ADHD Treatment: The Silent Impact on the Cardiovascular System

Attention deficit hyperactivity disorder (ADHD) is a condition that makes it difficult to concentrate and control impulsivity. It is common in children, but can also continue into adulthood. Treatment usually involves medication, which helps to improve focus and reduce hyperactivity. However, these medications can affect the heart and blood pressure, so it is important to have regular medical check-ups.

Attention deficit hyperactivity disorder (ADHD) is a common neuropsychiatric condition that usually begins in childhood, but can persist into adulthood. It is characterized by symptoms of inattention, hyperactivity, and impulsivity, which can significantly affect school performance, social relationships, and work life.

Although the exact cause of ADHD is not yet fully understood, genetic and environmental factors are believed to play a role. Treatment often involves a combination of behavioral and pharmacological interventions, with stimulant medications being the most commonly used approach.

However, the long-term safety of these treatments, especially with regard to cardiovascular effects, remains an area of ​​concern and investigation.

Medications to treat attention deficit hyperactivity disorder (ADHD) are widely used, but there are still concerns about possible effects on the heart and blood circulation (such as increased blood pressure and changes in heart rhythm). This study aimed to better understand how these medications affect these parameters in children, adolescents and adults.

The researchers reviewed a large number of studies already conducted, analyzing 102 clinical trials involving more than 22,000 people (both children and adolescents and adults). They searched medical databases for information up to January 2024.

The medications studied included several used for ADHD, such as amphetamines, atomoxetine, bupropion, methylphenidate, lisdexamfetamine, among others, also comparing them with placebo (a "dummy drug").

The main things they looked at were:

• Changes in systolic blood pressure (the top number on your blood pressure)

• Changes in diastolic blood pressure (the bottom number)

• Changes in pulse rate (heartbeats per minute)

These data were gathered using statistical methods that allow multiple drugs to be compared with each other, even when the original studies were different.

In general, some drugs such as amphetamines, atomoxetine, lisdexamfetamine, methylphenidate, and viloxazine caused small increases in blood pressure and pulse rate in children, adolescents, and adults.

For example, in children and adolescents, systolic blood pressure increased by an average of 1 to 2 mmHg, and diastolic blood pressure increased by about 2 mmHg. Pulse rates increased by between 3 and 6 beats per minute depending on the drug.

In adults, the increases were also small, but varied slightly more depending on the drug. Guanfacine was the only drug that reduced blood pressure and pulse in both children and adults.

Most studies followed patients for a short time (an average of 7 weeks), and there is little data on medium- and long-term effects. All ADHD medications, not just traditional stimulants, can have some effect on the heart and blood pressure.

Doctors should regularly monitor the blood pressure and pulse of patients taking these medications. More research is needed to understand the effects of these medications when used for many months or years, since what we know today is based on short-term studies.

READ MORE:

Comparative cardiovascular safety of medications for attention-deficit hyperactivity disorder in children, adolescents, and adults: a systematic review and network meta-analysis

Luis C Farhat,  Alice Lannes, Cinzia Del Giovane, Valeria Parlatini,  Miguel Garcia-Argibay,  Edoardo G Ostinelli, Anneka Tomlison, Zheng Chang, Henrik Larsson, Cristiano Fava, 

François Montastruc,Andrea Cipriani, Alexis Revet,  and Samuele Cortese

Lancet Psychiatry, April 06, 2025

DOI: 10.1016/S2215-0366(25)00062-8