Cardiovascular effects of stimulant and non-stimulant medication for children and adolescents with ADHD: A systematic review and meta-analysis of trials of methylphenidate, amphetamines and atomoxetine

Abstract

This article presents a review to evaluate potential cardiovascular effects of these treatments, the authors conducted a systematic review and meta-analysis of the effects of methylphenidate (MPH), amphetamines (AMP), and atomoxetine (ATX) on diastolic and systolic blood pressure (DBP, SBP) and heart rate (HR) in children and adolescents with attention deficit/hyperactivity disorder (ADHD). The authors conducted systematic searches in electronic databases (PsychINFO, EMBASE and Medline) to identify published trials which involved individuals who were (i) diagnosed with ADHD and were aged between 0–18 years; (ii) treated with MPH, AMP or ATX and (iii ) had their DBP and SBP and/or HR measured at baseline (pre) and the endpoint (post) of the study treatment. Eighteen clinical trials met the inclusion criteria (10 for MPH, 5 for AMP, and 7 for ATX) with data from 5837 participants (80.7% boys) and average duration of 28.7 weeks (range 4–96 weeks). Statistically significant pre–post increases of SBP, DBP and HR were associated with AMP and ATX treatment in children and adolescents with ADHD, while MPH treatment had a statistically significant effect only on SBP in these patients. These increases may be clinically significant for a significant minority of individuals that experience larger increases. Since increased BP and HR in general are considered risk factors for cardiovascular morbidity and mortality during adult life, pediatric patients using ADHD medication should be monitored closely and regularly for HR and BP. (PsycINFO Database Record (c) 2017 APA, all rights reserved)