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Which Blood Pressure Medications Cause ED?

Kelly Brown MD, MBA

Reviewed by Kelly Brown MD, MBA

Written by Sian Ferguson

Published 08/11/2021

Updated 03/21/2024

Certain cardiovascular diseases — including hypertension (high blood pressure) — can cause erectile dysfunction (ED). Unfortunately, some types of blood pressure medication may also affect your ability to get an erection. 

Which blood pressure medications cause ED? And what can you do to improve it?

Many issues can contribute to erectile dysfunction, from physical health conditions and psychological issues to lifestyle factors and medications. Figuring out the root causes of your ED can be the first step in getting effective treatment.

If you start experiencing ED after taking blood pressure medications, there’s a chance the drugs are affecting your sexual function. Since some blood pressure drugs are less likely to cause ED than others, a healthcare professional might suggest changing your medication.

Let’s look at which blood pressure medications cause ED and what you can do about it.

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Blood pressure medications — also called antihypertensive drugs — are among many groups of medications that may cause ED.

There are several types of blood pressure medications. Some are more likely to cause ED than others — or at least, more people report erectile dysfunction as a side effect of certain blood pressure medications.

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Beta Blockers

Also known as beta-adrenergic blocking agents, beta blockers are often prescribed for cardiovascular issues. They may also be prescribed for anxiety disorders.

Common beta blockers include:

  • Atenolol (generic Tenormin®)

  • Carvedilol (generic Coreg®) 

  • Metoprolol (generic for Lopressor and Toprol XL®) 

  • Propranolol (generic for Inderal and Inderal LA®)

Beta blockers work by blocking the effects of certain stress hormones — like adrenaline. Since they reduce the effects of these hormones, they slow the heart rate and lower blood pressure.

Research shows that beta blockers might cause erectile dysfunction. Other side effects of beta blockers include tiredness, cold hands and asthma symptoms.  

A 2003 study published in the European Heart Journal found that there may be a psychological component to ED caused by beta blockers.

Beta blockers were given to all participants in the study, but only some were told erectile dysfunction was a possible side effect. Of those who were told, 31.2 percent reported having ED, whereas only 3.1 percent of those who weren’t told said they experienced the condition.

The study went on to treat men who reported having ED. Interestingly, both sildenafil (Viagra®) and placebo ED medications worked equally well for those participants.

Hydrochlorothiazide

Hydrochlorothiazide (HCTZ) is a medication that’s used alone or with other medications to treat high blood pressure. It can also treat edema (fluid retention), which can be a result of certain medical conditions issues or a side effect of various medications.

This drug is a diuretic (also known as a “water pill”). It essentially makes the kidneys get rid of excess fluid and salt.

Hydrochlorothiazide can cause erectile dysfunction. Research suggests that high doses of thiazide diuretics, like 50 milligrams of hydrochlorothiazide, are more likely to lead to ED.  

Sexual dysfunction can occur with all blood pressure medications. But there are fewer reports of ED with certain blood pressure medications, which suggests that some drugs are less likely to cause erection problems.

Alpha Blockers

Alpha blockers relax muscles in the vascular walls (the layer of cells between blood and smooth muscle within blood vessels) to lower blood pressure. Common alpha blockers include doxazosin (Cardura®), prazosin (Minipress®) and terazosin (Hytrin®).

These medications are unlikely to cause sexual side effects like erectile dysfunction. If you have ED and take alpha blockers, it’s possible another issue is to blame. 

On that note, be careful with how you treat ED when taking alpha blockers. They’re among many drugs sildenafil interacts with, meaning mixing alpha blockers with Viagra can be dangerous. 

Don’t dig into your buddy’s ED prescription, no matter how well it works for him. Always speak with a healthcare professional before trying any ED treatment. 

ACE Inhibitors

ACE (angiotensin-converting enzyme) inhibitors are used to treat kidney disease and cardiovascular issues, including high blood pressure. Lisinopril is an example of an ACE inhibitor.

ACE-inhibiting medications reduce the effects of angiotensin-converting enzymes in your body. (These enzymes narrow your blood vessels, which increases blood pressure.) By widening blood vessels, they lower blood pressure.

ACE inhibitors may cause uncomfortable side effects like headaches, fatigue or a loss of appetite. Erectile dysfunction isn’t a commonly reported side effect.

According to a 2014 review, ACE inhibitors may even improve sexual function. Some believe it’s because they stimulate nitric oxide production, which is essential for erectile function.  

Angiotensin-Receptor Blockers 

Angiotensin-receptor blockers (ARBs) are often used to treat blood pressure. Sometimes called angiotensin II receptor blockers, they work by reducing the effects of angiotensin II, a hormone that restricts blood vessels.

The most common side effect of ARBs is dizziness. If you experience this, definitely let your healthcare provider know.  

ARBs aren’t commonly reported to affect sexual activity. In fact, the above-mentioned 2014 review noted that these may actually have beneficial effects on sexual function — so much so that the researchers recommended using ARBs for patients who have ED.

You think your blood pressure medications may be causing ED. What’s the next step?

Before you do anything, we want to emphasize that you shouldn’t change your medication without consulting a healthcare practitioner. Don’t adjust your dosage, either. 

If left untreated, high blood pressure may lead to heart attack, stroke or kidney disease. Incidentally, it’s also a risk factor for ED.

So, to take care of your erectile function and cardiovascular health, seeking medical advice from a qualified professional is vital. 

For men with high blood pressure, there are many possible treatment options for ED. 

Talk to a Healthcare Professional

When it comes to erectile dysfunction, speaking with a healthcare professional should be your first move. They can help you figure out the root cause of your ED, which may or may not be blood pressure medication. 

If your provider thinks your medication could be contributing to the issue, they might suggest switching medications or changing your dosage. 

They may also prescribe erectile dysfunction treatments that are safe to use with your blood pressure medication.

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Consider ED Medications

A healthcare professional can advise you on erectile dysfunction medications that may suit your unique needs.

Not all ED meds are safe to take with blood pressure medications. In certain doses, these drugs can interact with each other and potentially cause serious side effects. 

Erectile dysfunction is often treated with PDE5 inhibitors. PDE5 (phosphodiesterase type 5) inhibitors increase blood flow to your penis, which makes it possible to get an erection. 

But since these medications widen blood vessels, they can also lower blood pressure. So if you combine PDE5 inhibitors with certain doses of high blood pressure medications, your blood pressure could drop dangerously low. 

That said, PDE5 inhibitors might be safe and effective for people with hypertension, according to research. A medical professional can assess which medications are safe for you.

Common PDE5 inhibitors include:

  • Sildenafil (and the brand-name version Viagra®

  • Tadalafil (and the brand-name version Cialis®

  • Stendra® (and its generic Avanafil), which can be used with alpha-blockers in certain doses

  • Vardenafil (sold under the brand names Levitra® and Staxyn​​​​​​​®)

Our hard mints are chewable ED meds that contain the same active ingredients as these prescription treatments in safe, effective doses.

Some PDE5 inhibitors are taken once a day, while others are taken shortly before sexual intercourse. It’s important to use your ED meds as specified by your healthcare provider — and not to increase your dosage. 

Explore ED Devices

When medication is a no-go, physical treatments can help. For example, penile vacuum therapy can help you achieve an erection. This involves using a vacuum erection device to increase blood flow to the penis, making it possible to get and maintain an erection.

See a Therapist

The mind is an incredibly powerful thing — and your mental health can affect your sexual function. Although many people don’t realize it, psychological ED is real. 

Issues like anxiety, depression, and stress can affect sex drive and erectile function. Sometimes, sexual performance anxiety can also contribute to ED. 

Fortunately, there are many ways to prioritize your mental health. You might consider in-person or online therapy, which can help you find and address the root cause of the issue.

Of course, the benefits of therapy go beyond improving your sex life. Taking care of your mental health can boost your relationships, self-esteem and overall well-being.

Make Some Lifestyle Changes

For some people, the most effective treatment for ED isn’t a pill or a device but healthy day-to-day habits.

A 2020 review of studies found that lifestyle modifications play an essential role in improving sexual health in both men and women. These healthy habits can be used alongside (or instead of) medications.

Some lifestyle changes that promote erectile function include:

  • Quitting smoking 

  • Avoiding drugs and excessive alcohol

  • Exercising regularly

  • Following a balanced diet

  • Reducing stress

As a bonus, all these lifestyle changes are great for high blood pressure and overall cardiovascular health. Not only can they improve erectile function, but they can also lower your chances of developing heart disease. Win-win!

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Certain blood pressure medications can cause ED. On top of that, high blood pressure — especially when left untreated — can contribute to erectile function.

Here’s the bottom line:

  • Not all blood pressure medications tend to cause ED. While ED is a frequently reported side effect of beta blockers and hydrochlorothiazide, for example, other blood pressure medications are less likely to cause ED.

  • Don’t change your blood pressure drugs without consulting a professional. Blood pressure is not something to take lightly. Never, ever change your dosage, stop your medication or use a different drug without medical supervision.

  • Treatment options are available. Certain erectile dysfunction medications are shown to be safe and effective. Other possible ED treatments include mental health care and ED devices.

Ready to take the first step in addressing ED? We can connect you with a qualified medical professional through our telehealth platform.

17 Sources

  1. Keene, L., Davies, P., (1999). Drug-related erectile dysfunction. Adverse Drug Reaction Toxicology Review. Retrieved from https://pubmed.ncbi.nlm.nih.gov/10401520/
  2. Yafi, F.A., et al. (2017). Erectile dysfunction. Nat rev dis primers, 2: 16003. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5027992/
  3. Types of Blood Pressure Medication. American Heart Association. Retrieved from https://www.heart.org/en/health-topics/high-blood-pressure/changes-you-can-make-to-manage-high-blood-pressure/types-of-blood-pressure-medications#beta
  4. Silvestri, A., Galetta, P., Cerquetani, E., et al, (2003, November 1). Report of erectile dysfunction after therapy with beta-blockers is related to patient knowledge of side effects and is reversed by placebo. European Heart Journal, 1928-1932. Retrieved from https://academic.oup.com/eurheartj/article/24/21/1928/450074
  5. Hydrochlorothiazide. Medline Plus. Retrieved from https://medlineplus.gov/druginfo/meds/a682571.html
  6. Muller, A., (2010, September). Taking the stress out of treating erectile dysfunction. Official Publication of The College of Family Physicians of Canada, 56(9): 898-903. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2939118/
  7. ACE Inhibitors. Medline Plus. Retrieved from https://medlineplus.gov/ency/patientinstructions/000087.htm
  8. Angiotensin Receptor Blockers. AHA Journals. Retrieved from https://www.ahajournals.org/doi/full/10.1161/01.CIR.0000072344.12827.13
  9. Sildenafil (2018). Medline Plus. Retrieved from https://medlineplus.gov/druginfo/meds/a699015.html
  10. Tadalafil (2016). Retrieved from https://medlineplus.gov/druginfo/meds/a604008.htm
  11. Smith BP, Babos M. Sildenafil. Updated 2020 Jun 25. In: StatPearls Internet. Treasure Island (FL): StatPearls Publishing; 2021 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK558978/
  12. The Food and Drug Administration. (2018). https://www.accessdata.fda.gov/drugsatfda_docs/label/2018/021368s030lbl.pdf
  13. The Food and Drug Administration. (2017). https://www.accessdata.fda.gov/drugsatfda_docs/label/2017/021400s020lbl.pdf
  14. The Food and Drug Administration (2007). https://www.accessdata.fda.gov/drugsatfda_docs/label/2007/021400s010lbl.pdf
  15. The Food and Drug Administration. (2018). https://www.accessdata.fda.gov/drugsatfda_docs/label/2018/202276s018lbl.pdf
  16. Stein, M.J., Lin, H., & Wang, R. (2014). New advances in erectile technology. Ther adv urol, 6(1): 15-24. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3891291/
  17. Symptoms & Causes of Erectile Dysfunction (July 2017). National Institute of Diabetes and Digestive and Kidney Disease. Retrieved from https://www.niddk.nih.gov/health-information/urologic-diseases/erectile-dysfunction/symptoms-causes
Editorial Standards

Hims & Hers has strict sourcing guidelines to ensure our content is accurate and current. We rely on peer-reviewed studies, academic research institutions, and medical associations. We strive to use primary sources and refrain from using tertiary references. See a mistake? Let us know at [email protected]!

This article is for informational purposes only and does not constitute medical advice. The information contained herein is not a substitute for and should never be relied upon for professional medical advice. Always talk to your doctor about the risks and benefits of any treatment. Learn more about our editorial standards here.

Kelly Brown MD, MBA
Kelly Brown MD, MBA

Dr. Kelly Brown is a board certified Urologist and fellowship trained in Andrology. She is an accomplished men’s health expert with a robust background in healthcare innovation, clinical medicine, and academic research. Dr. Brown is a founding member of Posterity Health where she is Medical Director and leads strategy and design of their Digital Health Platform, an innovative education and telehealth model for delivering expert male fertility care.

She completed her undergraduate studies at University of North Carolina at Chapel Hill (go Heels!) with a Bachelor of Science in Radiologic Science and a Minor in Chemistry. She took a position at University of California Los Angeles as a radiologic technologist in the department of Interventional Cardiology, further solidifying her passion for medicine. She also pursued the unique opportunity to lead departmental design and operational development at the Ronald Reagan UCLA Medical Center, sparking her passion for the business of healthcare.

Dr. Brown then went on to obtain her doctorate in medicine from the prestigious Northwestern University - Feinberg School of Medicine and Masters in Business Administration from Northwestern University - Kellogg School of Management, with a concentration in Healthcare Management. During her surgical residency in Urology at University of California San Francisco, she utilized her research year to focus on innovations in telemedicine and then served as chief resident with significant contributions to clinical quality improvement. Dr. Brown then completed her Andrology Fellowship at Medical College of Wisconsin, furthering her expertise in male fertility, microsurgery, and sexual function.

Her dedication to caring for patients with compassion, understanding, as well as a unique ability to make guys instantly comfortable discussing anything from sex to sperm makes her a renowned clinician. In addition, her passion for innovation in healthcare combined with her business acumen makes her a formidable leader in the field of men’s health.

Dr. Brown is an avid adventurer; summiting Mount Kilimanjaro in Tanzania (twice!) and hiking the incredible Torres del Paine Trek in Patagonia, Chile. She deeply appreciates new challenges and diverse cultures on her travels. She lives in Denver with her husband, two children, and beloved Bernese Mountain Dog. You can find Dr. Brown on LinkedIn for more information.

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