Article Impact Level: HIGH Data Quality: STRONG Summary of The Lancet Psychiatry. https://doi.org/10.1016/S2215-0366(25)00062-8 Dr. Luis C. Farhat et al.
Points
- A systematic review and network meta-analysis of 102 RCTs evaluated the effects of various pharmacological treatments for ADHD on hemodynamic parameters in children, adolescents, and adults.
- The analysis showed that medications like amphetamines, atomoxetine, lisdexamfetamine, methylphenidate, and viloxazine increased systolic blood pressure, diastolic blood pressure, and pulse in both children and adults.
- Methylphenidate significantly increased systolic blood pressure, diastolic blood pressure, and pulse in children and adolescents, while amphetamines and methylphenidate led to smaller increases in adults.
- Guanfacine was associated with significant decreases in systolic, diastolic, and pulse in children and adults, with notable reductions in children and adolescents.
- The study emphasizes the need for careful cardiovascular monitoring in ADHD patients on pharmacological treatments. It highlights the importance of long-term studies to understand the effects of ADHD treatments on cardiovascular health.
Summary
This systematic review and network meta-analysis aimed to evaluate the effects of various pharmacological treatments for attention-deficit hyperactivity disorder (ADHD) on hemodynamic parameters, including systolic blood pressure (SBP), diastolic blood pressure (DBP), and pulse rate in children, adolescents, and adults. The study included 102 randomized controlled trials (RCTs) involving 13,315 children and adolescents (mean age 11 years) and 9,387 adults (mean age 35 years). The primary outcomes assessed were changes in SBP, DBP, and pulse at 12 weeks, 26 weeks, and 52 weeks. The results were pooled using random-effects network meta-analysis, and the certainty of the evidence was evaluated using the Confidence in Network Meta-Analysis (CINeMA) framework.
The analysis revealed that medications like amphetamines, atomoxetine, lisdexamfetamine, methylphenidate, and viloxazine increased hemodynamic values in both children and adults. In children and adolescents, methylphenidate led to a significant increase in SBP (mean difference 1.81, 95% CI 1.05–2.57), DBP (mean difference 2.42, 95% CI 1.69–3.15), and pulse (mean difference 5.58, 95% CI 4.67–6.49). In adults, amphetamines and methylphenidate also resulted in increases in SBP and DBP, but these increases were generally smaller compared to other medications. Guanfacine, on the other hand, was associated with decreases in SBP, DBP, and pulse in both groups, with significant reductions in children and adolescents (SBP: mean difference −2.83, 95% CI −3.8 to −1.85) and adults (SBP: mean difference −10.1, 95% CI −13.76 to −6.44).
The study highlights the need for careful monitoring of cardiovascular parameters in ADHD patients treated with pharmacological interventions, including stimulants. Despite the relatively short duration of the trials analyzed, the findings underscore the importance of conducting long-term studies to understand the causal effects of ADHD treatments on cardiovascular health.
Link to the article: https://www.sciencedirect.com/science/article/abs/pii/S2215036625000628
References Farhat, L. C., Lannes, A., Del Giovane, C., Parlatini, V., Garcia-Argibay, M., Ostinelli, E. G., … Cortese, S. (2025). Comparative cardiovascular safety of medications for attention-deficit hyperactivity disorder in children, adolescents, and adults: a systematic review and network meta-analysis. The Lancet Psychiatry. https://doi.org/10.1016/S2215-0366(25)00062-8
