always, it’s important to talk to your healthcare provider and work out the most appropriate medication for you based on your needs, lifestyle and expectations. 

I Have Atrial Fibrillation Can I Use Viagra?

If you have a history of atrial fibrillation or coronary artery disease, you should talk to a cardiologist or other healthcare professional before taking Viagra. 

While oral medications like sildenafil may be the most well-known form of treatment for erectile dysfunction, they’re not the only options available.

Other options for treating ED include injectable medication and psychotherapy for issues such as psychological erectile dysfunction. Certain lifestyle changes, such as quitting smoking, can also improve your erectile function naturally. 

Other ED Medications

In addition to oral PDE5 inhibitors, other medications are available to treat ED. One medication that’s often used is alprostadil — an injectable medication that works by relaxing the local blood vessels and smooth muscle tissue inside the penis.

Alprostadil is also available as a suppository, which is inserted into the urethra. Your healthcare provider may prescribe alprostadil if other ED medications aren’t suitable for you to use or don’t produce the intended effects.

Lifestyle Changes

Although lifestyle changes alone aren’t always enough to treat severe ED, changing your habits can often strengthen your erections and improve your sexual performance. Try the following tips and lifestyle changes for better erections and sexual performance:

• Quit cigarette smoking

• Limit your alcohol intake or stop drinking alcohol

• Avoid using illicit drugs

• Get regular physical activity and exercise

• Maintain a healthy body weight

Our list of natural ways to protect your erection goes into more detail about how you can reduce the severity of ED naturally. 

Use Therapy to Treat Psychological ED

Many cases of ED are psychological, meaning they’re caused primarily by mental or emotional issues rather than physical ones.

If your erectile dysfunction has a psychological cause, you may benefit from counseling to work on anxiety, stress or depression. You can talk to a counselor locally or online using our mental health services.

Erectile dysfunction can have a serious impact on both your sexual function and your quality of life. Luckily, even if you have heart disease or specific cardiovascular risk factors, ED is almost always a treatable condition.

• Patients with cardiovascular disease are often concerned about taking phosphodiesterase type 5 medications like Viagra.

• Side effects of using medications like Viagra, Cialis, Stendra or Levitra can sometimes include chest pain and sudden drops in blood pressure when combined with other medications. They can also negatively interact with nitrates.

If you’re affected by erectile dysfunction, it’s best to talk to your healthcare provider about your options. You can also access our full range of FDA-approved ED treatments online, following a private online consultation with a licensed healthcare provider. 

Worried your physical health may be contributing to ED? Our guide to the most common causes of erectile dysfunction explains how ED usually develops, as well as the steps that you can take to improve your erections and sexual health.