 Hello, I am Dr. Vasan, I am a Euro-andrologist practicing at Manipal Hospital's Bangalore. Now when you say blood pressure, blood pressure can be a simple elevation of your systolic and diastolic pressures or it could be a significant elevation. Now do all men with hypertension ask are we our blood pressure as we call it do they develop erectile dysfunction? No. The reason being that there are some men who have significant elevation and when this elevation of blood pressure happens there is what is called as renin angiotensin mechanism in the kidney and that is a complex interplay of neurochemical mechanisms which cause blood vessels to relax and also contract. So in essentially why do we develop blood pressure because our vessels become stiff the terminal arterioles and the capillaries become stiff and capillaries are the primary end organs which cause the whole blood flow to come into the tissue. If your capillaries don't relax or your arterioles don't relax, you don't get blood flow. It is like your finger pulp of your finger. If you press and release you will see blood gushing into the pulp. So in erectile dysfunction especially in a BP patient or a blood pressure patient, these terminal arterioles do not relax or what we call as helicine arterioles that is what is present in the penis and they don't relax and if they don't relax oxygen doesn't come into the penis and there is what is called as a nitric oxide which is the primary mediator of a reaction mechanism that doesn't get released. So because of these facts the men with hypertension some of them are more prone for erectile dysfunction and this generally happens when you are on two drug regime not a single drug regime that means your hypertension can be controlled with a single drug some men require two drugs and some men require three drugs. So those men with two and three drugs have a higher risk of erectile dysfunction than those with single drug.