Long term, the things that cause vascular disease also cause ED. That’s because Ed IS a vascular disease.
With HTN, the arterial vessels become chronically narrowed and eventually calcified. When that happens, they no longer dilate properly and you don’t get enough flow to the penis to cause tumescence.
Blood pressure, simply put, is cardiac output X systemic vascular resistance.
There are 3 principle ways that antihypertensives work:
-Diuretics reduce circulating volume, causing a reduction in cardiac output via reduced preload.
- Beta Blockers, some calcium channel blockers, and some other types have negative inotropic effects on the heart, causing a reduction in cardiac output.
-ACE inhibitors, ARBs, beta-blockers, alpha-blockers, some calcium channel blockers, nitrates, as well as a bunch of other drugs act on the smooth muscle in the blood vessel walls, causinn them to relax and dilate. The effect is reduction in systemic vascular resistance.
As far as erectile function goes, those drugs that reduce cardiac output and don’t reduce system have the potential to reduce sexual function because they reduce pressure but don’t address the constricted blood vessels.
Every drug has pros and cons. For essential hypertension, look into the calcium channel blockers (amlodipine) and ARBs (losartan). And, of course, discuss your sexual health concerns with the prescribing physician.