How do you balance the risks and benefits of stimulant treatment in patients with poorly controlled hypertension?

The short answer is that there are no clear cutoffs to clearly guide management, and often decisions are guided by shared decision making with patients and relevant specialties (psychiatry, primary care, cardiology).

Clinical factors which may prompt you to stop or reduce stimulants:

1. Elevated BP that...

The question of how to balance stimulant therapy with uncontrolled hypertension remains one of the more challenging clinical crossroads in contemporary psychiatric practice. While stimulants are among the most effective treatments for ADHD, they also carry well-documented cardiovascular risks. When ...

It seems some of my colleagues feel we have to coordinate with primary care. As psychiatrists whose medications regularly interact with lipids, blood sugar, and blood pressure, we should have at least a moderate amount of expertise in treating these issues ourselves. Involving primary care becomes t...

There’s always a question of how high? In fact, some of my cardiology friends have told me that for some with persistently slightly elevated chronic hypertension, they may require that pressure to maintain adequate perfusion (I just put that out there). From my perspective, I will work with the PCP ...