People taking ADHD drugs – children, adults and adolescents – showed minimal increases in blood pressure and pulse rates, with the “risk-benefit ratio” being “reassuring”, according to a recent international study.
The study team said the benefits of taking drugs for attention deficit hyperactivity disorder outweighed the impact of increases in blood pressure and heart rate, reports The Guardian.
The international team of researchers, led by scientists from the University of Southampton, found the majority of children taking ADHD medication experienced small increases in blood pressure and pulse rates, but that the drugs had “overall small effects”.
They said the study’s findings highlighted the need for “careful monitoring”.
Professor Samuele Cortese, senior lead author of the study from the University of Southampton, said the risks and benefits of taking any medication had to be assessed together, but for ADHD drugs the risk-benefit ratio was “reassuring”.
“Other studies show clear benefits in terms of reductions in mortality risk and improvement in academic functions, as well as a small increased risk of hypertension, but not other cardiovascular diseases. Overall, the risk-benefit ratio is reassuring.”
About 3% to 4% of adults and 5% of children in the UK are believed to have ADHD, according to the National Institute for Health and Care Excellence (Nice).
Doctors can prescribe stimulants, such as methylphenidate, of which the best-known brand is Ritalin, while other stimulant medications used to treat ADHD include lisdexamfetamine and dexamfetamine. Non-stimulant drugs include atomoxetine, an sNRI (selective norepinephrine reuptake inhibitor), and guanfacine.
The study of children, adolescents and adults, published in The Lancet Psychiatry, states: “There is uncertainty regarding whether medications that are used for the treatment of ADHD may lead to cardiovascular diseases, and concerns remain around their cardiovascular safety.”
It found all ADHD medications were associated with small increases of blood pressure and heart rate, except guanfacine, which led to decreased blood pressure and heart rate.
There were no significant differences regarding the impact on blood pressure and heart rate between stimulants (including methylphenidate and amphetamine) and non-stimulants (atomoxetine and viloxazine).
The researchers advised people with existing heart conditions to discuss the side effects of ADHD medications with a specialist cardiologist before starting treatment.
Dr Ulrich Müller-Sedgwick, a consultant psychiatrist and expert on ADHD, said most clinicians prescribing ADHD medication understood the cardiovascular risks and followed Nice guidelines for monitoring blood pressure, pulse and weight. “We need more detailed guidelines for scenarios when ADHD medication needs to be adjusted or stopped,” he said.
Last year, a think-tank warned that the NHS was experiencing an “avalanche of need” over autism and ADHD, and said the system in place to cope with surging demand for assessments and treatments was “obsolete”.
The number of prescriptions issued in England for ADHD medication has risen by 18% year on year since the pandemic, with the biggest rise in London.
Dr Tony Lloyd, a former chief executive of the ADHD Foundation, said the long-term benefits of ADHD medication were well established, and included a reduced risk of anxiety and depression, eating disorders, harm from smoking, improved educational outcomes and economic independence.
“Sadly, ignorance about ADHD medications persists – a throwback to the 80s and 90s when ADHD medications were mistakenly viewed as a morality pill that made naughty, fidgety disruptive children behave – which of course it is not,” he said.
“It is simply a cognitive enhancer that improves information processing, inhibits distractions, improves focus, planning and prioritising, self monitoring and reduces impulsivity of thought and action.”
Study details
Comparative cardiovascular safety of medications for attention-deficit hyperactivity disorder in children, adolescents, and adults: a systematic review and network meta-analysis
Luis C Farhat, Alice Lannes, Cinzia Del Giovane et al.
Published in The Lancet Psychiatry on 6 April 2025
Summary
Background
Concerns about the cardiovascular safety of medications used for the treatment of attention-deficit hyperactivity disorder (ADHD) remain. We aimed to compare the effects of pharmacological treatments for ADHD on haemodynamic values and electrocardiogram (ECG) parameters in children, adolescents, and adults.
Methods
For this systematic review and network meta-analysis, we searched 12 electronic databases, including Cochrane CENTRAL, Embase, PubMed, and the WHO International Clinical Trials Registry Platform, from database inception to Jan 18, 2024, for published and unpublished randomised controlled trials comparing amphetamines, atomoxetine, bupropion, clonidine, guanfacine, lisdexamfetamine, methylphenidate, modafinil, or viloxazine against each other or placebo. Primary outcomes were change in systolic blood pressure (SBP) and diastolic blood pressure (DBP), measured in mm Hg, and pulse, measured in beats per minute, at timepoints closest to 12 weeks, 26 weeks, and 52 weeks. Summary data were extracted and pooled in random-effects network meta-analyses. Certainty of evidence was assessed with the Confidence in Network Meta-Analysis (CINeMA) framework. This study was registered with PROSPERO, CRD42021295352. Before study initiation, we contacted representatives of a UK-based charity of people with lived experience of ADHD – the ADHD Foundation – regarding the relevance of the topic and the appropriateness of the outcomes chosen.
Findings
A total of 102 randomised controlled trials with short-term follow-up (median 7 weeks [IQR 5–9]) were included, encompassing 13 315 children and adolescents (aged ≥5 years and <18 years; mean age 11 years [SD 3]; of available data, 9635 [73%] were male and 3646 [27%] were female; of available data, 289 [2%] were Asian, 1719 [15%] were black, and 8303 [71%] were white) and 9387 adults (≥18 years, mean age 35 years [11]; of available data, 5064 [57%] were male and 3809 [43%] were female; of available data, 488 [6%] were Asian, 457 [6%] were black, and 6372 [79%] were white). Amphetamines, atomoxetine, lisdexamfetamine, methylphenidate, and viloxazine led to increments in haemodynamic values in children and adolescents, adults, or both. In children and adolescents, mean increase against placebo ranged from 1·07 (95% CI 0·36–1·79; moderate CINeMA confidence) with atomoxetine to 1·81 (1·05–2·57; moderate) with methylphenidate for SBP; from 1·93 (0·74–3·11; high) with amphetamines to 2·42 (1·69–3·15; low) with methylphenidate for DBP; and from 2·79 (1·05–4·53; moderate) with viloxazine to 5·58 (4·67–6·49; high) with atomoxetine for pulse. In adults, mean increase against placebo ranged from 1·66 (95% CI 0·38–2·93; very low) with methylphenidate to 2·3 (0·66–3·94; very low) with amphetamines for SBP; from 1·60 (0·29–2·91; very low) with methylphenidate to 3·07 (0·69–5·45; very low) with lisdexamfetamine for DBP; and from 4·37 (3·16–5·59; very low) with methylphenidate to 5·8 (2·3–9·3; very low) with viloxazine for pulse. Amphetamines, lisdexamfetamine, or methylphenidate were not associated with larger increments in haemodynamic values compared with atomoxetine or viloxazine in either children and adolescents or adults. Guanfacine was associated with decrements in haemodynamic values in children and adolescents (mean decrease against placebo of –2·83 [95% CI –3·8 to –1·85; low CINeMA confidence] in SBP, –2·08 [–3 to –1·17; low] in DBP, and –4·06 [–5·45 –2·68; moderate] in pulse) and adults (mean decrease against placebo of –10·1 [–13·76 to –6·44; very low] in SBP, –7·73 [–11·88 to –3·58; very low] in DBP, and –6·83 [–10·85 to –2·81; very low] in pulse). Only four RCTs informed on effects in the medium term and none on the long term.
Interpretation
Practitioners should monitor blood pressure and pulse in patients with ADHD treated with any pharmacological intervention, and not stimulants only. Given the short duration of available randomised controlled trials, new research providing insights on the causal effects of ADHD medications on cardiovascular parameters in the longer term should be funded.
The Guardian article – Benefits of ADHD medication outweigh health risks, study finds (Open access)
See more from MedicalBrief archives:
ADHD scripts in England up by 18% each year since pandemic
No conclusive CVD risk link to ADHD medicines – Swedish meta-analysis