ADHD Medication Use Associated With Increased Risk of Hypertension, Arterial Disease

A study in JAMA Psychiatry investigated the long-term cardiovascular impact of treatment with attention-deficit/hyperactivity disorder (ADHD) medications. The findings showed that use of these medications may be related to an increased risk of cardiovascular disease (CVD).

The study analyzed data from 278,027 individuals with ADHD in Sweden who were between the ages of 6 and 64 years. Data on ADHD medication prescriptions and CVD diagnoses were collected from the Swedish National Inpatient Register and the Swedish Prescribed Drug Register. CVD diagnoses collected were ischemic heart disease, cerebrovascular diseases, hypertension, heart failure, arrhythmias, thromboembolic disease, arterial disease, and other forms of heart disease. Cases with CVD were matched with up to 5 controls without CVD based on age, sex, and calendar time. Follow-up durations were similar between cases and controls.

Overall, 10,388 cases of CVD were identified in patients with a median age of 34.6 years. Fifty-nine percent of patients with CVD were male. These patients were matched with 51,672 controls. Median follow-up in both groups was 4.1 years.

Patients with a longer cumulative duration of ADHD medication use had an increased risk of CVD compared with patients who did not use these medications. The adjusted odds ratios [AORs] for risk of CVD per year of duration (compared with nonuse) were:

• 0 to ≤1 year: 0.99 (95% CI, 0.93-1.06)
• 1 to ≤2 years: 1.09 (95% CI, 1.01-1.18)
• 2 to ≤3 years: 1.15 (95% CI, 1.05-1.25)
• 3 to ≤5 years: 1.27 (95% CI, 1.17-1.39)
• >5 years: 1.23 (95% CI, 1.12-1.36)

Specifically, longer use of ADHD medication was associated with increased risk of hypertension and arterial disease. For hypertension, the AOR for use for 3 to 5 years was 1.72 (95% CI, 1.51-1.97), and for use for >5 years the AOR was 1.80 (95% CI, 1.55-2.08). For arterial disease, the AOR was 1.65 for 3 to ≤5 years of use (95% CI, 1.11-2.45) and 1.49 for >5 years (95% CI, 0.96-2.32).

“The results of this population-based case-control study with a longitudinal follow-up of 14 years suggested that long-term use of ADHD medication was associated with an increased risk of CVD, especially hypertension and arterial disease, and the risk was higher for stimulant medications,” the authors summarized. “These findings highlight the importance of carefully weighing potential benefits and risks when making treatment decisions on long-term ADHD medication use.”