Nav: Home

ADHD medication linked to slightly increased risk of heart rhythm problems

May 31, 2016

Use of methylphenidate in children and young people with ADHD is associated with a slightly increased risk of abnormal heart rhythm (arrhythmia) shortly after the start of treatment, suggests research published by The BMJ today.

Though the absolute risk is likely to be low, the researchers say the benefits of methylphenidate "should be carefully weighed against the potential cardiovascular risks of these drugs in children and adolescents."

Methylphenidate is a central nervous system stimulant used to treat attention deficit hyperactivity disorder (ADHD), and narcolepsy. It is sold under various trade names, Ritalin being one of the most commonly known.

The cardiac safety of stimulants, which are known to slightly raise blood pressure and accelerate the heart rate, has been hotly debated, but the evidence is conflicting.

So a team of researchers based in Australia, Canada and South Korea set out to measure the cardiac safety of methylphenidate in children and young people with ADHD.

Using the South Korea National Health Insurance Database, they extracted data on 1,224 cardiac events from a population of 114,647 children and young people aged 17 or younger and newly treated with methylphenidate at any time from 2008 to 2011.

Cardiac events included heart rhythm problems (arrhythmias), high blood pressure (hypertension), heart attacks (myocardial infarction), ischemic stroke, and heart failure.

Cases of arrhythmia were statistically significantly more likely to have occurred during the first two months of use compared with periods of non-use, and risk was highest in the first three days of use.

The risk was more pronounced in children with existing congenital heart disease.

No significant risk of myocardial infarction was observed, though risk increased after the first week of treatment and remained raised for the first two months of continuous treatment.

No increased risk was observed for hypertension, ischemic stroke, or heart failure.

The authors point out that this is an observational study so no firm conclusions can be drawn about cause and effect - and that their findings should be interpreted with caution. However, the results prompt them to suggest that methylphenidate use might "trigger" the occurrence of arrhythmia in individual patients.

"Methylphenidate exposure in children and young people with diagnosis of ADHD is associated with arrhythmia and potentially with myocardial infarction in specific time periods of use," they write. "With the increased use of drugs for ADHD globally, the benefits of methylphenidate should be carefully weighed against the potential cardiovascular risks of these drugs in children and adolescents."

In a linked editorial, John Jackson, a research fellow at Harvard School of Public Health in Boston, says it is difficult to describe the absolute risk in this type of study, but in the average child, the risk of serious cardiovascular events is extremely small (3 per 100,000 per year) and any absolute increase associated with methylphenidate is also likely to be small.

And he points out that regulatory labeling and treatment guidelines for stimulants recommend caution using these drugs in children with personal or familial history of cardiovascular disease and call for routine monitoring of blood pressure.

"This study underscores the need to consider the severity of ADHD symptoms and the option of non-stimulants for children with high cardiovascular risk and to closely monitor patients for whom stimulants are critical for their wellbeing and development," he concludes.
-end-


BMJ

Related Blood Pressure Articles:

Do you really have high blood pressure?
A study by researchers at the University of Montreal Hospital Research Centre (CRCHUM) shows that more than half of family doctors in Canada are still using manual devices to measure blood pressure, a dated technology that often leads to misdiagnosis.
Why do we develop high blood pressure?
Abnormally high blood pressure, or hypertension, may be related to changes in brain activity and blood flow early in life.
For some, high blood pressure associated with better survival
Patients with both type 2 diabetes and acute heart failure face a significantly lower risk of death but a higher risk of heart failure-related hospitalizations if they had high systolic blood pressure on discharge from the hospital compared to those with normal blood pressure, according to a study scheduled for presentation at the American College of Cardiology's 66th Annual Scientific Session.
$9.4 million grant helps scientists explore how cell death from high blood pressure fuels even higher pressure
It's been known for decades that a bacterial infection can raise your blood pressure short term, but now scientists are putting together the pieces of how our own dying cells can fuel chronically high, destructive pressure.
Blood pressure diet improves gout blood marker
A diet rich in fruits, vegetables, low-fat dairy and reduced in fats and saturated fats (the DASH diet), designed decades ago to reduce high blood pressure, also appears to significantly lower uric acid, the causative agent of gout.
New tool to improve blood pressure measurement
Oxford University researchers have developed a prediction model that uses three separate blood pressure readings taken in a single consultation and basic patient characteristics to give an adjusted blood pressure reading that is significantly more accurate than existing models for identifying hypertension.
Blood vessels sprout under pressure
It is blood pressure that drives the opening of small capillaries during angiogenesis.
Better blood pressure control -- by mobile phone
An interactive web system with the help of your mobile phone can be an effective tool for better blood pressure control.
Time to reassess blood-pressure goals
High blood pressure or hypertension is a major health problem that affects more than 70 million people in the US, and over one billion worldwide.
With help from pharmacists, better blood pressure costs $22
A pharmacist-physician collaboration in primary-care offices effectively and inexpensively improved patients' high blood pressure.

Related Blood Pressure Reading:

Best Science Podcasts 2019

We have hand picked the best science podcasts for 2019. Sit back and enjoy new science podcasts updated daily from your favorite science news services and scientists.
Now Playing: TED Radio Hour

Changing The World
What does it take to change the world for the better? This hour, TED speakers explore ideas on activism—what motivates it, why it matters, and how each of us can make a difference. Guests include civil rights activist Ruby Sales, labor leader and civil rights activist Dolores Huerta, author Jeremy Heimans, "craftivist" Sarah Corbett, and designer and futurist Angela Oguntala.
Now Playing: Science for the People

#520 A Closer Look at Objectivism
This week we broach the topic of Objectivism. We'll be speaking with Keith Lockitch, senior fellow at the Ayn Rand Institute, about the philosophy of Objectivism as it's taught through Ayn Rand's writings. Then we'll speak with Denise Cummins, cognitive scientist, author and fellow at the Association for Psychological Science, about the impact of Objectivist ideology on society. Related links: This is what happens when you take Ayn Rand seriously Another Critic Who Doesn’t Care What Rand Thought or Why She Thought It, Only That She’s Wrong Quote is from "A Companion to Ayn Rand"