From the Guidelines
Adderall can cause or worsen hypertension and should be used cautiously in people with existing hypertension. Adderall, a stimulant medication containing amphetamine salts, works by increasing levels of norepinephrine and dopamine in the brain, but this mechanism also leads to blood vessel constriction and increased heart rate, which raises blood pressure 1. For patients with hypertension who require Adderall for conditions like ADHD, close blood pressure monitoring is essential, typically checking blood pressure before starting treatment and regularly thereafter. According to the 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA guideline for the prevention, detection, evaluation, and management of high blood pressure in adults, amphetamines, including Adderall, may cause elevated blood pressure, and possible management strategies include discontinuing or decreasing the dose, or considering behavioral therapies for ADHD 1. Blood pressure increases of 2-4 mmHg systolic and diastolic are common, though some individuals may experience more significant elevations. If a patient develops hypertension while taking Adderall, their doctor might adjust the Adderall dosage, switch to a non-stimulant ADHD medication like atomoxetine (Strattera), or prescribe antihypertensive medication to control blood pressure. Lifestyle modifications such as regular exercise, maintaining healthy weight, limiting sodium and alcohol intake, and avoiding tobacco can help minimize blood pressure effects. Patients should never abruptly stop taking Adderall without medical supervision, as this can cause withdrawal symptoms.
Some key points to consider when managing hypertension in patients taking Adderall include:
- Monitoring blood pressure regularly
- Adjusting the Adderall dosage or switching to a non-stimulant medication if necessary
- Prescribing antihypertensive medication if needed
- Encouraging lifestyle modifications to minimize blood pressure effects
- Avoiding abrupt cessation of Adderall without medical supervision.
It is essential to weigh the benefits of Adderall treatment against the potential risks of hypertension and to closely monitor patients with pre-existing hypertension or those who develop hypertension while taking the medication 1.
From the FDA Drug Label
ADVERSE REACTIONS Cardiovascular: Palpitations, tachycardia, elevation of blood pressure. Cardiovascular effects include arrhythmias, hypertension or hypotension and circulatory collapse The elevation of blood pressure and hypertension are potential adverse effects of amphetamine use, as stated in the drug labels 2 and 2.
- Hypertension is a possible effect of amphetamine overdose.
- Elevation of blood pressure is a known adverse reaction to amphetamine use. It is essential to monitor blood pressure when using amphetamines, especially in patients with pre-existing hypertension.
From the Research
Adderall and Hypertension
- Adderall, a medication used to treat attention-deficit/hyperactivity disorder (ADHD), has been associated with increased blood pressure and heart rate in some studies 3, 4.
- A study published in 2005 found that active drug treatment for ADHD, including stimulants like amphetamine, was associated with statistically significant changes in systolic blood pressure and heart rate 3.
- Another study published in 2013 found that long-term exposure to ADHD medications, including Adderall, was associated with an increased risk of cardiovascular diseases, especially hypertension and arterial disease 5.
- The exact mechanism of Adderall-induced hypertension is not fully understood, but it is thought to be related to the stimulation of α- and β-adrenergic receptor sites, leading to vasoconstriction and increased heart rate 6.
- Clinical signs of Adderall overdose, including hyperactivity, hyperthermia, tachycardia, and seizures, can be managed with various treatments, including benzodiazepines, phenothiazines, and β-blockers 6.
Cardiovascular Risks
- A meta-analysis published in 2013 found that CNS stimulant treatment of ADHD in adults was associated with a statistically significant increased resting heart rate and systolic blood pressure compared to placebo 4.
- The same meta-analysis found that there was a statistically significant increased risk for a resting heart rate >90bpm associated with CNS stimulant treatment 4.
- A study published in 2024 found that longer cumulative duration of ADHD medication use was associated with an increased risk of cardiovascular disease, including hypertension and arterial disease 5.
- Clinicians should regularly and consistently monitor cardiovascular signs and symptoms throughout the course of treatment with Adderall or other ADHD medications 5.