Does Sildenafil Increase Blood Pressure?

Short answer: No. Sildenafil does not increase blood pressure. Rather, it tends to cause a small decrease in blood pressure due to the dilation and relaxation of blood vessels. In the majority of healthy adults, the changes are minor and go unnoticed. Those who take certain medications for high blood pressure and nitrate medications should strictly use sildenafil with a doctor’s guidance due to the risk of significantly lower blood pressure.

What Is Sildenafil?

Sildenafil is a PDE5 (phosphodiesterase type 5) inhibitor and a prescription medication that treats erectile dysfunction (ED). Sildenafil aids in the ability to receive and maintain an erection by increasing the blood flow to the penis during a sexual act.

Sildenafil is also known for its affect of pulmonary arterial hypertension. This contributes to a decreasing BP, rather than increasing it.

Does Sildenafil Increase Blood Pressure?

Sildenafil does not increase blood blood pressure. In fact, the studies of sildenafil show that there is a small decrease in blood pressure.

The blood vessels widening due to relaxation of smooth muscles of the blood vessel walls leads to a process called vasodilation. This aids in blood flow and can also cause a small and temporary change in BP.

What Do Clinical Studies Show?

One of the studies that is widely known and referenced, published in PubMed, looks at the effects of 100 mg of sildenafil in both hypertensive men and healthy men.

In experiments, participants taking sildenafil showed an average decrease in blood pressure of:

• Systolic blood pressure: 6 mmHg
• Diastolic blood pressure: 4.5 mmHg

These changes did not cause symptoms of hypotension, and participants taking the medication reported good tolerance of the drug.

Another study of patients with resistant hypertension reported an average decrease of 24-hour Circulatory pressure with sildenafil of:

• Systolic: 8.8 mmHg
• Diastolic: 5.3 mmHg

This data supports the hypothesis that sildenafil decreases blood pressure rather than increases it.

FDA Safety Data

The Viagra (sildenafil) prescribing information reports an average maximum decrease of 100 mg of the drug of:

• Systolic: 8.3 mmHg
• Diastolic: 5.3 mmHg

The maximum decrease occurred 1-2 hours after the dose and the effect decreased and disappeared in the following several hours.

Why Do Some People Think Sildenafil Increases Blood Pressure?

Some patients experience:

• Facial Flushing
• Warm Feeling
• Increased Heart Rate
• Mild Headaches

While these problems mimic increased blood pressure, they are actually the result of the blood vessels temporarily dilating, not increased  pressure og blood.

Increased heart rate or increased blood pressure right before sexual activity, which some people experience due to anxiety, is also often blamed on sildenafil.

Is Sildenafil Safe for People With High Blood Pressure?

Sildenafil is generally safe in patients with well controlled hypertension when used under supervision.

In studies on men taking antihypertensives, the only significant change in BP was a reduction noted to be an average of:

• 6 mmHg for systolic
• 9 mmHg for diastolic

Most of the men in these studies tolerated the medication with few side effects.

When Can Sildenafil Become Dangerous?

Sildenafil will usually create only a small decrease in blood pressure, but when combined with some other drugs the decrease in blood pressure may be significant.

Sildenafil should not be used in combination with the following:

• Nitrates (like nitroglycerin or isosorbide)
• Recreational “poppers” that are also nitrates
• Some alpha-blockers, unless prescribed by your doctor
• Several antihypertensives without the advice of a doctor

These combinations create the risk of:

• Dizziness
• Blurred vision
• Fainting
• Significantly low BP

Because of this, sildenafil is contraindicated with nitrates.

When Should You be Cautious About Taking Sildenafil?

This is especially warranted when you have:

• Uncontrolled hypertension
• Very low blood pressure
• Recent history of a heart attack or stroke
• Severe heart disease
• Are taking nitrates
• Are on multiple antihypertensives

Your doctor can determine the safety and advisability of sildenafil for you.

Safe Use of Sildenafil

• Take it exactly as prescribed and not more than once in a 24 hour period with the exception of other specific instructions.
• Diminish high risk activities, such as the overuse of alcohol that can increase the likelihood of dizziness or a decrease in blood pressure.
• Report to your doctor all the medications you are currently taking, both prescription and over-the-counter.
• Seek emergency medical attention for chest pain, fainting, or an erection lasting more than 4 hours.

Frequent Questions

Can sildenafil increase blood pressure?

No. Studies show that sildenafil causes a slight decrease in blood pressure, if any.

Does sildenafil have an effect on heart rate?

Sildenafil does not show any significant effect on heart rate, if it is even measurable, in healthy individuals or in those who are taking antihypertensive medication.

Can hypertensive individuals take sildenafil?

Sildenafil is generally considered safe for use in individuals with controlled hypertension, but it is essential to make sure that it is discussed with a healthcare provider, especially in patients taking other cardiovascular medication.

How long does sildenafil affect blood pressure?

The BP reducing effect generally peaks in the 1-2 hour window following the dose and begins to wane as the drug is eliminated from the system.

Conclusion

Sildenafil does not cause an increase in blood pressure; in fact, it causes a slight and brief lowering of Circulatory pressure due to the blood vessels being relaxed. The average reduction of BP measured in a clinical setting is in the range of systolic 6-8 mmHg and diastolic 4-5 mmHg, which is generally safe and well tolerated in a healthy population and in most individuals with mild to controlled hypertension. In patients who are taking nitrate medications or other antihypertensive medications, the use of should be avoided and it should be taken only under the supervision of a healthcare provider.