Cardiac autonomic dysfunction and arterial stiffness among children and adolescents with attention deficit hyperactivity disorder treated with stimulants

Aaron S Kelly; Kyle Rudser; Donald R Dengel; Christopher L. Kaufman; Michael I Reiff; Anne L. Norris; Andrea M. Metzig; Julia Steinberger

doi:10.1016/j.jpeds.2014.05.043

Cardiac autonomic dysfunction and arterial stiffness among children and adolescents with attention deficit hyperactivity disorder treated with stimulants

Aaron S Kelly, Kyle Rudser, Donald R Dengel, Christopher L. Kaufman, Michael I Reiff, Anne L. Norris, Andrea M. Metzig, Julia Steinberger

Research output: Contribution to journal › Article › peer-review

20 Scopus citations

Abstract

Objective To compare markers of cardiovascular health in youth diagnosed with attention deficit hyperactivity disorder (ADHD) by the use of stimulant medication with healthy controls.

Study design Children and adolescents (n = 85; mean age 11.2 ± 2.8 years; 66 boys) diagnosed with ADHD using a stimulant and 53 siblings without ADHD (mean age 11.1 ± 3.8 years; 28 boys) were included in this cross-sectional study. Measured variables included blood pressure, heart rate (HR), HR variability: SD of the RR interval and low frequency to high frequency ratio, carotid-radial pulse wave velocity, carotid artery augmentation index (AIx), radial artery AIx, brachial artery flow-mediated dilation, and digital reactive hyperemic index.

Results Compared with control patients, participants with ADHD had greater resting systolic blood pressure (3.9 mm Hg, 95% CI [1.2-6.7], P =.005), diastolic blood pressure (5.5 mm Hg, 95% CI [3.2-7.8], P <.001), HR (9.2 beats/min, 95% CI [6.0-12.3], P <.001), low frequency to high frequency ratio (0.55, 95% CI [0.22-0.89], P =.001), carotid AIx (7.2%, 95% CI [1.9-12.5], P =.008), and pulse wave velocity (0.36 m/s, 95% CI [-0.05, 0.78], P =.089), and lower SD of the RR interval (-33.7 milliseconds, 95% CI [-46.1, -21.3], P <.001). Neither flow-mediated dilation nor reactive hyperemic index was significantly different.

Conclusions Children and adolescents being treated with a stimulant medication for ADHD exhibited signs of altered cardiac autonomic function, characterized by increased sympathetic tone, and showed evidence of arterial stiffening.

Original language	English (US)
Pages (from-to)	755-759
Number of pages	5
Journal	Journal of Pediatrics
Volume	165
Issue number	4
DOIs	https://doi.org/10.1016/j.jpeds.2014.05.043
State	Published - Oct 1 2014

Bibliographical note

Funding Information:
Funded by the Thrasher Research Fund (to A.K.), the National Center for Research Resources (Clinical and Translational Science Award), and the National Center for Advancing Translational Sciences of the National Institutes of Health ( UL1TR000114 ). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. The authors declare no conflicts of interest.

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© 2014 Elsevier Inc.

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10.1016/j.jpeds.2014.05.043

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@article{88127531c4d4425ab9f529b1dfeb82f5,

title = "Cardiac autonomic dysfunction and arterial stiffness among children and adolescents with attention deficit hyperactivity disorder treated with stimulants",

abstract = "Objective To compare markers of cardiovascular health in youth diagnosed with attention deficit hyperactivity disorder (ADHD) by the use of stimulant medication with healthy controls.Study design Children and adolescents (n = 85; mean age 11.2 ± 2.8 years; 66 boys) diagnosed with ADHD using a stimulant and 53 siblings without ADHD (mean age 11.1 ± 3.8 years; 28 boys) were included in this cross-sectional study. Measured variables included blood pressure, heart rate (HR), HR variability: SD of the RR interval and low frequency to high frequency ratio, carotid-radial pulse wave velocity, carotid artery augmentation index (AIx), radial artery AIx, brachial artery flow-mediated dilation, and digital reactive hyperemic index.Results Compared with control patients, participants with ADHD had greater resting systolic blood pressure (3.9 mm Hg, 95% CI [1.2-6.7], P =.005), diastolic blood pressure (5.5 mm Hg, 95% CI [3.2-7.8], P <.001), HR (9.2 beats/min, 95% CI [6.0-12.3], P <.001), low frequency to high frequency ratio (0.55, 95% CI [0.22-0.89], P =.001), carotid AIx (7.2%, 95% CI [1.9-12.5], P =.008), and pulse wave velocity (0.36 m/s, 95% CI [-0.05, 0.78], P =.089), and lower SD of the RR interval (-33.7 milliseconds, 95% CI [-46.1, -21.3], P <.001). Neither flow-mediated dilation nor reactive hyperemic index was significantly different.Conclusions Children and adolescents being treated with a stimulant medication for ADHD exhibited signs of altered cardiac autonomic function, characterized by increased sympathetic tone, and showed evidence of arterial stiffening.",

author = "Kelly, {Aaron S} and Kyle Rudser and Dengel, {Donald R} and Kaufman, {Christopher L.} and Reiff, {Michael I} and Norris, {Anne L.} and Metzig, {Andrea M.} and Julia Steinberger",

note = "Funding Information: Funded by the Thrasher Research Fund (to A.K.), the National Center for Research Resources (Clinical and Translational Science Award), and the National Center for Advancing Translational Sciences of the National Institutes of Health ( UL1TR000114 ). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. The authors declare no conflicts of interest. Publisher Copyright: {\textcopyright} 2014 Elsevier Inc.",

year = "2014",

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doi = "10.1016/j.jpeds.2014.05.043",

language = "English (US)",

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T1 - Cardiac autonomic dysfunction and arterial stiffness among children and adolescents with attention deficit hyperactivity disorder treated with stimulants

AU - Kelly, Aaron S

AU - Rudser, Kyle

AU - Dengel, Donald R

AU - Kaufman, Christopher L.

AU - Reiff, Michael I

AU - Norris, Anne L.

AU - Metzig, Andrea M.

AU - Steinberger, Julia

N1 - Funding Information: Funded by the Thrasher Research Fund (to A.K.), the National Center for Research Resources (Clinical and Translational Science Award), and the National Center for Advancing Translational Sciences of the National Institutes of Health ( UL1TR000114 ). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. The authors declare no conflicts of interest. Publisher Copyright: © 2014 Elsevier Inc.

PY - 2014/10/1

Y1 - 2014/10/1

N2 - Objective To compare markers of cardiovascular health in youth diagnosed with attention deficit hyperactivity disorder (ADHD) by the use of stimulant medication with healthy controls.Study design Children and adolescents (n = 85; mean age 11.2 ± 2.8 years; 66 boys) diagnosed with ADHD using a stimulant and 53 siblings without ADHD (mean age 11.1 ± 3.8 years; 28 boys) were included in this cross-sectional study. Measured variables included blood pressure, heart rate (HR), HR variability: SD of the RR interval and low frequency to high frequency ratio, carotid-radial pulse wave velocity, carotid artery augmentation index (AIx), radial artery AIx, brachial artery flow-mediated dilation, and digital reactive hyperemic index.Results Compared with control patients, participants with ADHD had greater resting systolic blood pressure (3.9 mm Hg, 95% CI [1.2-6.7], P =.005), diastolic blood pressure (5.5 mm Hg, 95% CI [3.2-7.8], P <.001), HR (9.2 beats/min, 95% CI [6.0-12.3], P <.001), low frequency to high frequency ratio (0.55, 95% CI [0.22-0.89], P =.001), carotid AIx (7.2%, 95% CI [1.9-12.5], P =.008), and pulse wave velocity (0.36 m/s, 95% CI [-0.05, 0.78], P =.089), and lower SD of the RR interval (-33.7 milliseconds, 95% CI [-46.1, -21.3], P <.001). Neither flow-mediated dilation nor reactive hyperemic index was significantly different.Conclusions Children and adolescents being treated with a stimulant medication for ADHD exhibited signs of altered cardiac autonomic function, characterized by increased sympathetic tone, and showed evidence of arterial stiffening.

AB - Objective To compare markers of cardiovascular health in youth diagnosed with attention deficit hyperactivity disorder (ADHD) by the use of stimulant medication with healthy controls.Study design Children and adolescents (n = 85; mean age 11.2 ± 2.8 years; 66 boys) diagnosed with ADHD using a stimulant and 53 siblings without ADHD (mean age 11.1 ± 3.8 years; 28 boys) were included in this cross-sectional study. Measured variables included blood pressure, heart rate (HR), HR variability: SD of the RR interval and low frequency to high frequency ratio, carotid-radial pulse wave velocity, carotid artery augmentation index (AIx), radial artery AIx, brachial artery flow-mediated dilation, and digital reactive hyperemic index.Results Compared with control patients, participants with ADHD had greater resting systolic blood pressure (3.9 mm Hg, 95% CI [1.2-6.7], P =.005), diastolic blood pressure (5.5 mm Hg, 95% CI [3.2-7.8], P <.001), HR (9.2 beats/min, 95% CI [6.0-12.3], P <.001), low frequency to high frequency ratio (0.55, 95% CI [0.22-0.89], P =.001), carotid AIx (7.2%, 95% CI [1.9-12.5], P =.008), and pulse wave velocity (0.36 m/s, 95% CI [-0.05, 0.78], P =.089), and lower SD of the RR interval (-33.7 milliseconds, 95% CI [-46.1, -21.3], P <.001). Neither flow-mediated dilation nor reactive hyperemic index was significantly different.Conclusions Children and adolescents being treated with a stimulant medication for ADHD exhibited signs of altered cardiac autonomic function, characterized by increased sympathetic tone, and showed evidence of arterial stiffening.

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Cardiac autonomic dysfunction and arterial stiffness among children and adolescents with attention deficit hyperactivity disorder treated with stimulants

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