COMMENTARY

Stimulants in ADHD: A Road to Hypertension?

Leslie Citrome, MD, MPH

Disclosures

June 19, 2012

Stimulant Medication Use in Children: A 12-Year Perspective

Zuvekas SH, Vitiello B
Am J Psychiatry. 2012;169:160-166

Blood Pressure and Heart Rate Over 10 Years in the Multimodal Treatment Study of Children With ADHD

Vitiello B, Elliott GR, Swanson JM, et al
Am J Psychiatry. 2012;169:167-177

ADHD Treatment in Children

The February 2012 issue of the American Journal of Psychiatry contains several articles about the use of stimulants and other aspects of attention-deficit/hyperactivity disorder (ADHD) in both children and adults. In one article, Zuvekas and Vitiello describe the increasing use of stimulants in children. In another, Vitiello and colleagues report a study of blood pressure and heart rate in children being treated for ADHD over a 10-year period.

Zuvekas and Vitiello examined the use of stimulant medications for treatment of ADHD in children using the 1996-2008 database of the Medical Expenditure Panel Survey, a nationally representative annual survey of US households. An estimated 3.5% of US children received stimulant medication in 2008, up from 2.4% in 1996. The increase was driven primarily by more stimulant prescriptions for adolescents.

Vitiello and colleagues examined the association between stimulant medication and blood pressure and heart rate over 10 years in 579 children, ages 7-9 years. The children were randomly assigned to 14 months of medication treatment, behavioral therapy, a combination of medication and behavioral therapy, or usual community treatment. This controlled trial was followed by naturalistic treatment with periodic assessments. No treatment effect on either systolic or diastolic blood pressure could be detected. At the end of the 14-month trial (but not thereafter), children who were treated with stimulants had higher mean heart rates (84.2 beats/min on medication alone and 84.6 beats/min on medication plus behavioral therapy) than those who were treated with behavioral therapy alone (79.1 beats/min) or those who received usual community treatment (78.9 beats/min). Stimulant medication did not increase the risk for tachycardia, but greater cumulative stimulant exposure was associated with a higher heart rate at years 3 and 8.

Viewpoint

Zuvekas and Vitiello observed that although overall use of stimulants in children has increased, there were differences depending on age group. Use has decreased in preschoolers but has increased in 13- to 18-year-olds, with rates now similar to those for 6- to 12-year-olds. Whether increased use of stimulant medication will ultimately yield a higher incidence and prevalence of hypertensive disease is a public health concern. Vitiello and colleagues concluded that stimulant treatment did not increase the risk for prehypertension or hypertension over a 10-year period of observation, but they did find that stimulants had a persistent adrenergic effect on heart rate during treatment. This latter effect can be deleterious for individuals with underlying cardiac abnormalities and is the subject of further long-term safety studies.

Abstract

Abstract

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