Photo Credit: istock.com/Tatiana Stepanishcheva

Cardiovascular safety risks associated with ADHD medications for children, adolescents, and adults were found to be relatively small, according to researchers.

ADHD medications are associated with only small increases in BP and heart rate in children and adolescents (aged 5 to 18 years) and adults (aged 18 years and older) after several weeks or months of use, according to Samuele Cortese MD, PhD, University of Southampton, and colleagues in a recent study published in The Lancet Psychiatry.¹

The team’s findings contributed valuable input to the ongoing discussion regarding the impact of ADHD medications on cardiovascular (CV) safety, reinforcing that CV risks associated with ADHD medications are relatively minor in the short term yet should continue to be monitored and researched.

Risk-Benefit Ratio Considerations

In a University of Southampton press release, Cortese emphasized that any medication’s benefits and risks should be considered concurrently: “We found an overall small increase in blood pressure and pulse for the majority of children taking ADHD medications. 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.”²

Methodology & Findings

The systematic review and network meta-analysis involved searching 12 electronic databases—including Cochrane CENTRAL, Embase, PubMed, and the WHO International Clinical Trials Registry Platform—from database inception to January 18, 2024, for published and unpublished randomized controlled trials comparing amphetamines, atomoxetine, bupropion, clonidine, guanfacine, lisdexamfetamine, methylphenidate, modafinil, or viloxazine with each other or placebo. Primary outcomes were change in systolic BP and diastolic BP, measured in millimeters of mercury, and pulse, measured in beats per minute, at timepoints closest to 12 weeks, 26 weeks, and 52 weeks. The analysis comprised 13,315 children and adolescents and 9,387 adults. Summary data were extracted and pooled in random-effects network meta-analyses.

The study found that all ADHD medications were generally associated with small effects on BP, heart rate, and ECG parameters. Guanfacine was the sole agent associated with a decrease in both BP and heart rate. In contrast, all other medications were linked to modest increases in these parameters. No significant differences were observed between stimulants and non-stimulants in terms of their effects on heart rate and BP.

Informing the Future

The study’s insights pave the way for continued research into the long-term implications and potential individual susceptibilities to CV side effects, ultimately guiding safer and more effective treatment strategies for patients with ADHD.

“Our findings should inform future clinical guidelines, stressing the need to systematically monitor blood pressure and heart rate, both for stimulants and non-stimulants,” said lead author Luis C. Farhat, PhD. “This should be particularly relevant for practitioners who might assume that only stimulants have a negative effect on the cardiovascular system.”²

The researchers urged clinicians to remain vigilant in monitoring BP and pulse in patients receiving any form of pharmacologic treatment for ADHD.¹

Cortese cautioned that “we cannot exclude that a subgroup of individuals may have a higher risk of more substantial cardiovascular alterations. 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.”