Hi Docs,
My husband takes a combo of adderall and Wellbutrin for ADHD and depression. The medication causes high blood pressure for him. In morning before medication, his typical BP might be around or under 120/80. After medication and especially after any stress or frustration, his BP can be in the 130’s, 140’s or even 150’s over mid 80’s.
His psychiatrist caught one of his very high readings when he came in for an appt (above 150/80) and asked him if he was dizzy or felt ill. He was very concerned. He told him to stop drinking coffee or at least reduce to one cup and told him to stop taking adderall on weekends. His PCP shows little to no concern because my husband is an avid runner (several races per year - ultra, tri, marathon) and has very good bloodwork in all other ways. He is 52 years old and his morning RHR is typically in the 50’s. I’ve listened to you BP podcasts and I think I’ve read most of your materials but maybe I missed something about this.
Is there anything you would suggest he monitor or any specific tests he should do periodically to assess the effects of this over time?
Thanks!
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Hi there –
I understand your concern.
It sounds like his waking/”resting” blood pressure of 120/80 is in a good place. I would also be curious about the quality of the office measurement that you mention at 150/80, as it is common for in-office blood pressures to be elevated for all sorts of reasons that aren’t reflective of people’s true resting blood pressure that we care about.
With that said, I would not be checking his blood pressure during stressful/frustrating episodes or periods of time. It is physiologically appropriate for blood pressure to increase under periods of significant acute stress. These types of episodic fluctuations are not the elevations that we are concerned with, nor are those the blood pressure data on which we base our treatment decisions.
If you are interested in better quality data to guide decisions moving forward, undergoing a period of ambulatory blood pressure monitoring (ABPM) would be a reasonable consideration, especially given that we do know both Adderall and Wellbutrin can contribute to blood pressure elevation. The recommendation to reduce / avoid coffee intake is not relevant or helpful here.
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This is so helpful. Thank you!
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