The Impact of Stimulant Medications on Blood Pressure and Body Mass Index in Children with Attention Deficit Hyperactivity Disorder

Abstract

Objective: To describe changes in blood pressure (BP) and body mass index (BMI) associated with stimulant medication fills in children.

Methods: Observational, retrospective matched cohort study of children 6-17.9 years initiating stimulant medication between 7/1/2010-6/30/2017 matched 1:3 by age, race, ethnicity, and sex to children with no stimulant use during this period. All BPs and BMIs recorded during ambulatory visits were identified. Generalized linear models were used to estimate differences in change in systolic BP (SBP), diastolic BP (DBP), and BMI over time.

Results: The 686 children with stimulant prescription fills and 2048 matched controls did not differ by baseline SBP or BMI. The matched control group (30.5% female, mean age 11.2 ± 3.4 years 79.7% white) was more likely to be publicly insured (35% vs. 21%, P < .01). After adjusting for baseline values, over a mean follow-up of 144 days change in SBP or DBP did not differ significantly between patients with stimulant medication fills and matched controls. Stimulant use was associated with a 4.7 percentile decrease in BMI percentile compared to matched controls (95% CI: 3.69, 5.71; P < .01).

Conclusions: In a pediatric primary care cohort, stimulant prescription fills were associated with marked decreases in BMI but no significant changes in BP over time.

Keywords: attention deficit hyperactivity disorder (ADHD); children; elevated blood pressure; hypertension; stimulant medication.

Figure 1.

Identification of analytic sample. Notes: The index date among patients with stimulant medication fills was defined as the first date a stimulant medication was filled following at least 6 months without a stimulant medication fill or the first qualifying visit in the 2 years with vitals measured (control group); Extreme BPs defined as values 5 mm Hg below the 5th age/sex percentile or 20 mmHg above the 95th age/sex percentile; Patients who reported a race of “Other,” “American Indian/Alaska Native,” or “Hawaiian/Pacific Islander” were excluded from analyses as there were insufficient numbers for matching. ADHD indicates attention deficit hyperactivity disorder; BP, blood pressure; EHR, electronic health records; and HTN, hypertension.

Figure 2.

Summary of Systolic and Diastolic Blood Pressure Percentiles occurring in the year after index date. Notes: The index date among patients with a stimulant medication fill was defined as the first date a stimulant medication was filled following at least 6 months without a stimulant medication fill or the first qualifying visit in the two years with vitals measured (control group). DBP indicates diastolic blood pressure; SBP, systolic blood pressure; Control, control group; and Stimulant, patients with stimulant medication fills group.