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To treat erectile (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 ( 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.

A 2001 study published in the American Journal of the Medical
Sciences looked at the drug Cozaar, an ARB. At first, just 7% of men and
women in the study said they felt sexually satisfied overall. After 12 weeks of
Cozaar, about 58% said they were sexually satisfied. The percentage of men who
reported having erectile dysfunction dropped from 75% to 12%.

Another study compared the drug Diovan, an ARB, with Coreg, a beta-blocker.
The study, published in the American Journal of Hypertension in 2001,
compared the effect of the two drugs on blood pressure and frequency of sexual
intercourse.

The drugs controlled blood pressure equally well. But people who took the
ARB reported having sex more often during the 16 weeks of treatment. They said
they had sex about eight times a month before, and 10 times a month after.
People taking the beta-blocker had sex much less often: eight times a month
before, and four times a month after.

Steps to Take If Your Medicine Causes Erection Problems

Tell your doctor if you think your blood pressure medicine may be causing
problems with your erections.

If it is your medication, and not just your high blood pressure,
switching to another may solve the problem. Never stop taking your
medicine without your doctor’s OK.

But high blood pressure itself still could be to blame for your erectile
dysfunction. In that case, ask about trying an erectile dysfunction drug like
Viagra, Cialis, or Levitra.

You should only take these drugs once your blood pressure is under control.
They are not safe for men with untreated high blood pressure. They are also not
safe for men taking alpha-blockers, or men taking nitrate drugs for heart
disease.

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In one study of 2267 patients visiting a primary care physician, 41%
reported experiencing night sweats during the previous month, so the perception
of excessive sweating at night is fairly common. It is important to note that
flushing (a warmth and redness of the face or trunk) may also be hard to
distinguish from true night sweats.

There are many different causes of night sweats. To determine what is
causing night sweats in a particular individual, a doctor must obtain a
detailed medical history and order tests to decide if an underlying medical
condition is responsible for the night sweats. Some of the known conditions
that can cause night sweats are:

1. Menopause
   The hot flashes that accompany the menopausal
   transition can occur at night and cause sweating. This is a very common cause
   of night sweats in perimenopausal women.

1. Idiopathic hyperhidrosis Idiopathic hyperhidrosis is a condition
   in which the body chronically produces too much sweat without any identifiable
   medical cause.

1. Infections Classically, tuberculosis is the infection most
   commonly associated with night sweats. However, bacterial infections, such as
   endocarditis (inflammation of the heart valves), osteomyelitis (inflammation
   within the bones), and abscesses all may result in night sweats. Night sweats
   are also a symptom of AIDS virus (HIV) infection.

1. Cancers Night sweats are an early symptom of some cancers. The
   most common type of cancer associated with night sweats is lymphoma. However,
   people who have an undiagnosed cancer frequently have other symptoms as well,
   such as unexplained weight loss and fevers.

1. Medications Taking certain medications can lead to night sweats.
   In cases without other physical symptoms or signs of tumor or infection,
   medications are often determined to be the cause of night sweats.
   Antidepressant medications are a common type of medication that can lead to
   night sweats. All types of s can cause night sweats as a side
   effect, with a range in incidence from 8 to 22% of persons taking
   antidepressant drugs. Other psychiatric drugs have also been associated with
   night sweats. Medicines taken to lower fever such as aspirin and acetaminophen
   can sometimes lead to sweating. Other types of drugs can cause flushing, which,
   as mentioned above, may be confused with night sweats. Some of the many drugs
   that can cause flushing include:

• niacin (taken in the higher doses used for lipid disorders),
• tamoxifen,
• hydralazine,
• nitroglycerine, and
• sildenafil (Viagra).

Many other drugs not mentioned above, including cortisone medications such
as prednisone and prednisolone, may also be associated with flushing or night
sweats.

1. Hypoglycemia
   Sometimes low blood glucose can cause
   sweating. People who are taking insulin or oral anti-diabetic medications may
   experience hypoglycemia at night that is accompanied by sweating.

1. Hormone disorders - Sweating or flushing can be seen with several
   hormone disorders, including , carcinoid syndrome, and
   hyperthyroidism.

1. Neurologic conditions Uncommonly, neurologic conditions including
   autonomic dysreflexia, post-traumatic syringomyelia, stroke, and autonomic
   neuropathy may cause increased sweating and possibly lead to night sweats.

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If you have high blood pressure (or hypertension) and are having problems
with erectile (ED), the first step toward a solution is to see your
doctor. You may be a bit hesitant to discuss your sex life with a doctor, but
rest assured. Your doctor has heard it all before and will know how to help
you.

Erectile dysfunction is fairly common in men with high blood pressure. One
study in the Journal of the American Geriatrics Society found that
nearly half of men aged 40 to 79 with high blood pressure had it.

Your doctor will need a lot of information from you before suggesting any
treatment. If this doctor had been involved in your care for high blood
pressure in the past, you can talk about how well you’ve been your
blood pressure and about how you are doing with the medications you’re taking.
If you are meeting with a new doctor, you will share all that, plus
information about other health problems you may have, like diabetes or high
cholesterol.

Telling a doctor that you have difficulty with your erection is not the
easiest thing to do. But to get the right care you have to tell your doctor
everything, including the truth about things like drinking a lot of alcohol,
doing drugs, or smoking cigarettes. It’s in your best interest to be totally
honest.

You may also feel uncomfortable if the doctor asks a lot of questions about
your sex life and your emotions. You may be asked things like:

• What’s your sexual orientation?
• Do you have a steady partner? Multiple partners?
• How is sex with your partner? Has anything changed recently?
• Has anything upsetting happened to you lately?
• In general, are you under a lot of stress?
• Do you feel depressed a lot?

Again, it’s best to answer honestly, even though these things are very
personal.

A doctor you are seeing for the first time may also need to examine your
penis, testicles, and prostate gland. Some men have their testosterone level
tested.

There is another test that is done sometimes to see whether you get
erections while you are asleep. The doctor may send you home with a special
tape that you wrap around your penis before you go to bed. If the tape is
broken in the morning, you’ve had an erection during the night. That means the
cause of your erection problem may not be physical.

In many cases erectile dysfunction does have a physical cause.

The first treatment doctors usually try is one of the erectile dysfunction
pills: Cialis, Levitra, or Viagra.

Typically you will see the doctor again for follow-up around the time that
your prescription runs out. You can talk then about any issues you may be
having with the medication. Maybe it’s not working as well as you’d like. If
not, you can make sure you’re using it correctly. The doctor might switch you
to a different drug or a different type of treatment if thing’s aren’t
improving.

It’s a good idea to stay in touch with your doctor about your erectile
dysfunction. Changes in your health over time may affect your treatment. But
you don’t need to be in the doctor’s office more often. Since you will already
have regular checkups for managing your blood pressure, bring up your erectile
dysfunction treatment at those visits.

Remember, there’s no such thing as a bad question. Your doctor asks you lots
of questions. Feel free to ask as many of your own, until you’re confident that
you all the risks and benefits of your treatment. Also, it’s
important to show your doctor all the other medications that you take. And, if
the doctor doesn’t know the answer to a question you ask, you can have them get
back to you with it.

If you ever feel like your concerns are being ignored, don’t accept it. Find
another doctor who will talk to you.

But most doctors genuinely want to work together with you to solve your
health problems. You can help them help you by taking an active role in your
care.

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, and more another.

It is important to talk with your doctor to learn about the disease
and what you can do to help manage CAD and prevent its progression.

Making healthy lifestyle changes can delay and possibly reverse the
course of CAD. Quitting smoking, eating a low-fat and diet, and
getting regular exercise are the most important steps you can take to reduce
your risk of developing coronary artery disease.²⁶ For
more information, see:

Exercising for a healthy heart.

For more information on how to make healthy lifestyle changes, see
the Prevention section of this topic.

Most people are able to control
angina by taking medications as prescribed and
nitroglycerin when needed. See
how
to use nitroglycerin pills under the tongue. Remaining as active as
possible is important for most people. However, if angina is not controlled by
the above, consider these tips:

• If an activity causes angina, slow it
  down.
• Ease into activities in the morning, and reduce activity
  immediately after meals.
• Change your eating patterns. Eat smaller,
  more frequent meals rather than 2 or 3 large meals.

When angina is more severe and cannot be controlled, the following
tips may be useful:

• If it is feasible, it may help to move to a
  different home to avoid physical stress caused by climbing stairs, shoveling
  snow, or mowing lawns. Or, find other ways to get chores done, such as hired
  help, family members, or trading for other services that are easier to
  do.
• It may be necessary to change the kind of work you perform to
  avoid physical stress. This may be especially important if your work involves
  heavy labor.

Taking nitroglycerin before an activity may reduce or eliminate the
chest pain associated with the activity. Discuss with your doctor the use of
nitroglycerin to prevent chest pain.

Do not use the medication
sildenafil (Viagra), vardenafil (Levitra), or tadalafil (Cialis) if you are
taking nitroglycerin or other nitrates. Combined, these two drugs can result in
a life-threatening drop in blood pressure. If you are taking an
erection-enhancing medication and develop chest pain, be sure to alert the
health professionals caring for you about your use of this medication so that
they do not inadvertently give you nitroglycerin or another type of nitrate.
There are other oral medicines that may be .

Alert your doctor immediately if there is a sudden change in your
angina symptoms or if angina begins to occur unpredictably or when you are at
rest.

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A sexual problem, or sexual dysfunction, refers to a problem
during any phase of the sexual response cycle that prevents the individual or
couple from experiencing satisfaction from the sexual activity. The sexual
response cycle has four phases: excitement, plateau, orgasm and resolution.

While research suggests that sexual dysfunction is common (43%
of women and 31% of men report some degree of difficulty), it is a topic that
many people are hesitant to discuss. Fortunately, most cases of sexual
dysfunction are treatable, so it is important to share your concerns with your
partner and doctor.

What Causes Sexual Problems?

Sexual dysfunction can be a result of a physical or
psychological problem.

• Physical causes: Many physical and/or medical conditions can cause
  problems with sexual function. These conditions include diabetes, heart
  disease, neurological diseases, hormonal imbalances, menopause, chronic
  diseases such as kidney disease or liver failure, and alcoholism and drug
  abuse. In addition, the side effects of certain medications, including some
  antidepressant drugs, can affect sexual desire and function.
• causes: These include work-related stress and anxiety,
  concern about sexual performance, marital or relationship problems, depression,
  feelings of guilt and the effects of a past sexual trauma.

Who Is Affected By Sexual Problems?

Both men and women are affected by sexual problems. Sexual
problems occur in adults of all ages. Among those commonly affected are those
in the geriatric population, which may be related to a decline in health
associated with aging.

How Do Sexual Problems Affect Women?

The most common problems related to sexual dysfunction in women
include:

• Inhibited sexual desire: This involves a lack of sexual desire or
  interest in sex. Many factors can contribute to a lack of desire, including
  hormonal changes, medical conditions and treatments (for example cancer and
  chemotherapy), depression, pregnancy, stress and fatigue. Boredom with regular
  sexual routines also may contribute to a lack of enthusiasm for sex, as can
  lifestyle factors, such as careers and the care of children.
• Inability to become aroused: For women, the inability to become
  physically aroused during sexual activity often involves vaginal
  lubrication. The inability to become aroused also may be related to anxiety or
  inadequate stimulation. In addition, researchers are investigating how blood
  flow problems affecting the vagina and clitoris may contribute to arousal
  problems.
• Lack of orgasm (anorgasmia): This is the absence of sexual climax
  (orgasm). It can be caused by sexual inhibition, inexperience, lack of
  knowledge and psychological factors such as guilt, anxiety, or a past sexual
  trauma or abuse. Other factors contributing to anorgasmia include insufficient
  stimulation, certain medications and chronic diseases.
• Painful intercourse: Pain during intercourse can be caused by a
  number of problems, including endometriosis, a pelvic mass, ovarian cysts,
  vaginitis, poor lubrication, the presence of scar tissue from surgery or a
  sexually transmitted disease. A condition called vaginismus is a painful,
  involuntary spasm of the muscles that surround the vaginal entrance. It may
  occur in women who fear that penetration will be painful and also may stem from
  a sexual phobia or from a previous traumatic or painful experience.

How Is a Female Sexual Problem Diagnosed?

The doctor likely will begin with a thorough evaluation of
symptoms and a physical exam. The doctor may perform a pelvic examination to
evaluate the health of the reproductive organs and a Pap smear to detect
changes in the cells of the cervix (to check for cancer or a pre-cancerous
condition). He or she may order other tests to rule out any medical problems
that may be contributing to the problem.

An evaluation of your attitude regarding sex, as well as other
possible contributing factors (fear, anxiety, past sexual trauma/abuse,
relationship problems, alcohol or drug abuse, etc.) will help the doctor
understand the underlying cause of the problem and make appropriate
for treatment.

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