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

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.