The Association between Low Blood Pressure and Attention-Deficit Hyperactivity Disorder (ADHD) Observed in Children/Adolescents Does Not Persist into Young Adulthood. A Population-Based Ten-Year Follow-Up Study

Abstract

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.

Knowledge gaps and future directions in cognitive functions in children and adolescents with primary arterial hypertension: A systematic review

“…Besides, studies treating learning difficulties and ADHD as end-points may miss mild early-onset cognitive decline that does not produce significant learning difficulties ( 38 ). The executive deficits can be associated with attentional problems in children with AH, however, children with ADHD seem to present lower levels of BP ( 46 ), so the deficits related to AH could be independent from the ADHD symptomatology. Recently, it has also been shown that uric acid levels alongside high BP are associated with worse executive functions ( 36 ).…”

Childhood attention-deficit hyperactivity disorder problems and mid-life cardiovascular risk: prospective population cohort study

“…Our study further elaborates recent studies on younger populations which found that untreated ADHD is associated with low blood pressure in late adolescence 24 but that this finding does not persist into young adulthood. 25 This would suggest the need to examine mechanisms that lead to the increase in blood pressure through adulthood for individuals with ADHD and the need for caution in interpreting any findings from more recent cohorts that focus on examining the long-term effects of medication for ADHD on blood pressure.…”

Problematic issues of pathogenesis, diagnosis, prevention and approaches to the treatment of arterial hypotension in children (literary data, own researches)

“…Однак ці відмінності не зберігалися після 10-річного спостереження. Автори роблять висновки, що саме ці зміни від підліткового до раннього дорослого віку можуть відображати зміни в стані вегетативного збудження, модулюючи патофізіологію СДУГ та його вплив на рівень АТ у дітей [30].…”