title: Attention deficit-hyperactivity disorder is associated with reduced blood pressure and serum vitamin D levels: results from the nationwide German Health Interview and Examination Survey for Children and Adolescents (KiGGS).
abstract: Alterations in blood pressure in attention-deficit/hyperactivity disorder (ADHD), specifically during dopaminergic stimulant intake, are not fully understood. It has been reported that vitamin D deficiency might modify dopaminergic pathways and thus influence ADHD symptoms. Using data from the nationwide German Health Interview and Examination Survey for Children and Adolescents (KiGGS) study, we compared blood pressure and vitamin D levels in healthy controls to both diagnosed ADHD patients and suspected ADHD subjects, as defined by a value of ≥7 on the hyperactivity-inattention subscale of the Strengths and Difficulties Questionnaire. In a total cohort of n = 6922 study participants aged 11-17 years, mean arterial blood pressure was significantly higher in controls (86.7 ± 8.2 mmHg) than in the two groups of confirmed (85.5 ± 7.8 mmHg, p = 0.004, n = 430) and suspected ADHD patients (84.6 ± 8.2, p < 0.001, n = 399). In addition, we found an inverse association between vitamin D and blood pressure in both ADHD groups (p < 0.003). Regression analyses adjusted for age, sex, body-mass index, psychotropic medication use, and serum vitamin D levels confirmed that low blood pressure was a significant and independent predictor of ADHD. Furthermore, we observed that vitamin D mediated the effect of systolic blood pressure on ADHD diagnosis (b = 0.007, 95 % confidence interval [CI] 0.001-0.013, p = 0.021, R2= 0.050). In a large and representative national sample of German adolescents, we found a significant association between low blood pressure and ADHD symptoms. In addition, we observed that circulating vitamin D mediated the inverse relation between blood pressure and ADHD, although the effect size was very low. These findings highlight the role of dysregulated pathways of the autonomic nervous system in ADHD.
authors.affiliation: Department of Psychosomatic Medicine and Psychotherapy, University of Göttingen Medical Centre, Göttingen, Germany. thomas.meyer@med.uni-goettingen.de.|Department of Psychosomatic Medicine and Psychotherapy, and German Centre for Cardiovascular Research, University of Göttingen, Von-Siebold-Str. 5, Göttingen, Germany. thomas.meyer@med.uni-goettingen.de.
authors.forename: Thomas
authors.initials: T
authors.lastname: Meyer
authors.affiliation: Department of Child and Adolescent Psychiatry and Psychotherapy, University of Göttingen Medical Centre, Göttingen, Germany.
authors.forename: Andreas
authors.initials: A
authors.lastname: Becker
authors.affiliation: Department of Psychosomatic Medicine and Psychotherapy, University of Göttingen Medical Centre, Göttingen, Germany.
authors.forename: Jessika
authors.initials: J
authors.lastname: Sundermann
authors.affiliation: Department of Child and Adolescent Psychiatry and Psychotherapy, University of Göttingen Medical Centre, Göttingen, Germany.
authors.forename: Aribert
authors.initials: A
authors.lastname: Rothenberger
authors.affiliation: Department of Psychosomatic Medicine and Psychotherapy, University of Göttingen Medical Centre, Göttingen, Germany.|Department of Psychosomatic Medicine and Psychotherapy, and German Centre for Cardiovascular Research, University of Göttingen, Von-Siebold-Str. 5, Göttingen, Germany.
authors.forename: Christoph
authors.initials: C
authors.lastname: Herrmann-Lingen
mesh_terms: D000293:Adolescent; D001289:Attention Deficit Disorder with Hyperactivity / Q000097:blood / Q000150:complications / Q000175:diagnosis*; D001341:Autonomic Nervous System / Q000187:drug effects; D001794:Blood Pressure / Q000502:physiology*; D016022:Case-Control Studies; D002648:Child; D005260:Female; D005858:Germany; D006306:Health Surveys; D006801:Humans; D008297:Male; D011237:Predictive Value of Tests; D012044:Regression Analysis; D014807:Vitamin D / Q000097:blood*; D014808:Vitamin D Deficiency / Q000097:blood* / Q000150:complications*
chemical_list: D014807:Vitamin D
keywords: Attention-deficit hyperactivity disorder; Blood pressure; Vitamin D