Blood Pressure and Heart Rate Over 10 Years in the Multimodal Treatment Study of Children With ADHD

被引:66
作者
Vitiello, Benedetto [1 ]
Elliott, Glen R.
Swanson, James M.
Arnold, L. Eugene
Hechtman, Lily
Abikoff, Howard
Molina, Brooke S. G.
Wells, Karen
Wigal, Timothy
Jensen, Peter S.
Greenhill, Laurence L.
Kaltman, Jonathan R.
Severe, Joanne B.
Odbert, Carol
Hur, Kwan
Gibbons, Robert
机构
[1] NIMH, Bethesda, MD 20892 USA
关键词
SALTS EXTENDED-RELEASE; SUDDEN-DEATH; FOLLOW-UP; OROS METHYLPHENIDATE; SHORT-TERM; DISEASE; MTA; HYPERTENSION; ADOLESCENTS; STIMULANTS;
D O I
10.1176/appi.ajp.2011.10111705
中图分类号
R749 [精神病学];
学科分类号
100205 ;
摘要
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.
引用
收藏
页码:167 / 177
页数:11
相关论文
共 39 条
[1]   Sympathetic nervous system activity and ventricular tachyarrhythmias: Recent advances [J].
Anderson, KP .
ANNALS OF NONINVASIVE ELECTROCARDIOLOGY, 2003, 8 (01) :75-89
[2]  
ARNOLD LE, 1978, ARCH GEN PSYCHIAT, V35, P463
[3]  
Arnold LE, 1997, ARCH GEN PSYCHIAT, V54, P865
[4]   CARDIOVASCULAR-RESPONSES OF HYPERACTIVE-CHILDREN TO METHYLPHENIDATE [J].
BALLARD, JE ;
BOILEAU, RA ;
SLEATOR, EK ;
MASSEY, BH ;
SPRAGUE, RL .
JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION, 1976, 236 (25) :2870-2874
[5]   Sudden death in children and adolescents [J].
Berger, S ;
Utech, L ;
Hazinski, MF .
PEDIATRIC CLINICS OF NORTH AMERICA, 2004, 51 (06) :1653-+
[6]  
Bernstein D, 2000, NELSON TXB PEDIAT
[7]   A randomized, placebo-controlled trial of OROS methylphenidate in adults with attention-deficit/hyperactivity disorder [J].
Biederman, J ;
Mick, E ;
Surman, C ;
Doyle, R ;
Hammerness, P ;
Harpold, T ;
Dunkel, S ;
Dougherty, M ;
Aleardi, M ;
Spencer, T .
BIOLOGICAL PSYCHIATRY, 2006, 59 (09) :829-835
[8]   Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure [J].
Chobanian, AV ;
Bakris, GL ;
Black, HR ;
Cushman, WC ;
Green, LA ;
Izzo, JL ;
Jones, DW ;
Materson, BJ ;
Oparil, S ;
Wright, JT ;
Roccella, EJ .
HYPERTENSION, 2003, 42 (06) :1206-1252
[9]   Elevated resting heart rate is an independent risk factor for cardiovascular disease in healthy men and women [J].
Cooney, Marie Therese ;
Vartiainen, Erkki ;
Laakitainen, Tinna ;
Juolevi, Anne ;
Dudina, Alexandra ;
Graham, Ian M. .
AMERICAN HEART JOURNAL, 2010, 159 (04) :612-U134
[10]   Cardiovascular effects of mixed amphetamine salts extended release in the treatment of school-aged children with attention-deficit/hyperactivity disorder [J].
Donner, Richard ;
Michaels, M. Alex ;
Ambrosini, Paul J. .
BIOLOGICAL PSYCHIATRY, 2007, 61 (05) :706-712