# Exploring the Association Between Attention-Deficit/Hyperactivity Disorder and Essential Hypertension in a Pediatric Population

## TL;DR

Children with ADHD are more likely to develop high blood pressure over time compared to those without ADHD, suggesting a need for regular blood pressure checks.

## Contribution

This study is the first to show a long-term association between ADHD and essential hypertension in a pediatric population using a large, matched cohort.

## Key findings

- Children with ADHD had a 3.17 times higher risk of hypertension at 5 years compared to controls.
- ADHD patients used more antihypertensive medications, including calcium channel blockers and diuretics.
- The risk of hypertension in ADHD patients decreased over time but remained elevated at 20 years.

## Abstract

What are the main findings?
Children diagnosed with ADHD had a significantly higher long-term prevalence of essential hypertension compared to matched controls, with odds ratios ranging from 3.17 at 5 years to 1.92 at 20 years of follow-up.ADHD patients demonstrated greater use of antihypertensive medications, including calcium channel blockers, renin–angiotensin system blockers, and diuretics, indicating clinically meaningful hypertension requiring pharmacological management.

Children diagnosed with ADHD had a significantly higher long-term prevalence of essential hypertension compared to matched controls, with odds ratios ranging from 3.17 at 5 years to 1.92 at 20 years of follow-up.

ADHD patients demonstrated greater use of antihypertensive medications, including calcium channel blockers, renin–angiotensin system blockers, and diuretics, indicating clinically meaningful hypertension requiring pharmacological management.

What are the implications of the main findings?
These results underscore the need for regular cardiovascular monitoring in pediatric patients with ADHD to enable early detection and management of hypertension.The findings suggest potential shared biological and behavioral mechanisms between ADHD and hypertension, highlighting the importance of integrated care and further research to guide preventive strategies.

These results underscore the need for regular cardiovascular monitoring in pediatric patients with ADHD to enable early detection and management of hypertension.

The findings suggest potential shared biological and behavioral mechanisms between ADHD and hypertension, highlighting the importance of integrated care and further research to guide preventive strategies.

Objective: Current data on the association between attention-deficit/hyperactivity disorder (ADHD) and essential hypertension (EH) in pediatric populations are very limited, as most research has focused on adults. This study investigated the long-term prevalence of EH in Israeli youth aged 5–18 years with ADHD, examining also trends in antihypertensive medication use. Methods: A retrospective cohort study was conducted using data from Leumit Health Services. The ADHD cohort (N = 18,558) was compared in a 1:2 ratio to controls (N = 37,116), who were strictly matched for age, gender, birth year and quarter, socioeconomic status (SES), sectors, region, and cumulative years of LHS membership up to the index date. Diagnoses of ADHD and EH were identified using ICD-9/10 codes, depending on the year of diagnosis. Logistic regression analyses were used to assess the associations between ADHD, EH and the use of antihypertensive medications over a 20-year follow-up. Results: ADHD-diagnosed children had a higher prevalence of EH, with odds ratios (ORs) of 3.17 (95% CI: 1.46–7.16, p = 0.0017) at 5 years, 2.94 (95% CI: 1.45–6.09, p = 0.0013) at 10 years, and 1.92 (95% CI: 1.26–2.93, p = 0.0015) at 20 years. ADHD patients showed a greater use of antihypertensive medications, including calcium channel blockers (OR 1.85, 95% CI: 1.02–3.35, p = 0.035), renin angiotensin system blockers (OR 2.20, 95% CI: 1.15–4.25, p = 0.013), and diuretics (OR 1.77, 95% CI: 1.21–2.60, p = 0.0028). Conclusions: These findings highlight an association between ADHD diagnosis and EH, suggesting regular cardiovascular monitoring of children with ADHD. Further studies are needed to uncover the role of stimulant medications and shared biological and behavioral factors involved in the pathogenesis.