Blood pressure changes associated with medication treatment of adults with attention-deficit/hyperactivity disorder.
OBJECTIVE
To evaluate the effects of medications used in the treatment of adults with attention-deficit/hyperactivity disorder (ADHD) on blood pressure and pulse.


METHODS
Subjects were those with DSM-III-R-/DSM-IV-diagnosed ADHD enrolled in placebo-controlled studies of 5 different medications for ADHD. Cardiovascular data from these studies of both stimulants (methylphenidate, amphetamine compounds, pemoline) and nonstimulants (bupropion, desipramine) were reanalyzed for baseline-to-endpoint active-treatment or placebo effects on blood pressure and heart rate.


RESULTS
There were 125 subjects with a mean +/- SD age of 39 +/- 9 years. In general, active drug treatment for ADHD compared to baseline was associated with several statistically significant changes in systolic blood pressure (bupropion: +5.9 mm Hg, p < .05 by paired t test; amphetamine: +5.4 mm Hg, p < .05), diastolic blood pressure (desipramine: +7.1 mm Hg, p < .05), and heart rate (bupropion: +6.9 mm Hg, p < .05; amphetamine: +7.3 mm Hg, p < .05; methylphenidate: +4.5 mm Hg, p < .05). New-onset cases of systolic or diastolic hypertension (blood pressure > or = 140/90) were recorded in 8% (7/89) of placebo-treated subjects and 10% (9/89) of subjects receiving active medication, regardless of the class (stimulant, nonstimulant).


CONCLUSIONS
Both stimulant and nonstimulant catecholaminergic medications used in adults with ADHD are associated with minor, but statistically significant, changes in heart rate and blood pressure that were often observed in those receiving placebo. Given the minor pressor and chronotropic effect of these medications, adults with ADHD should have their blood pressure and heart rate checked at baseline and periodically during treatment.
Wilens
Timothy E
TE
Clinical Research Program in Pediatric Psychopharmacology, Massachusetts General Hospital, Boston, MA 02114, USA. twilens@partners.org
Hammerness
Paul G
PG
Biederman
Joseph
J
Kwon
Anne
A
Spencer
Thomas J
TJ
Clark
Sarah
S
Scott
Megan
M
Podolski
Amy
A
Ditterline
Jeffrey W
JW
Morris
Matthew C
MC
Moore
Hadley
H
D000328:Adult; D000662:Amphetamines / Q000009:adverse effects / Q000627:therapeutic use; D000928:Antidepressive Agents / Q000009:adverse effects / Q000627:therapeutic use*; D001289:Attention Deficit Disorder with Hyperactivity / Q000188:drug therapy* / Q000503:physiopathology; D001794:Blood Pressure / Q000187:drug effects* / Q000502:physiology; D016642:Bupropion / Q000009:adverse effects / Q000627:therapeutic use; D000697:Central Nervous System Stimulants / Q000009:adverse effects / Q000627:therapeutic use*; D018592:Cross-Over Studies; D003891:Desipramine / Q000009:adverse effects / Q000627:therapeutic use; D005260:Female; D006339:Heart Rate / Q000187:drug effects / Q000502:physiology; D006801:Humans; D006973:Hypertension / Q000139:chemically induced; D008297:Male; D008774:Methylphenidate / Q000009:adverse effects / Q000627:therapeutic use; D008875:Middle Aged; D010389:Pemoline / Q000009:adverse effects / Q000627:therapeutic use; D010919:Placebos; D017410:Practice Guidelines as Topic
D000662:Amphetamines; D000928:Antidepressive Agents; D000697:Central Nervous System Stimulants; D010919:Placebos; D016642:Bupropion; D008774:Methylphenidate; D010389:Pemoline; D003891:Desipramine