To treat erectile dysfunction (ED), you have to lower your blood pressure first. Some people are able to do that through lifestyle changes alone. Others need help from prescribed blood pressure medication.

A problem for many men, however, is that some types of blood pressure medicines can actually cause erectile dysfunction. That may make it difficult to stay on your medication, especially if your high blood pressure never caused any symptoms before. An estimated 70% of men who have side effects from blood pressure medicine stop taking it.

Many drugs used to treat high blood pressure have been linked to erectile dysfunction. But some are much less likely than others to cause problems. Certain of the blood pressures drugs may even improve erectile dysfunction for some men.

It's known that diuretics (or water pills, like hydrochlorothiazide) and beta-blockers (like Atenolol) can cause erection problems. These are also the first drugs that a doctor is likely to prescribe if you are not able to lower your blood pressure through diet and exercise.

If you're taking a diuretic, you should stay on your medicine until your blood pressure is under control. If your erection problem persists, or your blood pressure goes back up, then your doctor might switch you to a drug that's less likely to cause erectile dysfunction. Or, a combination of medications might work better to control your blood pressure and reduce the risk of erectile dysfunction.

If you take a beta blocker you may also want to ask your doctor if it might cause erectile dysfunction. You might be better off on a medication less likely to cause a problem.

Erection-Friendly High Blood Pressure Drugs

Some families of high blood pressure drugs rarely cause erectile dysfunction as a side effect:

• ACE inhibitors
• Alpha-blockers
• Calcium channel blockers
• ARBs

ACE (angiotensin converting enzyme) inhibitors -- such as Lotensin, Capoten, Zestril, Prinivil, etc. -- widen blood vessels and increase blood flow. Erectile dysfunction is rarely a side effect, occurring in less than 1% of patients. There are several different medications in the category. This seems to be true of all of them.

There are also medications known as calcium channel blockers, such as Diltiazem, Verapamil, or Amlodipine. As a group, they rarely cause erectile dysfunction. But erection problems may be less common with some individual drugs within that group than with others. Your doctor can tell you which.

In general, alpha-blockers do not often cause erection problems either. In one study published in the journal Hypertension in 1997, a small number of men actually had a 100% improvement in their erectile dysfunction after two years on the alpha-blocker Cardura.

Drugs known as ARBs (angiotensin II receptor blockers, like Losarten) are not only unlikely to cause erection problems, but they may actually improve sexual function in men with high blood pressure.