By: Thomas Pickering, MD, DPhil, FRCP, Director of Integrative and Behavioral Cardiology Program
of the Cardiovascular Institute at Mount Sinai School of Medicine, New York.

It is often thought that when men with hypertension are impotent, the drugs they are taking to lower the blood pressure are to blame. A survey was done in 101 men attending a Hypertension Clinic in Copenhagen, and 27 27%) said that they had impotence. Further testing was done in these men to identify the cause. These included evaluations of whether there was disease of the arteries supplying the penis. The tests showed that the main cause of the impotence was arterial disease in 89% of cases, even though nearly half of the men with impotence attributed it to their medications. No particular type of medication could be identified as causing impotence. One possible explanation for this is that, although disease of the arteries is the underlying cause of the impotence, reduction of blood pressure when the drugs are started reduces the blood flow to the penis even more, and makes the symptoms worse. Many of the men with impotence had other manifestations of arterial disease, such as coronary heart disease and intermittent claudication (pain in the legs during walking occurring from blocked arteries).

Doctor's comments

The main findings of this study are first, that impotence is common in men who have hypertension, and second, that the underlying cause is disease of the arteries which is associated with the hypertension. The authors quoted another survey of healthy men of the same age, in whom impotence was reported in only four percent.While medications may make the situation worse in some cases, it may be the reduction of blood pressure rather than a side effect of the particular type of medication that is to blame.