Psychostimulant Use in Patients with Well-Controlled Hypertension

Primary Management Strategy

The American College of Cardiology recommends that amphetamines, including methylphenidate, dexmethylphenidate, and dextroamphetamine, should be discontinued or dose-reduced as the first-line approach when hypertension is present, with a strength of evidence based on the 2017 ACC/AHA Hypertension Guidelines 1, 2
The American College of Cardiology and the National Comprehensive Cancer Network suggest that patients with uncontrolled or severe hypertension should avoid psychostimulants, while those with well-controlled hypertension can use them with caution and monitoring 1, 2, 3

The American College of Cardiology and the National Comprehensive Cancer Network recommend that methylphenidate and dextroamphetamine should be avoided in patients with uncontrolled hypertension, underlying coronary artery disease, and tachyarrhythmias, due to the increased risk of adverse cardiovascular effects 3
The American College of Cardiology advises against combining psychostimulants with other sympathomimetic agents, such as decongestants or appetite suppressants, as this can lead to hypertensive crisis 1
The American College of Cardiology notes that concomitant caffeine use may produce additive adverse effects, including elevated blood pressure, and recommends caution when using psychostimulants in patients who consume caffeine 1

The American College of Cardiology recommends that stimulants should generally be discontinued or dose-reduced in patients with hypertension, and they must be avoided entirely in those with severe or uncontrolled hypertension 4, 5
The American College of Cardiology and the American Heart Association explicitly list amphetamines as medications that cause elevated blood pressure and recommend discontinuation or dose reduction as the primary management strategy, with consideration of behavioral therapies for ADHD as alternatives 4, 5

The American College of Cardiology recommends that if hypertension develops or worsens on stimulants, the first-line management should be to discontinue or decrease stimulant dose, and the second-line management should be to consider behavioral therapies for ADHD as alternatives 4, 5
The American College of Cardiology also recommends that if stimulants must be continued, antihypertensive therapy should be initiated or intensified while continuing close blood pressure monitoring 4, 5

The International Society of Hypertension recommends screening all patients with hypertension for medications that may increase blood pressure, including sympathomimetics like stimulants 6