Blood Pressure and Heart Rate Over 10 Years in the Multimodal Treatment Study of Children With ADHD
- Benedetto Vitiello,
M.D. , - Glen R. Elliott,
M.D., Ph.D. , - James M. Swanson,
Ph.D. , - L. Eugene Arnold,
M.D. , - Lily Hechtman,
M.D. , - Howard Abikoff,
Ph.D. , - Brooke S.G. Molina,
Ph.D. , - Karen Wells,
Ph.D. , - Timothy Wigal,
Ph.D. , - Peter S. Jensen,
M.D. , - Laurence L. Greenhill,
M.D. , - Jonathan R. Kaltman,
M.D. , - Joanne B. Severe,
M.S. , - Carol Odbert,
B.S. , - Kwan Hur,
Ph.D. , and - Robert Gibbons,
Ph.D.
From NIMH, Bethesda, Md.; Psychiatry Department, Children's Health Council, Palo Alto, Calif.; Child Development Center, University of California, Irvine; Department of Psychiatry, Ohio State University, Columbus; Department of Psychiatry, McGill University, Montreal; Department of Child and Adolescent Psychiatry, New York University; Department of Psychiatry, University of Pittsburgh, Pittsburgh; Family Studies Clinic, Duke University Medical Center, Durham, N.C.; REACH Institute, New York; Research Unit of Pediatric Psychopharmacology, Columbia University and New York State Psychiatric Institute, New York; Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, Md.; Center for Health Statistics, University of Illinois at Chicago; and Center for Health Statistics, University of Chicago.
From NIMH, Bethesda, Md.; Psychiatry Department, Children's Health Council, Palo Alto, Calif.; Child Development Center, University of California, Irvine; Department of Psychiatry, Ohio State University, Columbus; Department of Psychiatry, McGill University, Montreal; Department of Child and Adolescent Psychiatry, New York University; Department of Psychiatry, University of Pittsburgh, Pittsburgh; Family Studies Clinic, Duke University Medical Center, Durham, N.C.; REACH Institute, New York; Research Unit of Pediatric Psychopharmacology, Columbia University and New York State Psychiatric Institute, New York; Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, Md.; Center for Health Statistics, University of Illinois at Chicago; and Center for Health Statistics, University of Chicago.
From NIMH, Bethesda, Md.; Psychiatry Department, Children's Health Council, Palo Alto, Calif.; Child Development Center, University of California, Irvine; Department of Psychiatry, Ohio State University, Columbus; Department of Psychiatry, McGill University, Montreal; Department of Child and Adolescent Psychiatry, New York University; Department of Psychiatry, University of Pittsburgh, Pittsburgh; Family Studies Clinic, Duke University Medical Center, Durham, N.C.; REACH Institute, New York; Research Unit of Pediatric Psychopharmacology, Columbia University and New York State Psychiatric Institute, New York; Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, Md.; Center for Health Statistics, University of Illinois at Chicago; and Center for Health Statistics, University of Chicago.
From NIMH, Bethesda, Md.; Psychiatry Department, Children's Health Council, Palo Alto, Calif.; Child Development Center, University of California, Irvine; Department of Psychiatry, Ohio State University, Columbus; Department of Psychiatry, McGill University, Montreal; Department of Child and Adolescent Psychiatry, New York University; Department of Psychiatry, University of Pittsburgh, Pittsburgh; Family Studies Clinic, Duke University Medical Center, Durham, N.C.; REACH Institute, New York; Research Unit of Pediatric Psychopharmacology, Columbia University and New York State Psychiatric Institute, New York; Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, Md.; Center for Health Statistics, University of Illinois at Chicago; and Center for Health Statistics, University of Chicago.
From NIMH, Bethesda, Md.; Psychiatry Department, Children's Health Council, Palo Alto, Calif.; Child Development Center, University of California, Irvine; Department of Psychiatry, Ohio State University, Columbus; Department of Psychiatry, McGill University, Montreal; Department of Child and Adolescent Psychiatry, New York University; Department of Psychiatry, University of Pittsburgh, Pittsburgh; Family Studies Clinic, Duke University Medical Center, Durham, N.C.; REACH Institute, New York; Research Unit of Pediatric Psychopharmacology, Columbia University and New York State Psychiatric Institute, New York; Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, Md.; Center for Health Statistics, University of Illinois at Chicago; and Center for Health Statistics, University of Chicago.
From NIMH, Bethesda, Md.; Psychiatry Department, Children's Health Council, Palo Alto, Calif.; Child Development Center, University of California, Irvine; Department of Psychiatry, Ohio State University, Columbus; Department of Psychiatry, McGill University, Montreal; Department of Child and Adolescent Psychiatry, New York University; Department of Psychiatry, University of Pittsburgh, Pittsburgh; Family Studies Clinic, Duke University Medical Center, Durham, N.C.; REACH Institute, New York; Research Unit of Pediatric Psychopharmacology, Columbia University and New York State Psychiatric Institute, New York; Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, Md.; Center for Health Statistics, University of Illinois at Chicago; and Center for Health Statistics, University of Chicago.
From NIMH, Bethesda, Md.; Psychiatry Department, Children's Health Council, Palo Alto, Calif.; Child Development Center, University of California, Irvine; Department of Psychiatry, Ohio State University, Columbus; Department of Psychiatry, McGill University, Montreal; Department of Child and Adolescent Psychiatry, New York University; Department of Psychiatry, University of Pittsburgh, Pittsburgh; Family Studies Clinic, Duke University Medical Center, Durham, N.C.; REACH Institute, New York; Research Unit of Pediatric Psychopharmacology, Columbia University and New York State Psychiatric Institute, New York; Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, Md.; Center for Health Statistics, University of Illinois at Chicago; and Center for Health Statistics, University of Chicago.
From NIMH, Bethesda, Md.; Psychiatry Department, Children's Health Council, Palo Alto, Calif.; Child Development Center, University of California, Irvine; Department of Psychiatry, Ohio State University, Columbus; Department of Psychiatry, McGill University, Montreal; Department of Child and Adolescent Psychiatry, New York University; Department of Psychiatry, University of Pittsburgh, Pittsburgh; Family Studies Clinic, Duke University Medical Center, Durham, N.C.; REACH Institute, New York; Research Unit of Pediatric Psychopharmacology, Columbia University and New York State Psychiatric Institute, New York; Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, Md.; Center for Health Statistics, University of Illinois at Chicago; and Center for Health Statistics, University of Chicago.
From NIMH, Bethesda, Md.; Psychiatry Department, Children's Health Council, Palo Alto, Calif.; Child Development Center, University of California, Irvine; Department of Psychiatry, Ohio State University, Columbus; Department of Psychiatry, McGill University, Montreal; Department of Child and Adolescent Psychiatry, New York University; Department of Psychiatry, University of Pittsburgh, Pittsburgh; Family Studies Clinic, Duke University Medical Center, Durham, N.C.; REACH Institute, New York; Research Unit of Pediatric Psychopharmacology, Columbia University and New York State Psychiatric Institute, New York; Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, Md.; Center for Health Statistics, University of Illinois at Chicago; and Center for Health Statistics, University of Chicago.
From NIMH, Bethesda, Md.; Psychiatry Department, Children's Health Council, Palo Alto, Calif.; Child Development Center, University of California, Irvine; Department of Psychiatry, Ohio State University, Columbus; Department of Psychiatry, McGill University, Montreal; Department of Child and Adolescent Psychiatry, New York University; Department of Psychiatry, University of Pittsburgh, Pittsburgh; Family Studies Clinic, Duke University Medical Center, Durham, N.C.; REACH Institute, New York; Research Unit of Pediatric Psychopharmacology, Columbia University and New York State Psychiatric Institute, New York; Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, Md.; Center for Health Statistics, University of Illinois at Chicago; and Center for Health Statistics, University of Chicago.
From NIMH, Bethesda, Md.; Psychiatry Department, Children's Health Council, Palo Alto, Calif.; Child Development Center, University of California, Irvine; Department of Psychiatry, Ohio State University, Columbus; Department of Psychiatry, McGill University, Montreal; Department of Child and Adolescent Psychiatry, New York University; Department of Psychiatry, University of Pittsburgh, Pittsburgh; Family Studies Clinic, Duke University Medical Center, Durham, N.C.; REACH Institute, New York; Research Unit of Pediatric Psychopharmacology, Columbia University and New York State Psychiatric Institute, New York; Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, Md.; Center for Health Statistics, University of Illinois at Chicago; and Center for Health Statistics, University of Chicago.
From NIMH, Bethesda, Md.; Psychiatry Department, Children's Health Council, Palo Alto, Calif.; Child Development Center, University of California, Irvine; Department of Psychiatry, Ohio State University, Columbus; Department of Psychiatry, McGill University, Montreal; Department of Child and Adolescent Psychiatry, New York University; Department of Psychiatry, University of Pittsburgh, Pittsburgh; Family Studies Clinic, Duke University Medical Center, Durham, N.C.; REACH Institute, New York; Research Unit of Pediatric Psychopharmacology, Columbia University and New York State Psychiatric Institute, New York; Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, Md.; Center for Health Statistics, University of Illinois at Chicago; and Center for Health Statistics, University of Chicago.
From NIMH, Bethesda, Md.; Psychiatry Department, Children's Health Council, Palo Alto, Calif.; Child Development Center, University of California, Irvine; Department of Psychiatry, Ohio State University, Columbus; Department of Psychiatry, McGill University, Montreal; Department of Child and Adolescent Psychiatry, New York University; Department of Psychiatry, University of Pittsburgh, Pittsburgh; Family Studies Clinic, Duke University Medical Center, Durham, N.C.; REACH Institute, New York; Research Unit of Pediatric Psychopharmacology, Columbia University and New York State Psychiatric Institute, New York; Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, Md.; Center for Health Statistics, University of Illinois at Chicago; and Center for Health Statistics, University of Chicago.
From NIMH, Bethesda, Md.; Psychiatry Department, Children's Health Council, Palo Alto, Calif.; Child Development Center, University of California, Irvine; Department of Psychiatry, Ohio State University, Columbus; Department of Psychiatry, McGill University, Montreal; Department of Child and Adolescent Psychiatry, New York University; Department of Psychiatry, University of Pittsburgh, Pittsburgh; Family Studies Clinic, Duke University Medical Center, Durham, N.C.; REACH Institute, New York; Research Unit of Pediatric Psychopharmacology, Columbia University and New York State Psychiatric Institute, New York; Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, Md.; Center for Health Statistics, University of Illinois at Chicago; and Center for Health Statistics, University of Chicago.
From NIMH, Bethesda, Md.; Psychiatry Department, Children's Health Council, Palo Alto, Calif.; Child Development Center, University of California, Irvine; Department of Psychiatry, Ohio State University, Columbus; Department of Psychiatry, McGill University, Montreal; Department of Child and Adolescent Psychiatry, New York University; Department of Psychiatry, University of Pittsburgh, Pittsburgh; Family Studies Clinic, Duke University Medical Center, Durham, N.C.; REACH Institute, New York; Research Unit of Pediatric Psychopharmacology, Columbia University and New York State Psychiatric Institute, New York; Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, Md.; Center for Health Statistics, University of Illinois at Chicago; and Center for Health Statistics, University of Chicago.
From NIMH, Bethesda, Md.; Psychiatry Department, Children's Health Council, Palo Alto, Calif.; Child Development Center, University of California, Irvine; Department of Psychiatry, Ohio State University, Columbus; Department of Psychiatry, McGill University, Montreal; Department of Child and Adolescent Psychiatry, New York University; Department of Psychiatry, University of Pittsburgh, Pittsburgh; Family Studies Clinic, Duke University Medical Center, Durham, N.C.; REACH Institute, New York; Research Unit of Pediatric Psychopharmacology, Columbia University and New York State Psychiatric Institute, New York; Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, Md.; Center for Health Statistics, University of Illinois at Chicago; and Center for Health Statistics, University of Chicago.
Abstract
Objective:
It is unknown whether prolonged childhood exposure to stimulant medication for the treatment of attention deficit hyperactivity disorder (ADHD) increases the risk for developing abnormalities in blood pressure or heart rate. The authors examined the association between stimulant medication and blood pressure and heart rate over 10 years.
Method:
A total of 579 children, ages 7–9, were randomly assigned to 14 months of medication treatment, behavioral therapy, the combination of the two, or usual community treatment. The controlled trial was followed by naturalistic treatment with periodic assessments. Blood pressure and heart rate data were first analyzed with linear regression models based on an intent-to-treat approach, using raw data and the blood pressure categories of prehypertension and hypertension. Currently medicated patients were then compared with never or previously medicated patients. Associations between cumulative stimulant exposure and blood pressure or heart rate were assessed.
Results:
No treatment effect on either systolic or diastolic blood pressure could be detected. Children who were treated with stimulants had a higher heart rate (mean=84.2 bpm [SD=12.4] on medication alone and mean=84.6 bpm [SD=12.2] on medication plus behavioral therapy) than those who were treated with behavioral therapy alone (mean=79.1 bpm [SD=12.0]) or those who received usual community treatment (mean=78.9 bpm [SD=12.9]) at the end of the 14-month controlled trial, but not thereafter. Stimulant medication did not increase the risk for tachycardia, but greater cumulative stimulant exposure was associated with a higher heart rate at years 3 and 8.
Conclusions:
Stimulant treatment did not increase the risk for prehypertension or hypertension over the 10-year period of observation. However, stimulants had a persistent adrenergic effect on heart rate during treatment.
