Summary: A significant new analysis of 102 clinical trials concludes that ADHD medications have only marginally affecting children’s and adults ‘ blood pressure and heart rates. These cardiovascular effects, which were largely reasonable increases, were uniform across stimulants and non-stimulants, with guanfacine being the exception, lowering these guidelines.
Although there have been some side effects fears, the advantages of ADHD medications generally outweigh the risks. These include improved academic performance and a decreased mortality. The researchers make it a priority for ADHD patients to receive regular cardio monitoring, particularly those with heart conditions that have already existed.
Important Information
- Little Cardiovascular Effects: Other than guanfacine, which lowers them, guanfacine causes minimal increases in heart rate and body force.
- Substances vs. non-stimulants: Both types of medications demonstrated comparable cardiovascular effects, refuting the idea that simply stimulants could lead to risks.
- Monitoring Needed: Authors advise regular blood pressure and heart rate inspections for all patients, regardless of the type of treatment.
University of Southampton
A recent study led by the University of Southampton found that ADHD treatments have only marginally affecting blood pressure and heart rate after a few months of use.
The negative effects of ADHD drugs have been reported, but the fresh studies, in combination with other studies, suggest that the risks are outweighed by the advantages of taking them, while also highlighting the need for careful monitoring.
The largest and most thorough examination of the cardiovascular effects of ADHD medications was conducted by the study, which was published in the journal The Lancet Psychiatry. The study analyzed the results of randomised controlled trials, which is the most comprehensive form of scientific study to assess treatment effects.
According to Professor Samuele Cortese, older lead author of the study at the University of Southampton, “risks and rewards should always be evaluated up when it comes to taking any medication.” The majority of kids taking ADHD medications experienced a modest increase in blood pressure and pulse in general.
Another cardiovascular diseases are unmistakably associated with lower mortality risk, improved academic performance, and a small-added risk of hypertension, but other studies show no such benefits. Nevertheless, the risk-benefit amount is comforting for those taking ADHD medications.
The study was supported by the National Institute for Health and Care Research ( NIHR ), in accordance with the NIHR Research Professorships program, which includes Professor Samuele Cortese as the first author and Professor Alexis Revet as the second author.
Around 4 % of children in the UK are thought to have attention-deficit/hyperactivity disorder ( ADHD). Around 44 % of these are treated with medication.
Data from 102 randomized controlled trials, including the 22, 702 ADHD members, were analysed by the international team of authorities. They compared the effects of many medications using a sophisticated statistical technique called network meta-analysis, even when the medications were not immediately compared to those in the analysis.  ,
They discovered that all ADHD drugs had comparatively minor effects on blood pressure, heart rate, and ECG guidelines. Another drugs, with the exception of guanfacine, which causes a decrease in blood pressure and heart rate, caused these parameters to rise.
Regarding their effects on blood pressure and heart rate, there were no significant differences between stimulants ( including methylphenidate and amphetamine ) and non-stimulants ( including atomoxetine and viloxazine ).
Our findings may serve as guidance for potential therapeutic guidelines, highlighting the need to routinely monitor heart rate and blood pressure, both for stimulants and non-stimulants. This should be especially important for physicians who may assume that just substances have a detrimental effect on the cardiovascular system,” said Dr. Farhat.
The researchers advise those who already have heart conditions to consult with a qualified physician about the potential side effects of ADHD medications before beginning treatment.
Our conclusions, based on randomised controlled trials that typically have little durations due to social concerns, should be complemented by those from longer-term, real-world research, Professor Revet said.
The research team did then examine whether some individuals may have higher risk of cardiovascular complications than another.
While our results are useful at the team level, NIHR Research Professor Cortese argued that, on average, a subset of people may be at greater risk for serious cardio alterations.
” Attempts based on perfection medicine approaches will hopefully lead to significant insights in the future, even though it is presently impossible to identify those individuals at higher danger.”
About this cardiovascular heath and psychiatry
Author: Steven Williams
Source: University of Southampton
Contact: Steven Williams – University of Southampton
Image: The image is credited to Neuroscience News
Original Research: Disclosed entry.
A systematic review and network meta-analysis of the treatments for attention-deficit hyperactivity disorder in children, adolescents, and adults is a” Comparative cardiovascular health of medicines for attention-deficit restlessness condition: a systematic review and community meta-analysis” by Samuele Cortese et cetera. Lancet Psychiatry
Abstract
Comparison of the cardiovascular safety of attention-deficit hyperactivity disorder medications in children, adolescents, and adults: a systematic review and network meta-analysis
Background
Concerns persist regarding the cardiovascular safety of medications used to treat attention-deficit hyperactivity disorder ( ADHD). We wanted to compare the effects of pharmacological treatments for ADHD on electrocardiogram (ECG) parameters and hemodynamic values in children, adolescents, and adults.
Methods
From the database’s conception to Jan. 18, 2024, we searched 12 electronic databases, including Cochrane CENTRAL, Embase, PubMed, and the WHO International Clinical Trials Registry Platform, for published and unpublished randomised controlled trials comparing amphetamines, atomoxetine, bupropion, clonidine, guanfacine, lisdexamfetamine, methylphenidate, modafinil, and viloxazine against each other
At time points closest to 12 weeks, 26 weeks, and 52 weeks, the primary outcomes were changes in systolic blood pressure ( SBP ) and diastolic blood pressure ( DBP ) measured in mm Hg and pulse, measured in beats per minute.
Random-effects network meta-analyses were conducted on summary data and combined. The Confidence in Network Meta-Analysis ( CINeMA ) framework was used to evaluate the breadth of the evidence.
This study was registered with PROSPERO, CRD42021295352. Concerning the relevance of the subject and the appropriateness of the outcomes chosen, we contacted representatives of a UK-based charity of people with lived experience of ADHD ( the ADHD Foundation ).
Findings
102 randomised controlled trials with short-term follow-up ( median 7 weeks]IQR 5–9] ) were included, encompassing 13 315 children and adolescents ( aged ≥5 years and <, 18 years, mean age 11 years]SD 3], of available data, 9635]73 % ] were male and 3646]27 % ] were female, of available data, 289]2 % ] were Asian, 1719]15 % ] were Black, and 8303]71 % ] were White ) and 9387 adults ( ≥18 years, mean age 35 years]11], of available data, 5064]57 % ] were male and 3809]43 % ] were female, of available data, 488]6 % ] were Asian, 457]6 % ] were Black, and 6372]79 % ] were White ).
In addition to amplifications in hemodynamic values in children and adolescents, adults, or both, atomoxetine, lisdexamfetamine, methylphenidate, and viloxazine were found to increase in haemodynamic values.
In children and adolescents, mean increase against placebo ranged from 1·07 (95 % CI 0·36–1·79, moderate CINeMA confidence ) with atomoxetine to 1·81 ( 1·05–2·57, moderate ) with methylphenidate for SBP, from 1·93 ( 0·74–3·11, high ) with amphetamines to 2·42 ( 1·69–3·15, low ) with methylphenidate for DBP, and from 2·79 ( 1·05–4·53, moderate ) with viloxazine to 5·58 ( 4·67–6·49, high ) with atomoxetine for pulse.
In adults, mean increase against placebo ranged from 1·66 (95 % CI 0·38–2·93, very low ) with methylphenidate to 2·3 ( 0·66–3·94, very low ) with amphetamines for SBP, from 1·60 ( 0·29–2·91, very low ) with methylphenidate to 3·07 ( 0·69–5·45, very low ) with lisdexamfetamine for DBP, and from 4·37 ( 3·16–5·59, very low ) with methylphenidate to 5·8 ( 2·3–9·3, very low ) with viloxazine for pulse.
In comparison to atomoxetine or viloxazine, methylphenidate, lisdexamfetamine, or methylphenidate, no association was found to be greater in increases in haemodynamic increments in children, adolescents, or adults.
Guanfacine was associated with decrements in haemodynamic values in children and adolescents ( mean decrease against placebo of –2·83]95 % CI –3·8 to –1·85, low CINeMA confidence ] in SBP, –2·08]–3 to –1·17, low ] in DBP, and –4·06 ]–5·45 –2·68, moderate ] in pulse ) and adults ( mean decrease against placebo of –10·1]–13·76 to –6·44, very low ] in SBP, –7·73]–11·88 to –3·58, very low ] in DBP, and –6·83]–10·85 to –2·81, very low ] in pulse ). Only four RCTs had long-term and short-term effects, and none had long-term effects.
Interpretation
Practitioners should monitor blood pressure and pulse in those who have ADHD who have been receiving any pharmacological treatment, but not just stimulants. Given the short duration of the available randomised controlled trials, longer-term studies that study the causal effects of ADHD medications on cardiovascular parameters should be funded.
Funding
National Institute for Research on Health and Care.
