Spoiler alert: Yes. Experts say erectile dysfunction is often an early warning sign of subclinical cardiovascular disease. Here’s what you need to know. 

Safeguarding your vascular health is one of the most important things you can do to lower your risk of suffering a fatal heart attack or stroke. And if that’s not a compelling enough reason to embrace a heart-healthy lifestyle, consider this: Studies show a strong correlation between high blood pressure and erectile dysfunction.    

“Often the first symptom of hypertension a man experiences is trouble getting an erection,” urologist Irwin Goldstein, M.D., director of San Diego Sexual Medicine, says. “In the medical field, it’s considered an early warning sign of underlying vascular disease.” 

The Link Between High Blood Pressure and Sexual Functioning  

In the same way that high blood pressure can disrupt blood flow to the heart, brain and other key organs like the kidneys, HBP also compromises blood flow to the penis, Dr. Goldstein explains.   

And if you are looking for a coronary bell weather, the penile artery—which is approximately 3% of the size of the aorta — is a far more sensitive indicator of underlying vascular dysfunction, he says. 

“In this case, size matters,” Dr. Goldstein explains. The aorta, our largest artery, measures approximately 1.3 to 1.5 centimeters. The carotid artery in the neck is around .97 centimeter in diameter. 

And the penile artery? A mere .051 centimeters.

Due to its relatively diminutive size, the penile artery feels the impact of blood flow problems before all the other organs. “Men are sensitive to changes in blood flow to the penis,” Dr. Goldstein says. “They can perceive the sensation of an erection [or the absence]. But you can’t perceive a blockage in your neck or your heart.” 

Erectile Dysfunction Is Common in Older Men  

In the United States, an estimated 30 million men experience erectile dysfunction. While relatively rare among young healthy men (European studies found 8% between ages 20–29 years and 11% among those 30–39 years), rates dramatically increase with age. Between 40 and 70, 52% of men reported some degree of ED, according to the Massachusetts Male Aging Study. In the study, 60% of men at 60 years old and 70% of men at 70 years old had ED.

Some studies have found that ED is even more common in men recovering from Covid 19. The risk of erectile dysfunction increased by 20 percent after a bout with Covid, according to researchers at the University of Miami’s Desai Sethi Urology. Other investigators have reported even higher increases. 

However, researchers urge caution in interpreting these results as it’s unclear how much of these increases were related to pandemic-related psychological stress and anxiety versus biological mechanisms. 

Erectile Dysfunction and Cardiovascular Risk 

Progressing age and exposure to Covid 19 aren’t the only factors increasing the risk of ED: Almost 90 percent of all men with erectile dysfunction had at least one risk factor for cardiovascular disease, including diabetes, hypertension, having poor cholesterol levels or being a current smoker. 

Thirty percent of men with hypertension suffer from ED. 

Preventing High Blood Pressure Is Key 

While treatments like Viagra may work temporarily (after 36 and 52 weeks, studies show 92% and 89% of patients felt that treatment with sildenafil had improved their erections), they do not address the underlying problem, Dr. Goldstein says. “It’s kind of like putting on a Band-Aid.”

It is far more effective to prevent erectile dysfunction from occuring in the first place by addressing the underlying causes (90% of which are physical) before they manifest as ED, he says.

Erectile Dysfunction: A Common Side Side Effect of Medication

One more reason it’s better to prevent cardiovascular risk factors like high blood pressure than just pop a pill? By decreasing blood flow to the penis, some BP drugs (thiazide diuretics, loop diuretics, and beta-blockers) can actually make it more difficult to get an erection. Keep in mind: other BP drugs, such as alpha-blockers, ACE inhibitors, and angioten-sin-receptor blockers, rarely cause ED. 

Before doctors prescribe medicine, they often advise patients with prehypertension (defined as a systolic reading between 120-139 and a diastolic reading of 80-89) to make lifestyle adjustments that are scientifically proven to help lower blood pressure. 

Studies show maintaining a healthy weight, quitting smoking (and avoiding second hand smoke) following a heart-healthy (low sodium, high fiber, antioxidant-rich) diet, limiting alcohol and getting at least 30 minutes of moderate exercise a day (or 150 minutes a week) can go a long way to preventing hypertension, according to the American Heart Association.  

Lower ED Risk With a Home Central Blood Monitor  

By combining traditional brachial blood pressure with pulse wave analysis, central blood pressure devices can accurately predict blood pressure coming from the aorta, the large artery that feeds oxygen-rich blood to all of the peripheral organs (the brain, kidneys and yes, the penis, too). 

Doctors have been monitoring central blood pressure for over 20 years with in-office devices like the SphygmoCor, “the gold standard,” NYC longevity expert Joseph Raffaele, M.D., says. But now, with at home devices like CONNECT PULSE, the first dual blood pressure and arterial health monitor, patients (and their doctors) can track this important metric from the comfort of their own home.

This allows both individuals and the doctors overseeing their treatment to see how well treatments are working, and — perhaps more importantly — identify nascent vascular issues before they manifest as cardiovascular warning signs like erectile dysfunction or actual hypertensive crisis like heart attack or stroke.   

Sources: 

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3. Cobiella, R et al. “The carotid axis revisited.” Scientific reports vol. 11,1 13847. 5 Jul. 2021, doi:10.1038/s41598-021-93397-0
4. Lue, T F et al. “Functional evaluation of penile arteries with duplex ultrasound in vasodilator-induced erection.” The Urologic clinics of North America vol. 16,4 (1989): 799-807.
5. Nunes, Kenia Pedrosa et al. “New insights into hypertension-associated erectile dysfunction.” Current opinion in nephrology and hypertension vol. 21,2 (2012): 163-70. doi:10.1097/MNH.0b013e32835021bd
6. Rastrelli, Giulia, and Mario Maggi. “Erectile dysfunction in fit and healthy young men: psychological or pathological?.” Translational andrology and urology vol. 6,1 (2017): 79-90. doi:10.21037/tau.2016.09.06
7. Feldman HA, Goldstein I, Hatzichristou DG, Krane RJ, McKinlay JB. Impotence and its medical and psychosocial correlates: Results of the Massachusetts Male Aging Study. J Urol 1994; 151:54–61
8.  Ibid. 
9. Hsieh, Tung-Chin et al. “The Epidemic of COVID-19-Related Erectile Dysfunction: A Scoping Review and Health Care Perspective.” Sexual medicine reviews vol. 10,2 (2022): 286-310. doi:10.1016/j.sxmr.2021.09.002
10. Ibid
11. Ibid
12. Nunes, Kenia Pedrosa et al. “New insights into hypertension-associated erectile dysfunction.”
13. Steers, W et al. “Assessment of the efficacy and safety of Viagra (sildenafil citrate) in men with erectile dysfunction during long-term treatment.” International journal of impotence research vol. 13,5 (2001): 261-7. doi:10.1038/sj.ijir.3900714
14. “Blood pressure drugs and ED: What you need to know,” Harvard Men’s Health Watch (May 2017)
15. Ibid
16.  “Five Simple Steps to Control Your Blood Pressure,” American Heart Association
17. Ibid