Pedro Manuel Ruiz Lázaro
Head of the Child and Adolescent Psychiatry Department at the Lozano Blesa University Clinical Hospital in Zaragoza
A meta-analysis and systematic review published in a peer-reviewed scientific journal is a guarantee of good quality.
Another question is whether it contributes anything new, as on this subject it limits itself to confirming previous studies and does not change anything in the knowledge about the cardiovascular effects of stimulants and non-stimulants used in the pharmacological treatment of ADHD. That stimulants and noradrenergics increase the figures and guanfacine lowers them in the short term is known and expected.
It confirms previous findings, it does not contribute anything especially relevant. The cardiovascular safety of these drugs should not be questioned: their use does not increase mortality, it even decreases it. There are small short-term effects with no clinical impact. Long-term studies need to be increased.
I do not fully see the need for generalised and routine monitoring of blood pressure and pulse in the doctor's office during follow-up when the changes are small and without clinical relevance, except in exceptional cases. There is a need to collect personal or family history of cardiovascular disease and assess individual risk.
[Regarding possible limitations] The article reviews them:
- It is possible that people with a personal or family history of cardiovascular disease may experience greater increases in blood pressure with ADHD medications.
- Most studies are funded by the pharmaceutical industry.