Using Losartan to Treat Hypertension and Erectile Dysfunction

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For people living with hypertension (high blood pressure), many blood pressure medications can decrease a person's libido (sex drive) and sexual function. For this reason, some adults choose to forego taking them altogether.

Losartan, sold under the brand name Cozaar and others, may be one exception. Studies have shown that this commonly prescribed anti-hypertensive drug may benefit people with erectile dysfunction (the inability to achieve or sustain an erectile suitable for sexual intercourse or orgasm).

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This article looks at what the current research says about losartan and erectile dysfunction. It also explains the mechanism by which this popular anti-hypertensive drug might help.

Early Research: Losartan and Erectile Dysfunction

Erectile dysfunction (ED) is a condition that affects many males as they get older. Around 44% of males ages 60 to 69 and 70% of those 70 and older experience erection problems compared to 5% of males under 40.

Losartan is an oral drug used to treat hypertension that belongs to a class of drugs called angiotensin II receptor blockers (ARBs). Other ARBs include Diovan (valsartan), Atacand (candesartan), Avapro (irbesartan), Micardis (telmisartan), and Benicar (telmisartan).

In 2001, a study published in the American Journal of Medicine and Science was among the first to report that men with sexual dysfunction who were treated for hypertension experienced improvements in sexual function when taking losartan.

The study involved 164 males with hypertension, half of whom reported sexual dysfunction and half of whom reported normal sexual functioning. (Sexual dysfunction was broadly defined as having decreased libido, ED, and poor sexual satisfaction.)

Both groups were given a 50- to 100-milligram daily dose of losartan for 12 weeks. At the end of the study period, 88% of the sexual dysfunction group reported improvements in at least one of the three categories, while 73.7% reported improved quality of life. No such changes were reported in males with normal sexual functioning.

How It Is Thought to Help

Erections involve a complex series of biological mechanisms encompassing nerves, blood vessels, muscles, and emotions. These mechanisms work together to engorge the penis with blood by widening (dilating) blood vessels servicing the penis.

Hypertension can contribute to ED in several ways:

  • Firstly, with hypertension, the walls of the arteries that carry blood into the penis will gradually harden over time, making them less able to dilate as they are supposed to.
  • Secondly, hypertension causes smooth muscles like those inside the penis to stiffen. So, rather than relaxing and allowing blood to flow unimpeded, the muscles remain rigid and limit the amount the blood able to enter the penis.

Losartan is thought to help treat ED by blocking an enzyme called angiotensin II that causes vasoconstriction (the narrowing of blood vessels). It does so by binding to receptors on the walls of blood vessels that angiotensin II uses to "turn on" vasoconstriction.

By doing the same in the blood vessels of the penis, blood flow may be improved. This, in turn, can improve the quality and duration of erections.

Losartan has relatively mild side effects, including headache, cough, stomach pain, heart palpitations, and dizziness when standing.

One of losartan's "positive" side effects (and other ARBs) is their effects on moods. Among the studies investigating ARBs in treating ED, mild giddiness was one of the more common side effects.

ARBs are known to have fewer adverse effects on moods compared to other high blood pressure medications and, for many people, may even elevate moods. Elevated moods can, in turn, increase the likelihood of achieving and sustaining an erection.

Current Evidence

In the years since the publication of the 2001 research, other studies have looked into whether losartan or other ARBs can improve ED in people with hypertension. While many of the findings have been positive, the results overall remain mixed.

A 2019 review of studies published in the American Journal of Men's Health evaluated four clinical trials involving 2,809 males with sexual dysfunction, including ED. In addition to losartan, valsartan and telmisartan were also included.

The researcher found that the use of ARBs translated to improvements in sexual activity, particularly with valsartan. The same was not seen for ED.

This doesn't mean that losartan or other ARBs may not benefit people with ED. In their conclusions, the researchers noted that the quality of the available research was moderate at best and that three of the four studies demonstrated clear bias. What this suggests is that further quality studies are needed.

On the plus side, ARBs are unlikely to cause any harm to people with hypertension who have ED. In such cases, switching from another anti-hypertensive drug (like an ACE inhibitor) to losartan may be a reasonable option if ED interferes with your sex life.

Summary

Hypertension (high blood pressure) can lead to erectile dysfunction (ED) by causing changes in blood vessels and smooth muscles that service the penis.

Studies have suggested that losartan, a type of high blood pressure medication, may improve ED by preventing the constriction (narrowing) of blood vessels and increasing blood flow into the penis during sexual arousal.

With that said, the evidence supporting the use of losartan in treating hypertension-related ED is limited. Some studies suggest that the drug may not help at all. Even so, losartan may help boost mood and libido in some people, almost invariably enhancing sexual function.

A Word From Verywell

Many drugs used to treat hypertension can make erectile dysfunction worse, especially beta-blockers and, to a lesser extent, diuretics. ARBs are far less likely to do so.

If you have hypertension and ED is causing you distress, speak with your healthcare provider to see if losartan (or another ARB ) may be right.

Even though ACE inhibitors are considered the first-line option for treating hypertension, ARBs have fewer adverse effects and are better tolerated than ACE inhibitors. Unless there are reasons why you can't take ARBs, switching may be possible.

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