Pre-existing cardiovascular conditions linked to lower stimulant prescribing rates for adults with ADHD
Attention-deficit hyperactivity disorder (ADHD) affects 4-5 percent of the adult U.S. population and contributes to significant impairment in academic, occupational, and social function. Stimulants and the selective norepinephrin reuptake inhibitor atomoxetine are generally considered effective and well-tolerated treatments for adult ADHD. However, the Food and Drug Administration (FDA) advises that these ADHD medications, which raise blood pressure and heart rate, should be used with caution or avoided altogether in patients who have cardiovascular conditions.
The study identified 8,752 adult patients with new treatment episodes for ADHD, of whom 10 percent had pre-existing cardiovascular conditions, most commonly hypertension. Compared with patients without pre-existing cardiovascular conditions, patients with such conditions were less likely to fill a prescription for a stimulant (40.8 vs. 53 percent) within 3 months of the beginning of the treatment episode. Prescription rates for atomoxetine were similar for both groups (10.8 vs. 9.3 percent). The reduction in stimulant prescribing for patients with pre-existing cardiovascular conditions was more pronounced in younger (21-45 years) than older (46-64 years) patients, but was not influenced by patient sex or physician specialty.
The researchers believe that more research regarding the comparative cardiovascular safety of ADHD medications in adults is needed to inform appropriate clinical risk-benefit decisions. This study was supported by the Agency for Healthcare Research and Quality (HS16097).
See "Pre-existing cardiovascular conditions and pharmacological treatment of adult ADHD," by Tobias Gerhard, Ph.D., Almut G. Winterstein, Ph.D., Mark Olfson, M.D., M.P.H., and others in Pharmacoepidemiology and Drug Safety 19, pp. 457-464, 2010.
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