Doc, is this medication going to make me have problems with erection? I have heard this question so often from men concerned about getting on blood pressure medications that I have learned to respect this very important problem related to medication adherence. Truthfully though, like all questions that most doctors have to contend with, this one does not have a simple and straight-forward answer. If these answers were that easy I would be looking for a job in another field because I would soon become obsolete, to be replaced by AI (Artificial Intelligence).
Some blood pressure medications do have as a reported side-effect low libido and sometimes impotence, whilst these side-effects are very rare usually occurring in less than 1% of patients who took these medications in controlled studies. If you considered the complaints of real life patients you may think this was more frequent. More often than not the problem can be resolved with a little bit of digging around in the medical records. I often encounter patients who decide to stop taking the orange blood pressure pill because it was making their erections not as hard as previously. In most cases these guys are comparing their current erections with what pertained in their early twenties and a good review of the medical record would more often than not reveal that they had similar problems even prior to being on any Blood Pressure medication.
This is really a sad situation because any experienced physician would tell you that once the orange pill has been chosen as the culprit for the waning erections you must retire that pill irrespective of whatever evidence you discover disproving that claim. For like a secret agent whose cover gets blown that pill is worse than a placebo (plain sugar pill).
Whilst Erectile Dysfunction (ED) can be a real concern for some men with hypertension when I look at the frequency of this problem in controlled studies meaning in studies where the active drug was compared to a sham pill it is very likely that most blood pressure medications are getting more credit than they deserve for causing ED.
I believe it is easier for most men to blame the blood pressure pill than to admit that they may have problems with erection even before they started taking these pills. The irony though is that the block buster pill Viagra was originally developed for high blood pressure. Pfizer was considering pulling the plug on that drug until they decided to investigate why most of the study participants were refusing to return the left over medications. The nurses involved in the study had also noticed that most of men were turned over on their stomach when they went to check their blood pressures. Your guess is as good as mine as to what was happening in the pants of those men as the nurses entered the wards.
Whilst it is important to listen to patient concerns about ED with blood pressure treatment a good look at studies and background risks for sexual problems in men older than 40 year would suggest that not all of these complaints are really due to the drugs. Unfortunately studies suggest that close to 40% of men over the age of 40 yrs have some problems with erection and the problem only gets worse with age. Therefore the less than 1% incidence of erectile dysfunction and impotence reported in studies of blood pressure medications may fall within what is expected for men who enroll in such studies.
I am still looking for the man who was killed by ED, but I can count many people including my own relatives who died or had a stroke from hypertension. One study conducted in four US counties showed that individuals who had uncontrolled blood pressure above 160mmHg systolic pressure were;
58% more likely to develop heart failure
40% more likely to die of any cause
64% more likely to have a stroke, and
29% more likely to develop Angina Pectoris or cardiac chest pain
when I consider all these it looks like the less than 1% risk of ED is a very minimal problem indeed.
I would advice all men who have high blood pressure and have concerns about problems with erection to be very honest with their doctors. The good news is that today other than viagra there are many other medications that could take care of ED
To the doctors that are not comfortable treating erectile dysfunction just know that all you need to do is make sure there is no treatable medical problem causing ED. Whilst depression can cause erectile dysfunction and vice versa, viagra and sister drugs like cialis can alleviate these symptoms irrespective of the cause. In such a case you would not want to leave the underlying depression untreated. This advice applies to conditions like diabetes, hypothyroidism, obesity and the many other medical problems that could cause erectile dysfunction. In the US for patients who have to pay out of pocket the 20mg generic sildenafil is available with GoodRx coupons for prices ranging from $12 to $60 for 30 tablets in select pharmacies.
For what does it profit a man if he has a good strong erection but loses his life?
By Dr. Leonard Sowah, an internal medicine physician in Baltimore, Maryland
