What causes BP fluctuation despite taking medications?

Question

Hello doctor,

I am 49 years old, male, and my weight is 272 lbs. I have a history of high blood pressure and have been on both Amlodipine and Telmisartan-HCTZ. I recently received an ADHD diagnosis and started taking 20 mg Adderall XR. About two weeks later, my blood pressure dropped significantly, from an average of 130 by 85 to about 107 by 80. It still fluctuates throughout the day. The consensus was that I was dehydrated from starting the Adderall, per my prior PC. They discontinued the Amlodipine, but I am still taking the Telmisartan. I have since been very diligent about hydration, exercising, and making wiser diet decisions. Today, my BP dropped below 100. I did notice that my sodium intake for the day was only 95 mg.

My question is, could I be taking in too little sodium and overhydrating, thereby flushing out too much sodium? My urine has been consistently a very pale yellow. Could this be a cause for the sudden blood pressure drops?

Kindly advise.

Answer 1

Hello,

Welcome to icliniq.com.

I understand your concern.

It is possible that your recent drop in blood pressure is related to a combination of low sodium intake, increased hydration, and the effects of your medications, including Adderall XR (Dextroamphetamine and Amphetamine). Since starting Adderall, you have likely experienced changes in appetite, fluid balance, and possibly increased urination, all of which can lead to dehydration or shifts in electrolyte levels, especially sodium. You are also still on Telmisartan-Hydrochlorothiazide, which includes a diuretic that promotes fluid and sodium loss. When combined with a very low daily sodium intake, such as the 95 milligrams you mentioned, which is far below the recommended minimum and high water intake, your body may be experiencing relative hyponatremia (low sodium concentration in the blood), which can lead to low blood pressure, dizziness, and fatigue.

The pale yellow color of your urine is a sign that you are very well hydrated, possibly even overhydrated. While hydration is important, overhydration without adequate electrolyte replacement, particularly sodium, can dilute the sodium in your blood and contribute to the blood pressure drops you are seeing.

It is good that your healthcare team has already stopped the Amlodipine, but it might be worth reviewing whether you still need the diuretic portion of Telmisartan-HCTZ. In the meantime, consider slightly increasing your sodium intake to at least 1,000 to 1,500 milligrams (mg) per day and balancing hydration with occasional electrolyte support. If symptoms like dizziness, fatigue, or extremely low readings persist, it is important to follow up with your doctor, as your medications and lifestyle may need further adjustment to keep your blood pressure in a safe and stable range.

I hope you are satisfied with my answer. For further queries, you can consult me at iCliniq.

Thank you.