Experts discuss comprehensive treatment approaches including both medication and behavioral interventions.
Rates of ADHD medication use, particularly stimulants, have been rising in the United States, especially since the COVID-19 pandemic, with prescriptions for both stimulant and non-stimulant ADHD medications surging.
The rising frequency of ADHD medication prescription has prompted a renewed focus on their safety profiles. Recent research shows that all common treatments result in slight increases in blood pressure and heart rate. However, experts caution that these effects should be considered alongside the significant benefits these medications provide.
Increased Blood Pressure and Heart Rate
A comprehensive analysis published in The Lancet Psychiatry found that ADHD medications could increase or decrease blood pressure in patients.
Researchers analyzed data from more than 22,000 patients across 102 clinical trials, finding that stimulants and non-stimulants alike produced small cardiovascular changes.
The medications examined included stimulants like amphetamines, as well as nonstimulants such as atomoxetine (Axetra, Axepta, Attera, Tomoxetin, and Attentin), methylphenidate (Ritalin, Concerta, Delmosart, Equasym, Medikinet), and viloxazine (Qelbree), which are selective norepinephrine reuptake inhibitors (SNRIs). SNRIs work by hindering the reuptake of norepinephrine and serotonin in the brain.
SNRIs cause more norepinephrine and serotonin to remain in the brain to enhance focus and cognition. However, the elevated levels of norepinephrine may elevate sympathetic nervous system activity, thereby increasing blood pressure.
Among children and teens, systolic blood pressure rose by an average of 1.07 mmHg with atomoxetine, and 1.81 mmHg with methylphenidate. In adults, increases ranged from 1.66 mmHg with methylphenidate to 2.30 mmHg with amphetamines.
While these increases aren’t concerning on their own, especially in the context of a normal blood pressure reading, people who already have high blood pressure may experience further risks due to taking ADHD medications.
Guanfacine (Tenex, Intuniv), had the opposite effect. Since it can also be prescribed to reduce blood pressure, it lowered blood pressure and pulse rate in both groups, causing a drop of 2.83 mmHg in systolic blood pressure for children and a 10.10 mmHg decrease in adults.
