Blood Pressure Changes Associated With Medication Treatment of Adults With Attention-Deficit/Hyperactivity Disorder

Timothy E. Wilens, M.D.; Paul G. Hammerness, M.D.; Joseph Biederman, M.D.; Anne Kwon, M.S.; Thomas J. Spencer, M.D.; Sarah Clark, B.A.; Megan Scott, B.A.; Amy Podolski, B.A.; Jeffrey W. Ditterline, B.A.; Matthew C. Morris, B.A.; and Hadley Moore, B.A.

Objective: To evaluate the effects of medications used in the treatment of adults with attention-deficit/hyperactivity disorder (ADHD) on blood pressure and pulse.

Method: Subjects were those with DSM-III-R-/DSM-IV-diagnosed ADHD enrolled in placebo-controlled studies of 5 different medications for ADHD. Cardiovascular data from these studies of both stimulants (methylphenidate, amphetamine compounds, pemoline) and nonstimulants (bupropion, desipramine) were reanalyzed for baseline-to-endpoint active-treatment or placebo effects on blood pressure and heart rate.

Results: There were 125 subjects with a mean ± SD age of 39 ± 9 years. In general, active drug treatment for ADHD compared to baseline was associated with several statistically significant changes in systolic blood pressure (bupropion: +5.9 mm Hg, p < .05 by paired t test; amphetamine: +5.4 mm Hg, p < .05), diastolic blood pressure (desipramine: +7.1 mm Hg, p < .05), and heart rate (bupropion: +6.9 mm Hg, p < .05; amphetamine: +7.3 mm Hg, p < .05; methylphenidate: +4.5 mm Hg, p < .05). New-onset cases of systolic or diastolic hypertension (blood pressure >= 140/90) were recorded in 8% (7/89) of placebo-treated subjects and 10% (9/89) of subjects receiving active medication, regardless of the class (stimulant, nonstimulant).

Conclusion: Both stimulant and nonstimulant catecholaminergic medications used in adults with ADHD are associated with minor, but statistically significant, changes in heart rate and blood pressure that were often observed in those receiving placebo. Given the minor pressor and chronotropic effect of these medications, adults with ADHD should have their blood pressure and heart rate checked at baseline and periodically during treatment.

(J Clin Psychiatry 2005;66:253-259)

Received April 12, 2004; accepted July 20, 2004. From the Clinical Research Program in Pediatric Psychopharmacology, Massachusetts General Hospital (all authors), and the Department of Psychiatry, Harvard Medical School (Drs. Wilens, Hammerness, Spencer, and Biederman), Boston, Mass.

This article is supported by NIH grants RO1 DA 11929 and DA 14419 (Dr. Wilens).

Financial disclosure appears at the end of this article.

Corresponding author and reprints: Timothy E. Wilens, M.D., WACC 725, 15 Parkman Street, Boston, MA 02114(e-mail: twilens@partners.org).