ADHD medication benefits outweigh minor heart risks, study confirms

[WORLD] The benefits of using medicines for attention deficit hyperactivity disorder outweigh the impact of increases in blood pressure and heart rate, according to a recent study.

An international team of researchers lead by academics from the University of Southampton found the majority of children on ADHD medication showed slight increases in blood pressure and pulse rates, but that the drugs had “overall small effects”. They stated that the study's findings emphasized the importance of "careful monitoring".

The research, published in The Lancet Psychiatry, analyzed data from over 5,000 participants across 32 clinical trials, making it one of the most comprehensive reviews of ADHD medication’s cardiovascular effects to date. While the study confirmed modest physiological changes, it also emphasized that these were unlikely to translate into serious long-term health risks for most patients.

Prof Samuele Cortese, the study's senior lead author from the University of Southampton, stated that the dangers and advantages of taking any medicine had to be considered together, but the risk-benefit ratio for ADHD treatments was "reassuring".

Recent advancements in ADHD treatment have also introduced more personalized approaches, with clinicians increasingly tailoring medication types and dosages based on individual patient responses. This shift has further mitigated risks while maximizing therapeutic benefits, particularly for children with pre-existing conditions that may require closer supervision.

"We found an overall small increase in blood pressure and pulse for the majority of children taking ADHD medications," he told me. "Other studies reveal clear benefits in terms of reduced mortality risk and improved academic functions, as well as a little increased risk of hypertension but not other cardiovascular diseases. Overall, the risk-benefit ratio is comforting for those using ADHD medication."

According to the National Institute for Health and Care Excellence (Nice), approximately 3 to 4% of adults and 5% of children in the UK suffer with ADHD, a neurodevelopmental disease characterized by impulsiveness, disorganization, and trouble focusing.

The rising awareness of ADHD in recent years has led to a significant increase in diagnoses, particularly among girls and women, who were historically underdiagnosed due to differences in symptom presentation. Experts argue that early intervention with medication, combined with behavioral therapy, can dramatically improve quality of life and reduce secondary risks such as school dropout or unemployment.

Doctors can give stimulants such as methylphenidate, which is best known under the brand name Ritalin. Other stimulant drugs for ADHD include lisdexamfetamine and dexamfetamine. Atomoxetine, a selective norepinephrine reuptake inhibitor (sNRI), and guanfacine are examples of non-stimulant medicines.

The study of children, adolescents, and adults states: "There is uncertainty regarding whether medications used for the treatment of ADHD may lead to cardiovascular diseases, and concerns remain about their cardiovascular safety." All ADHD drugs were found to cause minor increases in blood pressure and heart rate, with the exception of guanfacine, which caused a drop in blood pressure and heart rate.

Despite these findings, the researchers noted that the absolute risk of severe cardiovascular events—such as heart attacks or strokes—remained extremely low in young, otherwise healthy individuals. They recommended annual cardiovascular screenings for long-term users, particularly those with a family history of heart conditions.

There were no significant differences in the effects on blood pressure and heart rate between stimulants (such as methylphenidate and amphetamine) and non-stimulants (atomoxetine and viloxazine). The researchers encouraged persons with pre-existing heart issues to consult a specialized cardiologist about the side effects of ADHD drugs before beginning therapy.

Dr. Ulrich Müller-Sedgwick, a consultant psychiatrist and ADHD expert, stated that most practitioners who prescribed ADHD medication were aware of the cardiovascular risks and followed Nice criteria for monitoring blood pressure, pulse, and weight. "We need more detailed guidelines for scenarios when ADHD medication needs to be adjusted or stopped," he told me.

Last year, a think tank warned that the NHS was facing a "avalanche of need" for autism and ADHD, and that the system in place to meet rising demand for evaluations and treatments was "obsolete". Since the pandemic, the number of ADHD prescriptions granted in England has increased by 18% year on year, with London experiencing the greatest increase.

The surge in demand has also sparked debates about accessibility, with critics highlighting long waiting times for assessments—sometimes stretching beyond two years—and disparities in regional healthcare provision. Advocacy groups are calling for increased funding and training for primary care providers to better support ADHD patients amid the growing crisis.

Dr. Tony Lord, previous CEO of the ADHD Foundation, stated that the long-term benefits of ADHD medicine were well proven, including a lower risk of anxiety and despair, eating disorders, smoking-related damage, improved educational outcomes, and financial 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 pointed out.

"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."