ADHD Stimulant Raises Heart Rate and BP in Adolescents

NEW YORK (Reuters Health) - In adolescents with attention deficit hyperactivity disorder (ADHD), high-dose extended-release methylphenidate raises heart rate and blood pressure, say researchers from Massachusetts General Hospital in Boston.

"I would emphasize the possible moderators/mediators of cardiovascular outcomes, such as being more aware of pre-drug risk factors, such as high body-mass index (BMI) and borderline blood pressure," lead author Dr. Paul Hammerness told Reuters Health by email.

Dr. Hammerness and colleagues assessed the cardiovascular safety of daily methylphenidate doses of up to 1.5 mg/kg in 114 adolescents with ADHD, ages 12 to 18, followed for up to 6 months.

In the Journal of Pediatrics for July, they report that at 6 weeks, diastolic blood pressure and heart rate were slightly but significantly increased compared to baseline, whereas the increase in systolic blood pressure did not reach statistical significance.

By 6 months, the increase in systolic blood pressure had become significant, but the change in diastolic blood pressure from baseline was no longer significant.

Heart rate remained elevated at 6 months, but its change from baseline was not statistically significant.

During methylphenidate treatment, 8% of youngsters met the criteria for prehypertension and 6% met the criteria for hypertension. These patients had higher BMI than did the rest of the sample.

There were no significant ECG changes or serious adverse events during the study, the researchers note.
"We are planning additional studies in this area to examine cardiovascular outcomes in more detail," Dr. Hammerness said, adding that "clinicians have to be aware of the need for accurate and consistent blood pressure/heart rate monitoring."

J Pediatr 2009;155:84-89.
Monday, August 17, 2009
Reviewed by Aaron A. Gelfand, MD, FACOG, Clinical Assistant Professor, University of Medicine and Dentistry of New Jersey, Newark, NJ