title: Cardiac autonomic dysfunction and arterial stiffness among children and adolescents with attention deficit hyperactivity disorder treated with stimulants.
abstract: OBJECTIVE
  To compare markers of cardiovascular health in youth diagnosed with attention deficit hyperactivity disorder (ADHD) by the use of stimulant medication with healthy controls.
  
  
  METHODS
  Children and adolescents (n = 85; mean age 11.2 ± 2.8 years; 66 boys) diagnosed with ADHD using a stimulant and 53 siblings without ADHD (mean age 11.1 ± 3.8 years; 28 boys) were included in this cross-sectional study. Measured variables included blood pressure, heart rate (HR), HR variability: SD of the RR interval and low frequency to high frequency ratio, carotid-radial pulse wave velocity, carotid artery augmentation index (AIx), radial artery AIx, brachial artery flow-mediated dilation, and digital reactive hyperemic index.
  
  
  RESULTS
  Compared with control patients, participants with ADHD had greater resting systolic blood pressure (3.9 mm Hg, 95% CI [1.2-6.7], P = .005), diastolic blood pressure (5.5 mm Hg, 95% CI [3.2-7.8], P < .001), HR (9.2 beats/min, 95% CI [6.0-12.3], P < .001), low frequency to high frequency ratio (0.55, 95% CI [0.22-0.89], P = .001), carotid AIx (7.2%, 95% CI [1.9-12.5], P = .008), and pulse wave velocity (0.36 m/s, 95% CI [-0.05, 0.78], P = .089), and lower SD of the RR interval (-33.7 milliseconds, 95% CI [-46.1, -21.3], P < .001). Neither flow-mediated dilation nor reactive hyperemic index was significantly different.
  
  
  CONCLUSIONS
  Children and adolescents being treated with a stimulant medication for ADHD exhibited signs of altered cardiac autonomic function, characterized by increased sympathetic tone, and showed evidence of arterial stiffening.
authors.affiliation: Department of Pediatrics, University of Minnesota Medical School, and University of Minnesota Children's Hospital, Minneapolis, MN; Department of Medicine, University of Minnesota Medical School, Minneapolis, MN. Electronic address: kelly105@umn.edu.
authors.forename: Aaron S
authors.initials: AS
authors.lastname: Kelly
authors.affiliation: Division of Biostatistics, School of Public Health and Clinical and Translational Science Institute, University of Minnesota, Minneapolis, MN.
authors.forename: Kyle D
authors.initials: KD
authors.lastname: Rudser
authors.affiliation: School of Kinesiology, University of Minnesota, Minneapolis, MN.
authors.forename: Donald R
authors.initials: DR
authors.lastname: Dengel
authors.affiliation: ZOLL Medical Corporation, Chelmsford, MA.
authors.forename: Christopher L
authors.initials: CL
authors.lastname: Kaufman
authors.affiliation: Department of Pediatrics, University of Minnesota Medical School, and University of Minnesota Children's Hospital, Minneapolis, MN.
authors.forename: Michael I
authors.initials: MI
authors.lastname: Reiff
authors.affiliation: Department of Pediatrics, University of Minnesota Medical School, and University of Minnesota Children's Hospital, Minneapolis, MN.
authors.forename: Anne L
authors.initials: AL
authors.lastname: Norris
authors.affiliation: Department of Pediatrics, University of Minnesota Medical School, and University of Minnesota Children's Hospital, Minneapolis, MN.
authors.forename: Andrea M
authors.initials: AM
authors.lastname: Metzig
authors.affiliation: Department of Pediatrics, University of Minnesota Medical School, and University of Minnesota Children's Hospital, Minneapolis, MN.
authors.forename: Julia
authors.initials: J
authors.lastname: Steinberger
mesh_terms: D000293:Adolescent; D001289:Attention Deficit Disorder with Hyperactivity / Q000150:complications / Q000188:drug therapy*; D001341:Autonomic Nervous System / Q000473:pathology; D001783:Blood Flow Velocity; D001794:Blood Pressure; D001916:Brachial Artery / Q000473:pathology; D002318:Cardiovascular Diseases / Q000150:complications / Q000503:physiopathology*; D002339:Carotid Arteries / Q000473:pathology; D016022:Case-Control Studies; D000697:Central Nervous System Stimulants / Q000627:therapeutic use*; D002648:Child; D003430:Cross-Sectional Studies; D005260:Female; D006339:Heart Rate; D006801:Humans; D008297:Male; D063177:Pulse Wave Analysis; D035781:Siblings; D059289:Vascular Stiffness
chemical_list: D000697:Central Nervous System Stimulants