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

How do you weigh cardiovascular risks against the potential functional and emotional consequences of undertreated ADHD? What blood pressure thresholds or clinical factors prompt you to reduce or discontinue stimulants? Have you found particular strategies (e.g., dose timing, non-stimulant alternatives, close collaboration with primary care) helpful in mitigating risk?