A wide variety of medications for attention-deficit hyperactivity disorder (ADHD)—not just stimulants—can increase blood pressure and pulse in the short term among children, adolescents, and adults, according to a meta-analysis issued in Lancet Psychiatry.
“Although on average the effects are relatively small for most medications, there could be individual-level variability,” wrote Luis C. Farhat, Ph.D, at the Universidade de São Paolo in Brazil, and colleagues. “Therefore, practitioners should closely follow clinical guidelines and monitor blood pressure and pulse before and during treatment for ADHD.”
Farhat and colleagues combined data from 102 randomized controlled trials (encompassing 13,315 children and adolescents and 9,387 adults) that compared various ADHD pharmacotherapies against each other or placebo. Pharmacotherapies included antidepressants (bupropion, atomoxetine, and viloxazine), alpha-agonists (clonidine, guanfacine), and stimulants (amphetamines, lisdexamfetamine, methylphenidate, modafinil). The primary outcomes were the short-term (~12 weeks) changes in pulse, measured in heart beats per minute, and changes in blood pressure, measured at mm Hg.
Key results included:
- In children and adolescents, atomoxetine, lisdexamfetamine, methylphenidate, and viloxazine produced small increases in pulse and blood pressure; amphetamines produced small increases in blood pressure only.
- In adults, amphetamines, atomoxetine, lisdexamfetamine, and methylphenidate produced small increases in pulse and blood pressure; viloxazine produced small increases in pulse only.
- The increases in blood pressure in adults taking atomoxetine or methylphenidate were not observed when the medications were restricted to their FDA-licensed doses.
- Stimulants were not associated with larger increases in blood pressure or pulse compared with atomoxetine or viloxazine.
- By contrast, guanfacine was associated with decreases in pulse and blood pressure in both youth and adults.
Steven R. Pliszka, M.D., at the University of Texas Health Science Center at San Antonio, wrote in an accompanying editorial that small average increases—such as a 5 mm Hg elevation in blood pressure and a 5 beats per minute increase in pulse observed in one included study—typically “will not place the patient outside of the healthy range…. The more difficult question relates to determining whether there are any long-term consequences of mild but chronically elevated blood pressure and pulse over the course of possibly life-long ADHD medication treatment.” Only four of the 102 trials examined the cardiovascular effects of these medications up to 26 weeks, and none included 52-week data.
Overall, Pliszka said that the medications are not associated with increased natural mortality, but are associated with reduced mortality due to unnatural causes. “The overall benefits of ADHD medication treatment continue to outweigh still the risk.”
For related information, see the Psychiatric News article “ADHD Meds Linked to Cardiovascular Risk.”
(Image: Getty Images/iStock/Gam1983)
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