Does Adderall Cause High Blood Pressure?

Yes, Adderall (amphetamine) does cause increases in blood pressure, though the magnitude varies considerably between individuals. 1, 2, 3

Magnitude of Blood Pressure Effects

Most patients experience mild but statistically significant increases in blood pressure when taking Adderall:

Average increases are 1-4 mm Hg for both systolic and diastolic blood pressure across all stimulants 1, 2, 4
However, 5-15% of patients experience substantially higher increases that may be clinically significant 2, 5
In clinical trials, amphetamines specifically caused mean systolic blood pressure increases of +5.4 mm Hg 6
Heart rate also increases by an average of 1-2 beats per minute, with some studies showing increases up to 7.3 mm Hg 1, 6

Adderall raises blood pressure through direct sympathetic nervous system stimulation:

Amphetamines directly stimulate adrenergic receptors and cause release of dopamine and norepinephrine 5
The American College of Cardiology and American Heart Association specifically list amphetamines among medications that may cause elevated blood pressure 2, 5
New-onset hypertension (BP ≥140/90) occurred in 10% of patients receiving active ADHD medication versus 8% on placebo in controlled trials 6

Certain patients are at higher risk for clinically significant blood pressure elevations:

Higher doses of Adderall substantially increase cardiovascular risk 2, 5
Patients with pre-existing hypertension, coronary artery disease, or tachyarrhythmias should avoid stimulants 5
Personal or family history of cardiac conditions increases risk 2, 5
Dose-dependent effects exist, with positive correlation between stimulant dose (mg/kg) and percent change in blood pressure 7

Extended use of ADHD medications is associated with increased cardiovascular risk:

Longer cumulative duration of ADHD medication use correlates with increased CVD risk, particularly hypertension and arterial disease 8
Each 1-year increase in ADHD medication use was associated with a 4% increased risk of CVD, with larger increases (8%) in the first 3 years 8
Cumulative use >5 years showed an 80% increased risk of hypertension compared to nonuse 8

The American Academy of Pediatrics and American College of Cardiology recommend specific monitoring protocols:

Establish baseline blood pressure and heart rate before initiating Adderall 1, 2
Monitor blood pressure and pulse at each dose adjustment 1
Regular ongoing monitoring is essential throughout treatment 1, 5
Obtain history of cardiac symptoms and family history of cardiovascular conditions before starting treatment 2, 5

The American College of Cardiology recommends discontinuing or decreasing the dose of amphetamines when blood pressure becomes elevated: 1

If blood pressure rises significantly, consider dose reduction of Adderall, switching to alternative ADHD medication, or adjusting antihypertensive therapy 1
Target blood pressure should be <130/80 mmHg before continuing or restarting ADHD medication 1
Non-stimulant alternatives like atomoxetine or alpha-2 agonists (guanfacine, clonidine) have more favorable blood pressure profiles 1

While blood pressure increases are common, serious cardiovascular events remain rare:

The risk for serious cardiovascular adverse events and sudden cardiac death associated with therapeutic doses of stimulants is extremely low 9
Stimulants have not been shown to increase the risk of sudden death after 2-3 years of treatment on average 1
However, extremely high doses might cause cardiovascular damage and hypertension 2
Patients should avoid combining Adderall with other vasoconstrictive substances including alcohol, caffeine (>200mg/day), and decongestants 10, 5