ADHD medications have minor effects on heart rate and blood pressure, with benefits outweighing risks. Regular monitoring is advised for all patients.
A new study led by the University of Southampton has found that ADHD medications have only small effects on blood pressure and heart rate after several weeks or a few months of use.
While concerns have been raised about the potential cardiovascular side effects of these medications, the findings, supported by previous research, indicate that the benefits generally outweigh the risks. However, the study emphasizes the importance of ongoing monitoring during treatment.
Published in The Lancet Psychiatry, the study represents the largest and most comprehensive analysis to date of the cardiovascular effects of ADHD medications, drawing on data from randomized controlled trials—the gold standard for evaluating medication safety and efficacy.
Balancing Risks and Benefits
Professor Samuele Cortese, senior lead author of the study from the University of Southampton said: “When it comes to taking any medication, risks and benefits should always be assessed together. We found an overall small increase in blood pressure and pulse for the majority of children taking ADHD medications.
“Other studies show clear benefits in terms of reductions in mortality risk and improvement in academic functions, as well as a small increased risk of hypertension, but not other cardiovascular diseases. Overall, the risk-benefit ratio is reassuring for people taking ADHD medications.”
The study was funded by the National Institute for Health and Care Research (NIHR), within the framework of the NIHR Research Professorships scheme to Professor Samuele Cortese, with Dr Luis Farhat (University of São Paulo, Brazil) as first author and Professor Alexis Revet (University of Toulouse, France) as co-senior author.
Methodology and Findings
It is estimated that attention-deficit/hyperactivity disorder (ADHD) affects around 4 percent of children in the UK. Of these, around 45 percent are treated with medication.
The international team of investigators analyzed data from 102 randomized controlled trials, including a total of 22,702 participants with ADHD. They used an advanced statistical approach – network meta-analysis – that allowed them to compare the effects of several medications, even when the medications were not directly compared in the trials included in the analysis.
They found that all ADHD medications were generally associated with overall small effects on blood pressure, heart rate, and ECG parameters. With the exception of guanfacine (which leads to decreased blood pressure and heart rate), other medications led to increases in the values of these parameters.
No significant differences were found between stimulants (including methylphenidate and amphetamine) and non-stimulants (atomoxetine and viloxazine) with regard to their effects on blood pressure and heart rate.
“Our findings should inform future clinical guidelines, stressing the need to systematically monitor blood pressure and heart rate, both for stimulants and non-stimulants. This should be particularly relevant for practitioners who might assume that only stimulants have a negative effect on the cardiovascular system,” said Dr Farhat.
The researchers say that those with existing heart conditions should discuss the side effects of ADHD medications with a specialist cardiologist before starting treatment.
Need for Long-Term and Personalized Research
Professor Revet added: “Our findings, based on randomized controlled trials that tend to be of short duration due to ethical issues, should be complemented by results from real-world, longer-term studies.”
The research team will now look to see if some groups might be more vulnerable to cardiovascular side effects than others.
NIHR Research Professor Cortese concluded: “While our findings are informative at the group level, that is, on average, we cannot exclude that a subgroup of individuals may have a higher risk of more substantial cardiovascular alterations.
“While it is currently not possible to identify those individuals at higher risk, efforts based on precision medicine approaches will hopefully provide important insights in the future.”
Reference: “Comparative cardiovascular safety of medications for attention-deficit hyperactivity disorder in children, adolescents, and adults: a systematic review and network meta-analysis” by Luis C Farhat, Alice Lannes, Cinzia Del Giovane, Valeria Parlatini, Miguel Garcia-Argibay, Edoardo G Ostinelli, Anneka Tomlison, Zheng Chang, Henrik Larsson, Cristiano Fava, François Montastruc, Andrea Cipriani, Alexis Revet and Samuele Cortese, 6 April 2025, The Lancet Psychiatry.
DOI: 10.1016/S2215-0366(25)00062-8
The study was funded by the National Institute for Health Research.
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