Abstract 13866: ADHD Stimulant Medication Use is Associated With Cardiac Autonomic Dysfunction and Arterial Stiffness in Children and Adolescents
Background: Stimulant medications are used as the primary treatment for attention deficit hyperactivity disorder (ADHD) among children and adolescents but little is known about their effects on cardiac autonomic regulation and arterial stiffness. We conducted a case-control study comparing cardiovascular health in youth with ADHD currently using stimulant medication to healthy controls.
Methods: Eighty-four children and adolescents (mean age 11.2 ± 2.8 years; 65 boys) using methylphenidate or amphetamine preparations and 53 siblings without ADHD (mean age 11.1 ± 3.8 years; 28 boys) were enrolled. Measured variables included blood pressure, heart rate, heart rate variability: standard deviation of the RR interval (SDRR) and low frequency to high frequency (LF:HF) ratio, carotid-radial pulse wave velocity, and carotid and radial artery augmentation index. Comparisons were evaluated using general estimating equations with an exchangeable working correlation structure for family clusters and adjusted for sex, race, and Tanner stage. Robust variance estimation was used for confidence intervals and P-values.
Results: Participants with ADHD vs. controls had higher systolic blood pressure (113 ± 11 vs. 109 ± 12 mmHg, p<0.01), diastolic blood pressure (61 ± 8 vs. 56 ± 8 mmHg, p<0.001), heart rate (84 ± 12 vs. 73 ± 11 beats/minute, p<0.001), LF:HF ratio (1.55 ± 1.31 vs. 1.03 ± 0.77, p<0.001), carotid artery augmentation index (2.71 ± 14.9 vs. -2.29 ± 16.6%, p<0.01), a trend toward higher pulse wave velocity (7.4 ± 1.2 vs. 7.1 ± 1.2 meters/second, p=0.09), and lower SDRR (0.07 ± 0.03 vs. 0.10 ± 0.04 seconds, p<0.001).
Conclusion: Children and adolescents being treated with stimulant medication for ADHD exhibit signs of cardiac autonomic dysfunction, characterized by increased sympathetic tone, and show evidence of arterial stiffening. The long-term significance of these findings, particularly whether the cardiovascular effects persist into adulthood, warrant further investigation.
- © 2013 by American Heart Association, Inc.