The Effect of Methylphenidate and Atomoxetine on Heart Rate and Systolic Blood Pressure in Young People and Adults with Attention-Deficit Hyperactivity Disorder (ADHD): Systematic Review, Meta-Analysis, and Meta-Regression.

Edwin F Liang,Roger S Mcintyre,Cyrus S Ho,Wilson W Tam,Melvyn W Zhang,Roger C Ho,Samuel Z Lim

doi:10.3390/ijerph15081789

Abstract

Objectives: This meta-analysis aims to study the effects of atomoxetine and methylphenidate on heart rate (HR), systolic blood pressure (SBP), and a number of adverse cardiac events on patients receiving treatment for attention-deficit hyperactive disorder (ADHD) in comparison to placebo and between atomoxetine and methylphenidate. Methods: We searched the following databases: PubMed, EMBASE, and ScienceDirect. Meta-analysis was performed on studies that examined the relationships between methylphenidate or atomoxetine and HR, SBP, as well as a number of adverse cardiac events. These studies were either placebo-controlled or comparison studies between methylphenidate and atomoxetine. Meta-regression identified patient- and treatment-related factors that may contribute to heterogeneity. Results: Twenty-two studies were included and the total number of participants was 46,107. Children/adolescents and adults treated with methylphenidate had more significant increases in post- vs. pre-treatment HR (p < 0.001) and SBP (p < 0.001) than those treated by placebo. Children and adolescents treated with atomoxetine had more significant increases post- vs. pre-treatment HR (p = 0.025) and SBP (p < 0.001) than those treated with methylphenidate. Meta-regression revealed mean age of participants, mean dose, and duration of atomoxetine and methylphenidate as significant moderators that explained heterogeneity. There were no differences in the number of adverse cardiac events between participants with methylphenidate treatment and placebo or atomoxetine. Conclusions: Children/adolescents and adults treated with methylphenidate resulted in significant increases in post- vs. pre-treatment HR and SBP as compared to placebo. Similarly, children and adolescents treated with atomoxetine had significant increases in post- vs. pre-treatment HR and SBP than those treated with methylphenidate. These findings have potential implications for continuous monitoring of HR and SBP throughout the course of treatment although the risk for adverse cardiac events were insignificant.

Highlights

Attention deficit hyperactive disorder (ADHD) is a psychiatric disorder characterized by inattention, hyperactivity, and impulsivity
Fourteen studies compared the effect on post- vs. pre-treatment heart rate (HR) and systolic blood pressure (SBP) between methylphenidate and placebo
Our meta-analysis demonstrated that children/adolescents and adults treated with methylphenidate resulted in significant increases in post- vs. pre-treatment HR and SBP as compared to placebo

Summary

Introduction

Attention deficit hyperactive disorder (ADHD) is a psychiatric disorder characterized by inattention, hyperactivity, and impulsivity. In the United States, the prevalence ADHD among children 4–17 years of age had increased by 22% between. ADHD symptoms persist to adulthood in 25%–50% of patients with childhood onset, while the prevalence of ADHD in adults is 2%–5% [4]. The Multimodal Treatment Study of Children and Adolescents found that medications with or without behavioural treatment is the most effective for core ADHD symptoms [5]. Recent updates by the National Institute of Clinical Excellence (NICE) recommend that methylphenidate is effective for children and young people with ADHD as well as ADHD and coexisting intellectual disability or substance abuse [6]. The NICE guidelines recommend atomoxetine if methylphenidate has been ineffective at the maximum tolerated dose, or if the patient is intolerant to methylphenidate. Atomoxetine is a noradrenaline reuptake inhibitor [8]

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