Blood Pressure

Blood pressure. It’s one of the basic measures of health. We take blood pressure for granted unless it is way too high or far too low. Traditionally a reading of 120/80 millimeters of mercury has been the ideal blood pressure. These days internists want blood pressure to be 135/85 or less. Higher than that is “hypertension,” elevated blood pressure levels associated with hardened arteries and danger of heart attack and stroke.

As a child I never understood what adults meant if they said that so-and-so “had a stroke.” I imagined the afflicted person being felled, like a tree. Actually, that image is not so far off the truth. In a stroke an artery to the brain gets blocked off. Blood (and oxygen) fail to reach that part of the brain. Different symptoms result from the failure of different parts of the brain– inability to speak, paralysis of limbs, or death. Usually, hypertension is a silent symptom; many people with high blood pressure don’t know that they have it.

It’s important in ADHD since the medications we use to treat the disorder all have the potential to raise blood pressure. That is true for all the CNS stimulants and for atomoxetine (Strattera) and bupropion ( Wellbutrin). If the person has low or normal blood pressure, this raise (typically 3-5 mm of mercury) counts for little. In a person who has high blood pressure, the medications can jack up the readings.

I try to monitor all my ADHD patients for high blood pressure. If a patient develops high blood pressure, I stop the ADHD medication and refer the patient to an internist. Once blood pressure subsides we can try again, in collaboration with the primary care doctor. One new patient recently had such high blood pressure that I didn’t start any medicine. Instead I sent him directly to his internist, as in, “Go there right now.”

As I said recently to a patient, “We are focusing on your brain, but your heart comes first.” Moral of the story? Watch your blood pressure.