Blood Pressure Changes Associated With Medication Treatment of Adults With Attention-Deficit/Hyperactivity Disorder

Wilens, Timothy E.; Hammerness, Paul; Biederman, Joseph; Kwon, Anne; Spencer, Thomas; Clark, Sarah L.; Scott, Megan; Podolski, Amy; Ditterline, Jeffrey W.; Morris, Matthew C.; Moore, Hadley

doi:10.4088/jcp.v66n0215

Cited by 128 publications

(63 citation statements)

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“…133,134 ADHD studies in children have shown no significant ECG or vital sign changes with bupropion, 135 whereas significant increases in systolic and diastolic blood pressures have been reported in ADHD adults. 136 No significant cardiovascular effects have been reported in healthy volunteers, 137 although cardiovascular changes have been noted in patients with major depression. In a prospective safety surveillance study of 3100 patients treated with sustained-release bupropion for major depression, 3 patients, each with a preexisting cardiovascular pathology, suffered a myocardial infarction, 2 resulting in death.…”

Section: Other Pharmacological Treatment Of Adhdmentioning

confidence: 99%

Cardiovascular Monitoring of Children and Adolescents With Heart Disease Receiving Medications for Attention Deficit/Hyperactivity Disorder

Vetter¹,

Elia²,

Erickson³

et al. 2008

Circulation

265

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Section: Other Pharmacological Treatment Of Adhdmentioning

confidence: 99%

Cardiovascular Monitoring of Children and Adolescents With Heart Disease Receiving Medications for Attention Deficit/Hyperactivity Disorder

Vetter¹,

Elia²,

Erickson³

et al. 2008

Circulation

265

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“…Ballard et al found a mean 6 mmHg rise in blood pressure in response to a dose of methylphenidate as compared to placebo, with a range from 22 mmHg to 4 mmHg [6]. A recent study summarizing placebo-controlled trials of ADHD medications in adults found significant elevations in blood pressure for both stimulant and non-stimulant medication classes [13]. These relative increases in blood pressure are well within the range that could cause a previously normotensive child to become hypertensive and potentially lead to future cardiovascular morbidity and mortality.…”

Section: Discussionmentioning

confidence: 96%

Effect of stimulants on 24-h ambulatory blood pressure in children with ADHD: a double-blind, randomized, cross-over trial

et al. 2005

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Millions of children with attention deficit hyperactivity disorder (ADHD) are treated with stimulant medications. To evaluate cardiovascular risk, 24-h ambulatory blood pressure monitoring (ABPM) was performed on and off medication. Thirteen subjects underwent APBM both on stimulant therapy and placebo using a placebo-controlled, double-blind, randomized, cross-over design. After a 3-day run-in followed by a 24-h monitoring period, subjects crossed over to the alternate therapy for repeated ABPM. Subjects demonstrated elevations in most hemodynamic parameters derived from ABPM during the active treatment period. Total diastolic blood pressure (69.7 mmHg vs 65.8 mmHg, p =0.02) and waking diastolic blood pressure (75.5 mmHg vs 72.3 mmHg, p =0.03) were significantly higher during active treatment. Total heart rate was also significantly higher during active treatment (85.5 beats/min vs 79.9 beats/min, p =0.004). The rate-pressure product (the product of systolic blood pressure x heart rate), an index of myocardial oxygen demand, was higher during active treatment (9,958 vs 9,076, p =0.008). This study provides evidence for a possible negative cardiovascular effect of stimulant medications in children with ADHD. This potential cardiovascular risk should be balanced against the beneficial behavioral effects of this class of medication.

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“…Heart rate increases by 1-3 beats per minute (bpm) up to [50 bpm in extreme cases [81,82]. Similar effect sizes have been reported for treated adult ADHD subjects [80,83]. A post hoc analysis [84] of the Multimodal Treatment Study of Children with ADHD (MTA) trial [85] investigated blood pressure and heart rate data from the 10-year follow-up of a 14-month-long treatment period with stimulants (MPH accounted for 85 %).…”

Section: Cardiovascular Studiesmentioning

confidence: 51%

Assessment of potential cardiovascular risks of methylphenidate in comparison with sibutramine: do we need a SCOUT (trial)?

Antel

Albayrak

Heusch³

et al. 2014

Eur Arch Psychiatry Clin Neurosci

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With the recent approval of methylphenidate (MPH) for treating attention-deficit/hyperactivity disorder (ADHD) in adults, the number of patients exposed will increase tremendously. The ongoing debate on the cardiovascular safety of MPH has triggered two large retrospective cohort studies in children and adolescents as well as in young to middle-aged adults. These studies looked into serious cardiovascular events (sudden cardiac death, acute myocardial infarction and stroke) as primary endpoints and concluded that MPH was safe after a mean duration of 2.1 years of follow-up in children and adolescents and mean duration of 0.33 years of current use in adults. The results are encouraging with respect to the short- and medium-term use of MPH. Without the inherent limitations of retrospective cohort studies, a prospective randomized, double-blind, placebo-controlled, multicenter trial in individuals stratified for cardiovascular risk factors would allow for an optimized risk assessment. With many millions of patients treated per year and drawing parallels to the lately discovered risks of sibutramine, another sympathomimetic with an overlapping mode of action and similar side effects on heart rate and blood pressure, we hypothesize that such a trial might be a dedicated risk mitigation strategy for public health. A critical assessment of cardiovascular side effects of MPH appears particularly warranted, because ADHD is associated with obesity, smoking and poor health in general. We summarize recent findings with the focus on cardiovascular risks of MPH in humans; we additionally analyze the limited number of rodent studies that have addressed cardiovascular risks of MPH.

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Blood Pressure Changes Associated With Medication Treatment of Adults With Attention-Deficit/Hyperactivity Disorder

Cited by 128 publications

References 0 publications

Cardiovascular Monitoring of Children and Adolescents With Heart Disease Receiving Medications for Attention Deficit/Hyperactivity Disorder

Cardiovascular Monitoring of Children and Adolescents With Heart Disease Receiving Medications for Attention Deficit/Hyperactivity Disorder

Effect of stimulants on 24-h ambulatory blood pressure in children with ADHD: a double-blind, randomized, cross-over trial

Assessment of potential cardiovascular risks of methylphenidate in comparison with sibutramine: do we need a SCOUT (trial)?

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