Hypertension (HT)-related erectile dysfunction (ED), a condition secondary to HT, is characterized by a persistent inability to achieve or maintain an erection sufficient for satisfactory sexual performance. This study aimed to systematically analyze and visualize publications related to HT-related ED using bibliometrics to identify key topics, research hotspots, and knowledge gaps, and to explore the underlying causal relationship between HT and ED using Mendelian randomization (MR). Literature was retrieved from the Web of Science Core Collection, and publishing trends were profiled by country, institution, author, journal, and collaboration networks. For the MR analysis, single-nucleotide polymorphisms considerably associated with HT were selected, followed by pruning, filtering, and adjustment for potential confounders. The inverse variance weighting method was used as the primary analysis, complemented by MR-Egger and weighted median approaches, along with sensitivity analyses including heterogeneity and pleiotropy assessments to ensure robustness. Between 2001 and 2025, 1,661 articles were published in 1,099 journals, reflecting the evolving global research status and future directions. Academic institutions in Europe and North America have played a dominant role. The most prolific country, institution, journal, and author are the United States, University of São Paulo, Journal of Sexual Medicine, and Faix, A., respectively. Common keywords include nitric oxide, metabolic syndrome, and endothelial dysfunction. MR results confirmed that HT has a significant positive causal effect on ED risk. Research hotspots primarily involve impotence, oral sildenafil, vardenafil, safety, inhaled nitric oxide, international index, predictor, late onset hypogonadism, testosterone, obesity, oxidative stress, and phosphodiesterase 5 inhibitor. Two-sample MR provides robust causal evidence that supplements observational findings, offering a comprehensive framework for understanding HT-related ED.