Risk of methylphenidate-induced prehypertension in normotensive adult smokers with attention deficit hyperactivity disorder.

This article reports on a study examining predictors of methylphenidate-induced increases in blood pressure (BP). In this secondary analysis of CTN-0029, a randomized, double-blind, placebo-controlled smoking cessation trial, non-hypertensive adult smokers with attention deficit hyperactivity disorder randomized to osmotic-release oral system methylphenidate (OROS-MPH) (n=115) were matched one-to-one on baseline systolic BP (SBP) (+/-5 mm Hg) with participants randomized to placebo (n=115) and followed for 10 weeks. In adjusted mixed linear models of SBP and diastolic BP (DBP), baseline normal SBP (P<.0001) and DBP (P<.0001) were associated with significant OROS-MPH–induced increases compared with placebo, whereas significant increases were not observed in participants with baseline prehypertensive SBP (P=.27) and DBP (P=.79). Participants randomized to OROS-MPH with baseline normal BP had increased odds of developing either systolic (odds ratio [OR], 3.32; 95% confidence interval [CI], 1.41–8.37; P=.006) or diastolic prehypertension (OR, 4.32; 95% CI, 1.56–14.0; P=.004) compared with placebo using simple logistic regression.

Conclusions: This study suggests two findings: (1) adult ADHD participants with baseline normal blood pressure are more susceptible to the BP-raising effects of OROS-MPH than those with baseline prehypertensive BP, and (2) normotensive adults with ADHD have significantly greater odds of developing prehypertension when treated with OROS-MPH compared with placebo. Since previous studies have shown adverse cardiovascular outcomes associated with prehypertension, further studies are needed to clarify the long-term consequences, especially given the growing consensus of ADHD as a treatable lifelong illness.

Related protocols: CTN-0029