A comprehensive meta-analysis of 102 RCTs involving over 22,000 participants found mild cardiovascular effects from commonly used ADHD medications.
Short-term use of stimulants (e.g., amphetamines, lisdexamfetamine, methylphenidate) and non-stimulants (e.g., atomoxetine, viloxazine) led to slight increases in blood pressure and heart rate in both children and adults.
No significant differences in cardiovascular outcomes were observed among most ADHD medications, suggesting comparable CV safety profiles.
The alpha-2a agonist guanfacine was unique in that it reduced both systolic and diastolic blood pressure as well as heart rate.
Bupropion and amphetamines increased systolic BP in adults, but the certainty of evidence was rated very low.
ECG changes were minor; for example, atomoxetine and viloxazine reduced PR interval, while lisdexamfetamine increased QRS complex in children.
Despite small mean changes, individual responses may vary — some patients may show borderline abnormal CV readings, necessitating careful monitoring or switching medications.
The study highlights the importance of measuring baseline and follow-up BP and pulse, as per clinical guidelines.
No conclusive data on long-term cardiovascular risks — authors call for machine learning and big data approaches to identify at-risk subgroups.
A lack of racial, ethnic, and gender diversity in RCTs was identified as a limitation, impacting the generalizability of results.
Current findings support the notion that for most patients, the benefit-risk ratio favors continued use of ADHD medications under proper monitoring.

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