CONCERNS around the cardiovascular safety of ADHD medications are persistent, particularly for stimulant-based treatments. However, a recent study suggested that these risks may extend across a broader range of pharmacological options. The study revealed statistically significant increases in blood pressure and pulse across several commonly prescribed ADHD drugs—not just stimulants. A key finding was that all medications studied, including atomoxetine and viloxazine, were associated with measurable haemodynamic changes.
The analysis included children and adolescents (mean age 11 years; n=13,315), and adults (mean age 35 years; n=9,387), with a median follow-up of 7 weeks. The study compared nine medications with each other and placebo. In children and adolescents, systolic blood pressure (SBP) rose by up to 1.81 mm Hg; 95% CI: 1.05–2.57 with methylphenidate and 1.07 mm Hg; 95% CI: 0.36–1.79 with atomoxetine. Diastolic blood pressure (DBP) increased most with methylphenidate (2.42 mm Hg; 95% CI: 1.69–3.15), while amphetamines raised it by 1.93 mm Hg; 95% CI: 0.74–3.11. Additionally, pulse rose by 5.58 bpm; 95% CI: 4.67–6.49 with atomoxetine and 2.79 bpm; 95% CI: 1.05–4.53 with viloxazine. Adults showed similar patterns: SBP increased by 2.3 mm Hg; 95% CI: 0.66–3.94 with amphetamines and 1.66 mm Hg; 95% CI: 0.38–2.93 with methylphenidate. DBP rose by up to 3.07 mm Hg; 95% CI: 0.69–5.45 with lisdexamfetamine and 1.60 mm Hg; 95% CI: 0.29–2.91. Pulse increases ranged from 4.37 bpm; 95% CI: 3.16–5.59 with methylphenidate to 5.8 bpm; 95% CI: 2.3–9.3 with viloxazine. Guanfacine was unique in consistently lowering cardiovascular values, with reductions in SBP reaching –10.1 mm Hg; 95% CI: –13.76––6.44 in adults, –2.83; 95% CI: –3.8––1.85 in children. Researchers also saw reductions in DBP in adults (–7.73; 95% CI: –11.88––3.58) and children (–2.08; 95% CI: –3.0––1.17), and pulse in adults (–6.83 bpm; 95% CI: –10.85––2.81) and children (–4.06; 95% CI: –5.45––2.68).
While the absolute changes were modest, they may be clinically relevant in patients with pre-existing cardiovascular risks. Limitations of the study include the fact that evidence base was predominantly short-term and varied in certainty, with most adult data rated as very low confidence, and no long-term randomised data were available. These limitations highlight the need for extended follow-up trials to better assess causality and long-term risk.
Reference
Farhat LC et al. Comparative cardiovascular safety of medications for attention-deficit hyperactivity disorder in children, adolescents, and adults: a systematic review and network meta-analysis. Lancet Psychiatry. 2025;DOI: 10.1016/S2215-0366(25)00062-8.
