Key result
Attention-deficit hyperactivity disorder in children and adolescents was associated with significantly lower blood pressure at baseline, but this difference did not persist into young adulthood after a 10-year follow-up.
Why the study?
ADHD pathophysiology may involve autonomic arousal deficits that cause blood pressure deviations, but long-term changes in blood pressure from childhood into young adulthood remain unexamined.
Does ADHD affect long-term changes in blood pressure from childhood to young adulthood?
Cohort (n=10,960)
Yes
Does ADHD affect long-term changes in blood pressure from childhood to young adulthood?
Standardized Mean Difference: 0.17
Absolute Event Rate: 107.6% vs 109.5%
p-value: p=<0.001
Children and adolescents with ADHD have slightly lower blood pressure than those without, but this difference normalizes by young adulthood.
BP normalization by young adulthood in ADHD youth should not yet change practice; leaves open long-term CV risk implications.
Background: Attention-deficit hyperactivity disorder (ADHD) is one of the most common behavioral disorders in childhood and adolescence associated with relevant psychosocial impairments. The basic pathophysiology of ADHD may be related, at least partly, to a deficit in autonomic arousal processes, which not only influence core symptoms of the disorder, but may also lead to blood pressure (BP) deviations due to altered arousal regulation. Objectives: This study examined long-term changes in BP in children and adolescents with ADHD up to young adulthood. Methods: In children and adolescents aged between 7 and 17 years at baseline, we compared BP recordings in subjects with (n = 1219, 11.1%) and without (n = 9741, 88.9%) ADHD over a 10-year follow-up using data from the nationwide German Health Survey for Children and Adolescents (KiGGS). Propensity score matching was used to improve the comparability between children in the ADHD and control groups with now n = 1.190 in each group. Results: The results of these matched samples revealed that study participants with ADHD showed significantly lower systolic BP (107.6 ± 10.7 mmHg vs. 109.5 ± 10.9 mmHg, p < 0.001, Cohen’s d = 0.17) and diastolic BP (64.6 ± 7.5 mmHg vs. 65.8 ± 7.4 mmHg, p < 0.001, Cohen’s d = 0.16) at baseline. In a sensitivity analysis with a smaller (n = 272) and more stringently diagnosed ADHD group, the significant differences remained stable with somewhat higher Cohen’s d; i.e., 0.25 and 0.27, respectively. However, these differences did not persist after 10-year follow-up in a smaller matched longitudinal sub-group (ADHD n = 273; control n = 323), as subjects with and without ADHD had similar levels of systolic (123.4 ± 10.65 vs. 123.78 ± 11.1 mmHg, p = 0.675, Cohen’s d = 0.15) and diastolic BP (71.86 ± 6.84 vs. 71.85 ± 7.06 mmHg, p = 0.992, Cohen’s d = 0.16). Conclusions: At baseline, children and adolescents with ADHD had significantly lower BP (of small effect sizes) compared to the non-ADHD group, whereas this difference was no longer detectable at follow-up ten years later. These developmental alterations in BP from adolescence to early adulthood may reflect changes in the state of autonomic arousal, probably modulating the pathophysiology of ADHD.
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Schulz et al. (2021) conducted a cohort in Attention-Deficit Hyperactivity Disorder (ADHD) (n=10,960). Attention-Deficit Hyperactivity Disorder (ADHD) vs. Non-ADHD controls was evaluated on Systolic blood pressure at baseline (matched sample) (Cohen's d = 0.17, p=<0.001). Attention-deficit hyperactivity disorder in children and adolescents was associated with significantly lower blood pressure at baseline, but this difference did not persist into young adulthood after a 10-year follow-up.
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