Is it advisable to take Sildenafil in patients with hypertension?

Hello doctor,

I am a 61-year-old man weighing 185 pounds, a non-drinker, non-smoker, and generally in good health. I had never had an operation or been hospitalized. I work in an office, mainly sitting, and I walk about 15 to 45 minutes daily. I swim for about 5 (May to September) months every year for 30 minutes most days. I have high blood pressure. I take Irbesartan 150 mg (approved) once daily, and my blood pressure is maintained at 127/83 mmHg (average). I have been taking this pill for about eight years. I also have a slight enlargement of the ascending aorta, and the dimensions are: ascending thoracic aorta = 4.0 cm, aortic arch = 2.9 cm, descending aorta = 2.5 cm. These results are from a recent MRI. I also had an MRI 16 years ago, and the radiologist concluded that the above dimensions of the thoracic aorta in practice have not changed from then up until now. Taking only the Irbesartan pill has made my erection bad. A friend of mine told me that he noticed that if for one day he would not take Irbesartan that day, his erection would be better. I also noticed that for myself. Last year I used the Viagra pill 25 mg and 50 mg about once a month. The day that I used the Viagra pill, I did not take the Irbesartan pill. The erection was very good. I also noticed that the next day of having the Viagra pill, without the Irbersartan, my blood pressure was lower than average. My question now is, Is Viagra pills causing a problem with the dimension of my ascending aorta? Can the action of the pill increase the size of the aorta? Can I continue to use the viagra pill once a month (and not take the Irbesartan pill that day)? If not, what are the possible dangers to my health from using that pill? For my above question, you had the following answer. Hypertension itself can cause erection problems if atherosclerosis of concerned vessels is there. Irbesartan may cause erectile problems, so if you feel you can, go for another anti-hypertensive drug. Sildenafil, that is, Viagra, should not be used if you have any cardiac issues. Sildenafil can also cause a drop in blood pressure. Use of Sildenafil once in a while cannot cause aortic dilatation. I would also like to know a few more things. Do you have any cardiac issues? Any ECG you have ever got? Any flushing or headache, or sinus problems you develop on the consumption of Sildenafil? Any chest pain ever on taking Sildenafil? Your erectile problems are severe? I mean, are you unable to develop an erection and have intercourse if you do not take Sildenafil? Any history of diabetes? Please reply to me with these answers so that I can help you better. And tell you whether you should take Sildenafil or not. Stay healthy. My new query is, I am attaching a recent ECG and various results from a blood test conducted nine years ago. In your reply, you stated, "Sildenafil, that is Viagra, should not be used if you have any cardiac issue." Why? Should I consider I have a cardiac issue? What are the cardiac issues? I have no headache or flashing or sinus or chest pain when taking Sildenafil. Sometimes I feel one hour after taking the pill, and for a period of about 15 to 20 minutes, the heart rate is a bit more than normal, but I have not measured it. Perhaps I will have to measure it next time. My erection problem is not severe. If I have Irbesartan in the morning, I have an erection that lasts for a short time or sometimes no erection. If I omit the morning pill of Irbesartan, then I always have an erection. Sometimes it lasts for a short time; sometimes, it lasts for more time. If I omit the morning pill of Irbesartan and get a Viagra (I get the 25 mg, or a few times I got the 50 mg Viagra Sildenafil pill), erection is very good and lasts long. I have no history of diabetes. In your reply, you stated, "Use of Sildenafil once in a while cannot cause aortic dilatation." I suppose instead of aotic; you wanted to write aortic? Please study the new data with the attached files and reply to me if I can take Sildenafil; if yes, how should I take it by not taking Irbesartan in the morning? I am looking forward to your reply.