Lancet Psychiatry
Most ADHD meds—not just stimulants—can have modest effects on BP and pulse
Study details: This systematic review and network meta-analysis evaluated the CV safety of various ADHD medications in children, adolescents, and adults. The study included 102 RCTs with a median follow-up of 7 weeks, comprising 13,315 children and adolescents and 9,387 adults. The primary outcomes were changes in systolic blood pressure (SBP), diastolic blood pressure (DBP), and pulse rate at timepoints closest to 12, 26, and 52 weeks.
Results: Amphetamines, atomoxetine, lisdexamfetamine, methylphenidate, and viloxazine were associated with increases in hemodynamic values in both children and adults. For example, in children and adolescents, methylphenidate increased SBP by 1.81 mm Hg and DBP by 2.42 mm Hg. In adults, amphetamines increased SBP by 2.3 mm Hg and DBP by 3.07 mm Hg. Regarding heart rate, atomoxetine was associated with the highest increase among children and adolescents (+5.58 bpm), while viloxazine was associated with the highest increase among adults (+5.8 bpm). Guanfacine, however, was associated with decreases in hemodynamic values in both age groups. The certainty of evidence varied, with many findings rated as low to very low confidence.
Clinical impact: The findings underscore the importance of monitoring BP and pulse in patients with ADHD receiving pharmacological treatment, not limited to stimulants. Given the short duration of available RCTs, authors call for long-term studies to better understand the CV effects of ADHD medications. Clinicians should weigh the benefits of ADHD medications against potential CV risks and consider individual patient profiles when prescribing these meds.
Source:
Farhat LC, et al. (2025, April 6). Lancet Psychiatry. Comparative cardiovascular safety of medications for attention-deficit hyperactivity disorder in children, adolescents, and adults: a systematic review and network meta-analysis. https://pubmed.ncbi.nlm.nih.gov/40203844/