Protecting Your Long-Term Health Through Accurate Monitoring

National and international guidelines recommend regular monitoring of blood pressure and pulse in people taking ADHD medication. This is because stimulant medications such as lisdexamfetamine (Elvanse) and methylphenidate can occasionally cause increases in blood pressure and heart rate, although they are safe and effective treatments for the great majority of patients.

At Sloane Court Clinic, we view blood pressure monitoring as an important part of ensuring that your treatment remains both effective and safe. The purpose is not to look for problems or create anxiety. Rather, it is to help identify any trends early, allowing appropriate action to be taken long before there is any risk of long-term health consequences.

Modern hypertension guidelines emphasise that cardiovascular risk is best assessed using multiple measurements taken over time rather than relying on a single reading in clinic.

Home Blood Pressure Monitoring

The NICE Hypertension Guideline and the European Society of Hypertension recommend that home measurements are performed under standardised conditions to ensure accuracy.

Before Taking a Reading

For at least 30 minutes before measuring your blood pressure:

• Avoid caffeine-containing drinks.
• Avoid smoking or vaping nicotine products.
• Avoid vigorous exercise.

You should also:

• Empty your bladder.
• Sit quietly for at least five minutes before taking a reading.
• Avoid measuring when stressed, rushed or immediately after physical activity.

During Measurement

• Use a clinically validated upper-arm blood pressure monitor.
• Ensure the cuff is the correct size for your arm.
• Sit with your back supported.
• Keep both feet flat on the floor.
• Do not cross your legs.
• Support your arm at heart level.
• Remain still and silent during the measurement.

Recording Results

We recommend recording:

• Blood pressure (e.g. 128/78 mmHg)
• Pulse rate
• Date and time
• Current ADHD medication dose
• Any recent medication changes
• Relevant factors such as illness, significant stress, or missed medication doses

Taking two readings one minute apart and recording both measurements often provides a more reliable estimate than a single reading.

Looking Beyond Individual Readings

Blood pressure naturally varies throughout the day.

A single high reading is usually not clinically significant. What matters far more is the overall pattern over weeks and months.

For this reason, hypertension specialists increasingly recognise the value of repeated measurements performed in normal day-to-day life, as these provide a better indication of true blood pressure than occasional clinic measurements alone.

Continuous Monitoring with the Hilo System*

Some patients may prefer to monitor their blood pressure using the Hilo continuous blood pressure monitoring system.

According to the manufacturer, Hilo is a 'clinically validated blood pressure monitoring system designed to collect blood pressure measurements throughout the day and night during normal activities. It provides trend analysis, historical records and downloadable reports that can be reviewed with healthcare professionals.'

Potential advantages include:

• Collection of many more blood pressure measurements than is usually practical with conventional home monitoring.
• Better understanding of how blood pressure varies throughout the day.
• Identification of patterns that may not be apparent from occasional spot checks.
• Automated trend analysis and graphical reports.
• The ability to generate clinician-friendly summaries for review.

Many patients find that these reports provide a clearer picture of how their cardiovascular measurements change following:

• ADHD medication initiation
• Dose increases
• Dose reductions
• Medication switches
• Lifestyle changes such as exercise programmes, weight loss, reduced alcohol intake, or improved sleep

When medication changes are recorded within the monitoring record, trends can often be interpreted more easily during follow-up appointments.

In addition, patients can simply share their results electronically with the clinic using the reporting facilities available through the system, which may reduce the need for manual transcription of readings and provide a more comprehensive overview of blood pressure trends for clinical review. Please note that the specific methods of sharing reports depend on the features provided by the manufacturer and app version in use.

Traditional Home Monitoring vs Continuous Monitoring with Hilo

Both traditional home blood pressure monitoring and continuous monitoring can be useful. The most appropriate approach depends on the individual patient, their preferences, and the level of detail required by their clinician.

Why This May Be Helpful for ADHD Treatment

When starting or adjusting ADHD medication, clinicians are often interested in:

• Whether blood pressure is stable over time.
• Whether there has been a significant change after a dose increase.
• Whether any rise in blood pressure persists or settles.
• Whether changes in blood pressure correlate with medication timing or other lifestyle factors.

Traditional monitoring can provide valuable information, but only from relatively few readings. Continuous monitoring may provide a much richer dataset from which patterns can be identified.

Sharing Information with the Clinic

With conventional monitoring, patients usually need to note down readings and send them to the clinic manually.

The Hilo system provides downloadable reports and clinician-oriented summaries that can be shared electronically with healthcare professionals. According to the manufacturer, these reports can be used to support discussions about cardiovascular health and blood pressure trends.

Patients may find it useful to record important events alongside their monitoring data, such as:

• Starting ADHD medication
• Dose increases
• Dose reductions
• Medication switches
• Significant changes in caffeine intake
• Weight loss programmes
• Exercise programmes
• Changes in sleep patterns

Reviewing blood pressure trends in the context of these events can help clinicians make more informed decisions about treatment.

Our Message to Patients

The goal is not to collect more numbers. The goal is to obtain better information.

Whether you choose traditional home monitoring or a continuous monitoring system such as Hilo, accurate blood pressure measurement helps us ensure that your ADHD treatment remains safe, effective and tailored to your individual needs.

One isolated reading rarely tells the whole story. The pattern over time is usually far more important. National and international hypertension guidelines increasingly emphasise the value of repeated out-of-clinic measurements when assessing cardiovascular health.

At Sloane Court Clinic, our aim is simple: to maximise the benefits of ADHD treatment whilst safeguarding your long-term vascular health.

*Hilo – other wearable systems may come along to do the same job; at the time of writing we understand HiLo is a CE-marked Class IIa medical device that has undergone extensive clinical validation and its accuracy has been evaluated in clinical trials and validated according to the ISO 81060-2 international standard for blood pressure devices. In these studies, Hilo’s measurements were shown to be comparable to traditional upper-arm cuff devices.