All SPC patients taking stimulant medications for the treatment of ADD/ADHD, Binge Eating Disorder, and other conditions requiring such medications (for example, Adderall, Vyvanse, Ritalin, Concerta, etc.) are required to monitor their blood pressures and to submit a blood pressure log in order to initiate, continue, or resume treatment with those medications, regardless of their past medical histories.
this is a one-time requirement, designed to screen for medication-induced hypertension.
1. Purchase a home blood pressure cuff, and keep it on your nightstand.
(Why do I have to purchase a home blood-pressure cuff?)*
2. Measure your blood pressure sitting on the edge of your bed, as soon as you wake up, before getting started with your day, if possible. This is your morning baseline. Your blood pressure will vary throughout the day with hydration, exercise and other activities, stress, caffeine, other dietary intake, etc., so it's best to measure at the same time every morning , immediately upon awakening, before doing anything else, to get the best baseline.
3.Make sure you are using an ARM cuff (not a wrist cuff) that is the appropriate size, and that you are following the correct methodology (see below, and click for more information from the CDC).
4. Normal is 120/80 mmHg or below. Low blood pressures are desirable; very low blood pressures are not worrisome unless you feel faint, light-headed, dizzy or experience a fall, chest pain, or lose consciousness. Some medications cause light-headedness which can lead to falling or fainting if you stand up too quickly (see Orthostasis).
If you get widely disparate numbers (i.e., the top, systolic, value is normal or low, but the bottom, diastolic, value is very elevated, e.g., 122/98; or vice-versa, E.G., 143/70), or the reading is very different from most of the other readings you've been registering, disregard that result and remeasure, using the other arm (remeasuring too soon on the same side might produce a misleading result). The better-quality machines are very accurate and will abort and instruct you to start over if the reading goes awry, and some have a feature that will prompt you for three, separate but consecutive measurements that will then be averaged, for the most accurate estimate of your blood pressure at that time. Even if your machine does not offer this feature, taking and recording multiple measurements, one on each arm, will improve the accuracy and reliability of your measurements. Many relatively-inexpensive brands are Bluetooth-capable and can wirelessly send readings to your smartphone. I recommend the Omron brand, several of which I have used myself.
5. Record in writing the date, and your morning baseline blood pressure reading(s). to view a form you can download, print, and use, see here.
6. Take any blood pressure medication(s) you may already be taking, as usual.
7. If you are taking an immediate-release stimulant, remeasure your blood pressure 1-2 hours after dosing on an empty stomach, or a bit later if you take the medicine with food, or whenever you begin to feel the medication take effect. Record in writing this "after-stimulant" measurement(s). Repeat this procedure for 5-7 consecutive days. If your blood pressure rises significantly after dosing, or ever goes above 120/80 mmHg, and especially if it was 120/80 mmHg or lower before dosing, record and measure your blood pressure again, a third time, in the evening, well after your final dose (if you redose during the day), as you are preparing for bed. Even significantly elevated readings (135-140+/90+ mmHg) are almost always asymptomatic, and are not emergencies, but if your pressure is over 160/100 or you feel chest pain, nausea or headache, stop taking the stimulant and seek emergency medical treatment.
8. If you take an extended- or delayed-release, or long-acting, stimulant preparation, such as Adderall XR , Concerta, Ritalin LA, Vyvanse and others, take the "after-stimulant" measurement(s) later in the day, approximately 3-5 hours after dosing (different preparations have different delivery systems, and therefore different serum-level curves, but it is not important to be exact with timing, other than to avoid measuring too soon after dosing one of these longer-acting preparations). If you take a long-acting agent in the morning and sometimes re-dose with a smaller amount of an immediate-release preparation in the late mornings or early afternoons, remeasure 1-2 hours after the second dosage.
9. It is best to remeasure at approximately the same time every day, such as before lunch, and to avoid remeasuring in a moment of anger, anxiety or other acute stressor. Remain as calm and as still as possible during your measurements and find a quiet place; the machine is "auscultating" (listening to) your pulse, just like humans do when they measure blood pressure manually, using a stethoscope. Too much movement or noise will detract from the accuracy of the measurement.
10. If you are getting elevated readings at any time of the day, you should continue to measure multiple times daily: morning, mid-day and evening, or before-and-after each dose, until you have logged at least 5 days, preferably in a row. If you forget and miss a reading, just continue measuring at the next due time.
11. After approximately one week, send your readings to email@example.com (via e-mail, not text, please, so that I may more easily incorporate the message into your patient file; this is one of the few times that I prefer e-mail to texting).
If you are consistently getting readings over 130/85 by day two or three, contact me before continuing to take the stimulant, regardless of whether or not you are also already receiving anti-hypertensive treatment with another provider.
If the risk/benefit analysis indicates that continuing treatment with a stimulant is warranted and reasonable, and changing the stimulant or lowering the dosage is not the best option, stimulant-induced hypertension should be treated with a beta-blocker or an alpha-blocker, but there are many classes of anti-hypertensive medications (e.g., calcium-channel blockers, ACE inhibitors, diuretics, etc.) and so a change, or addition to, your existing regimen may be in order, as opposed to merely increasing the dosage of the anti-hypertensive medication you may already be taking. You will also want to notify your cardiologist, primary care physician, or whoever is managing your high blood pressure of the results of the trial, especially if I add a beta-blocker, which is my usual practice if we decide to continue treatment with the stimulant. Patients with asthma should avoid beta blockers, and there are other considerations and contraindications.
Ignoring hypertension from any cause can lead to serious, potentially fatal, outcomes.
HOW TO PROPERLY MEASURE YOUR BLOOD PRESSURE
"Measuring your blood pressure is the only way to know you have high blood pressure." --CDC
Recommended brand: Omron. Be sure to use an ARM CUFF, not a wrist cuff, and consider whether or not you require a LARGE or STANDARD cuff size. I have personally purchased several Omron home sphygmomanometers, in a range of prices, and here are my favorites in three categories, from least-to-most expensive (pricing and availability may vary over time). Click-to-purchase from Amazon.com below, or find similar, FDA-approved devices at your local pharmacy.
Omron 5 Series
Wireless Upper Arm Blood Pressure Monitor
Wireless Upper Arm Blood Pressure Monitor
Omron Silver Blood Pressure Monitor, Upper Arm Cuff, Digital Bluetooth Blood Pressure Machine
Omron Platinum Blood Pressure Monitor, Premium Upper Arm Cuff, Digital Bluetooth Blood Pressure Machine, for Two Users
*AS WELL AS EFFEXOR (VENLAFAXINE), AND CERTAIN OTHER MEDICATIONS KNOWN TO AFFECT BLOOD PRESSURE