Does Tadalafil Lower Blood Pressure? What the Research Says

Yes, tadalafil can lower blood pressure a little. It's a vasodilator, meaning it widens blood vessels, and that widening happens throughout your body, not just in the penis. For most healthy men, the drop is small. In men with high blood pressure, especially those already on several blood pressure medications, it can be more noticeable.

Tadalafil, the active ingredient in the brand-name medication Cialis, is best known for helping men get harder, longer-lasting erections with effects lasting up to 36 hours. But it isn't a blood pressure medication, and it isn't approved or prescribed to treat hypertension.

So if you have high blood pressure, what does this mean for you? Is tadalafil safe with your blood pressure medications? In this article, we'll explore how tadalafil affects blood pressure, what the research shows, who it's safe for, and who should avoid it.

• Tadalafil widens blood vessels throughout the body, which can lower blood pressure slightly.
• In healthy men the effect is minimal; in men with uncontrolled high blood pressure on multiple medications, it was larger.
• Large safety reviews found tadalafil didn't increase the risk of dangerously low blood pressure in men taking most blood pressure medications.
• Tadalafil should never be taken with nitrates or guanylate cyclase stimulators, and needs caution with alpha-blockers.
• Tadalafil isn't FDA-approved to treat high blood pressure. Keep taking your blood pressure medications as prescribed.

Before we dive into the nitty-gritty behind tadalafil, it helps to have a basic understanding of what blood pressure is.

Let's break down blood pressure in simple terms. You can think of it as a measurement of the force of your blood against the walls of your arteries.

When your heart pumps, it creates the highest pressure in your arteries. This is called systolic pressure. Picture it as the "go" signal when your heart works hard, pushing oxygen-rich blood out to your body.

On the flip side, when your heart relaxes between beats, we measure the lowest pressure in your blood vessels. This is known as diastolic pressure. You can think of it as the calm after the pump, giving your heart a moment to recharge.

Together, these two numbers give us a complete picture of your blood pressure. Readings consistently above 130/80 mmHg are considered high, and readings below 90/60 mmHg are considered low.

High blood pressure is common, and risk goes up with age, genetics, a diet high in salt and processed foods, physical inactivity, and chronic stress. Untreated, it's tied to serious complications like heart attack, stroke, and kidney disease, and heart disease is one of the leading causes of death in the U.S.

It also affects your sex life. High blood pressure damages the lining of blood vessels over time, including the small arteries in the penis, which is one reason it's so closely linked to erectile dysfunction. Some blood pressure medications can affect erections, too. That's why so many men with high blood pressure end up asking whether ED medication is safe for them.

Tadalafil is a prescription medication that belongs to the class of drugs known as phosphodiesterase type 5 (PDE5) inhibitors. These medications work by blocking the enzyme PDE5, which normally breaks down a molecule called cGMP. cGMP is what tells the smooth muscle in blood vessel walls to relax.

When PDE5 is blocked, cGMP sticks around longer, the smooth muscle relaxes, and more blood can flow through the vessels. PDE5 is especially concentrated in the penis, so the effect there is substantial, and this boost in blood flow during arousal leads to harder and longer-lasting erections (which is what tadalafil is mainly known for).

But PDE5 is also found in many other areas of the body, including the lungs and the smooth muscle lining arteries everywhere. That's why tadalafil can affect blood pressure, too. Under a different brand name, it's even approved to treat pulmonary arterial hypertension, high blood pressure in the arteries of the lungs. That's a different condition from the everyday high blood pressure most people mean.

Because PDE5 is found in vascular smooth muscle throughout the body, when you take tadalafil, vessels widen a little everywhere, not just in the penis.

Think of your vessels as a crowded three-lane highway: the cars are backed up, unable to move freely. Then a construction team comes in and widens it to a five-lane freeway. Suddenly the traffic clears, the pressure drops, and the cars can move easily.

That's roughly what tadalafil does. By widening your blood vessels, blood flows more freely and your blood pressure dips. For most people, though, it's more like adding a lane for an afternoon than rebuilding the freeway: the effect is mild and temporary.

In Healthy Men

In people with normal blood pressure, tadalafil's blood pressure-lowering effects are minimal. In other words, if you don't have high blood pressure, it likely won't change your numbers much.

In Men on Blood Pressure Medications

A large 2022 analysis pooled data from clinical trials of men taking tadalafil alongside blood pressure medications. It found no increase in low blood pressure-related side effects or major cardiac events compared with blood pressure medications alone. According to an accompanying editorial, the average extra drop in blood pressure was less than 1.5 mmHg, not enough to be clinically meaningful.

In Men With Uncontrolled High Blood Pressure

The effect was bigger in one group. In a study of men whose blood pressure stayed high despite taking two to four blood pressure medications, a single 20 mg dose of tadalafil lowered 24-hour blood pressure by an average of 7.5/4.3 mmHg.

That's interesting, but it doesn't make tadalafil a blood pressure treatment. It isn't approved for that, it was a single-dose study, and blood pressure needs to be managed with medications your doctor prescribes for it. What it does mean: if your blood pressure is high and hard to control, tell your provider before starting ED medication so they can account for the added effect.

Heart Health

Some observational research has linked tadalafil use to fewer major cardiac events in men with ED. Studies like this can't prove tadalafil caused the benefit, so it's best seen as reassuring for safety rather than a reason to take it for your heart.

For most men, yes. The goal with any blood pressure-lowering combination is to avoid dipping into hypotension, when blood pressure gets too low and you start feeling dizzy or faint.

The good news: in the large pooled analysis, tadalafil didn't increase low blood pressure side effects in men taking common blood pressure medications, including men on more than one. Medications like ACE inhibitors, ARBs, beta-blockers, calcium channel blockers, and diuretics are generally considered compatible, as long as your provider knows you're taking them.

There are a few important exceptions.

Never Take Tadalafil With:

• Nitrates for chest pain, such as nitroglycerin, isosorbide dinitrate, and isosorbide mononitrate
• Guanylate cyclase stimulators, such as riociguat
• "Poppers" (amyl or butyl nitrite)

These combinations can cause a sudden, dangerous drop in blood pressure.

Use Caution With:

• Alpha-blockers such as doxazosin, terazosin, or tamsulosin, which are used for blood pressure or an enlarged prostate. These can add to tadalafil's effect, so your provider may start you on a lower dose or ask you to be stable on the alpha-blocker first.

Check with your BlueChew provider about every medication you take before starting treatment. And never stop or change a blood pressure medication on your own.

The risk of tadalafil dropping your blood pressure to a dangerous level is low, but it's worth knowing the symptoms of unusually low blood pressure:

• Dizziness or lightheadedness
• Feeling faint, especially when standing up
• Confusion
• Blurred vision
• Weak or rapid pulse
• Feeling tired or weak
• Nausea

If you notice any of these, sit or lie down and contact your provider. Get emergency help for chest pain, fainting, or symptoms that don't improve. Alcohol can add to the blood pressure-lowering effect, so it's smart to go easy on drinking when taking tadalafil.

Tadalafil does lower blood pressure, but usually only a little. For most men with high blood pressure, that's good news on the safety front: research shows tadalafil is generally safe alongside common blood pressure medications, with a couple of important exceptions like nitrates and alpha-blockers.

What tadalafil isn't is a replacement for your blood pressure treatment. Keep managing your blood pressure with your doctor, and if erection problems are part of the picture, a provider can help you decide whether tadalafil is a safe fit. Erection problems can also be an early warning sign of heart disease, so they're worth bringing up with your doctor.

BlueChew offers tadalafil as TAD, an as-needed sublingual tablet that lasts up to 36 hours, and as DailyTAD, a daily chewable with 7 essential vitamins. It's also part of combination formulas like MAX and GOLD.

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Does tadalafil lower blood pressure?

Yes, slightly. Tadalafil widens blood vessels throughout the body, which can lower blood pressure. In healthy men the effect is minimal. In men with uncontrolled high blood pressure on several medications, one study found a larger drop of about 7.5/4.3 mmHg.

Can tadalafil be used to treat high blood pressure?

No. Tadalafil isn't approved to treat everyday high blood pressure (hypertension), and it shouldn't replace your blood pressure medication. Under a different brand name, it's approved for pulmonary arterial hypertension, a different condition affecting the arteries of the lungs.

Is it safe to take tadalafil with blood pressure medication?

For most men, yes. Large safety reviews found tadalafil didn't increase low blood pressure side effects in men taking common blood pressure medications. Never take it with nitrates or guanylate cyclase stimulators, and use caution with alpha-blockers. Always tell your provider about every medication you take.

Can I take tadalafil if I have high blood pressure?

Many men with high blood pressure can take tadalafil safely, especially if their blood pressure is well controlled. If your blood pressure is very high or hard to control, or you have heart disease, a provider will want to review your health history first.

What are the side effects of tadalafil?

Common side effects include headache, nasal congestion, back or muscle pain, flushing, and indigestion. Rare but serious side effects include sudden loss of hearing or vision, chest pain, an irregular heartbeat, and an erection lasting more than 4 hours. Get medical help right away if any of these happen. Tadalafil doesn't protect against sexually transmitted infections.

What are the symptoms of low blood pressure?

A reading below 90/60 mmHg is considered low. Symptoms can include dizziness, lightheadedness, feeling faint when you stand up, blurred vision, a weak or rapid pulse, fatigue, and nausea. A severe drop can be dangerous, so contact your provider if you notice these symptoms.