According to the American Psychiatric Association, “attention-deficit/hyperactivity disorder (ADHD) is one of the most common mental disorders affecting children. Symptoms include inattention, hyperactivity, and impulsivity. It is considered a chronic and debilitating disorder and is known to impact the individual in many aspects of their life, including academic and professional achievements, interpersonal relationships, and daily functioning. ADHD can lead to poor self-esteem and social function in children when not appropriately treated.”
Approximately 4% of children in the United Kingdom and 11.4% of American children aged 3-17 years old have been diagnosed with ADHD, and around 45% are treated with medication. A study recently published in The Lancet Psychiatry describes the largest analysis of the cardiovascular effects of ADHD medications based on the results of randomized and controlled trials. The results showed that some of these medications have effects on blood pressure as well as heart rate after weeks or a few months of use, highlighting the need for careful monitoring.
Investigating the effects of ADHD medications on the heart
The international team of researchers utilized data from 102 randomized controlled trials, which included 22,702 participants with ADHD, to compare the effects of several medications. The analysis revealed that all of the ADHD medications they investigated were generally associated with effects on blood pressure, heart rate, and ECG parameters, and some led to small increases in the values, with the exception of guanfacine, which leads to both decreased blood pressure and heart rate.
Additionally, there were no significant differences found between stimulants and non-stimulants with regard to the effects on heart rate and blood pressure, according to the researchers. However, the researchers suggest that those with existing heart conditions should thoroughly discuss the side effects of ADHD medications with a cardiologist before using ADHD medications. The team will now investigate if some groups are more vulnerable to the cardiovascular side effects than others.
“When it comes to taking any medication, risks and benefits should always be assessed together. We found an overall small increase in blood pressure and pulse for the majority of children taking ADHD medications,” said Professor Samuele Cortese, senior lead author of the study from the University of Southampton.
“Other studies show clear benefits in terms of reductions in mortality risk and improvement in academic functions, as well as a small increased risk of hypertension, but not other cardiovascular diseases. Overall, the risk-benefit ratio is reassuring for people taking ADHD medications,” said Cortese.
“Our findings should inform future clinical guidelines, stressing the need to systematically monitor blood pressure and heart rate, both for stimulants and non-stimulants. This should be particularly relevant for practitioners who might assume that only stimulants have a negative effect on the cardiovascular system,” said Dr. Farhat.
More research is needed
“Our findings, based on randomised controlled trials that tend to be of short duration due to ethical issues, should be complemented by results from real-world, longer-term studies,” added Professor Revet.
“While our findings are informative at the group level, that is, on average, we cannot exclude that a subgroup of individuals may have a higher risk of more substantial cardiovascular alterations,” concluded NIHR Research Professor Cortese. “While it is currently not possible to identify those individuals at higher risk, efforts based on precision medicine approaches will hopefully provide important insights in the future.”
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