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The Effect of Methylphenidate and Atomoxetine on Heart Rate and Systolic Blood Pressure in Young People and Adults with Attention-Deficit Hyperactivity Disorder (ADHD): Systematic Review, Meta-Analysis, and Meta-Regression

Author

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  • Edwin F. Liang

    (Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119228, Singapore)

  • Samuel Z. Lim

    (Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119228, Singapore)

  • Wilson W. Tam

    (Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119077, Singapore)

  • Cyrus S. Ho

    (Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119228, Singapore)

  • Melvyn W. Zhang

    (National Addiction Management Service, Institute of Mental Health, Singapore 539747, Singapore)

  • Roger S. McIntyre

    (Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, ON M5T 1R8, Canada
    Institute of Medical Science, University of Toronto, Toronto, ON M5T 1R8, Canada
    Department of Psychiatry, University of Toronto, Toronto, ON M5T 1R8, Canada
    Department of Pharmacology, University of Toronto, Toronto, ON M5T 1R8, Canada)

  • Roger C. Ho

    (Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119228, Singapore)

Abstract

Objectives : This meta-analysis aims to study the effects of atomoxetine and methylphenidate on heart rate (HR), systolic blood pressure (SBP), and a number of adverse cardiac events on patients receiving treatment for attention-deficit hyperactive disorder (ADHD) in comparison to placebo and between atomoxetine and methylphenidate. Methods : We searched the following databases: PubMed, EMBASE, and ScienceDirect. Meta-analysis was performed on studies that examined the relationships between methylphenidate or atomoxetine and HR, SBP, as well as a number of adverse cardiac events. These studies were either placebo-controlled or comparison studies between methylphenidate and atomoxetine. Meta-regression identified patient- and treatment-related factors that may contribute to heterogeneity. Results : Twenty-two studies were included and the total number of participants was 46,107. Children/adolescents and adults treated with methylphenidate had more significant increases in post- vs. pre-treatment HR ( p < 0.001) and SBP ( p < 0.001) than those treated by placebo. Children and adolescents treated with atomoxetine had more significant increases post- vs. pre-treatment HR ( p = 0.025) and SBP ( p < 0.001) than those treated with methylphenidate. Meta-regression revealed mean age of participants, mean dose, and duration of atomoxetine and methylphenidate as significant moderators that explained heterogeneity. There were no differences in the number of adverse cardiac events between participants with methylphenidate treatment and placebo or atomoxetine. Conclusions : Children/adolescents and adults treated with methylphenidate resulted in significant increases in post- vs. pre-treatment HR and SBP as compared to placebo. Similarly, children and adolescents treated with atomoxetine had significant increases in post- vs. pre-treatment HR and SBP than those treated with methylphenidate. These findings have potential implications for continuous monitoring of HR and SBP throughout the course of treatment although the risk for adverse cardiac events were insignificant.

Suggested Citation

  • Edwin F. Liang & Samuel Z. Lim & Wilson W. Tam & Cyrus S. Ho & Melvyn W. Zhang & Roger S. McIntyre & Roger C. Ho, 2018. "The Effect of Methylphenidate and Atomoxetine on Heart Rate and Systolic Blood Pressure in Young People and Adults with Attention-Deficit Hyperactivity Disorder (ADHD): Systematic Review, Meta-Analysi," IJERPH, MDPI, vol. 15(8), pages 1-16, August.
  • Handle: RePEc:gam:jijerp:v:15:y:2018:i:8:p:1789-:d:164737
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    References listed on IDEAS

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    1. David Moher & Alessandro Liberati & Jennifer Tetzlaff & Douglas G Altman & The PRISMA Group, 2009. "Preferred Reporting Items for Systematic Reviews and Meta-Analyses: The PRISMA Statement," PLOS Medicine, Public Library of Science, vol. 6(7), pages 1-6, July.
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    Cited by:

    1. Kim-San Lim & Celine H. Wong & Roger S. McIntyre & Jiayun Wang & Zhisong Zhang & Bach X. Tran & Wanqiu Tan & Cyrus S. Ho & Roger C. Ho, 2019. "Global Lifetime and 12-Month Prevalence of Suicidal Behavior, Deliberate Self-Harm and Non-Suicidal Self-Injury in Children and Adolescents between 1989 and 2018: A Meta-Analysis," IJERPH, MDPI, vol. 16(22), pages 1-26, November.
    2. Nicholas Abraham & P. Buvanaswari & Rahul Rathakrishnan & Bach X. Tran & Giang Vu. Thu & Long H. Nguyen & Cyrus S. Ho & Roger C. Ho, 2019. "A Meta-Analysis of the Rates of Suicide Ideation, Attempts and Deaths in People with Epilepsy," IJERPH, MDPI, vol. 16(8), pages 1-10, April.
    3. Corrado Manni & Giada Cipollone & Alessandro Pallucchini & Angelo G. I. Maremmani & Giulio Perugi & Icro Maremmani, 2019. "Remarkable Reduction of Cocaine Use in Dual Disorder (Adult Attention Deficit Hyperactive Disorder/Cocaine Use Disorder) Patients Treated with Medications for ADHD," IJERPH, MDPI, vol. 16(20), pages 1-12, October.
    4. Elvin T. Ng & Russell Z. Ang & Bach X. Tran & Cyrus S. Ho & Zhisong Zhang & Wanqiu Tan & Yu Bai & Min Zhang & Wilson W. Tam & Roger C. Ho, 2019. "Comparing Quality of Life in Breast Cancer Patients Who Underwent Mastectomy Versus Breast-Conserving Surgery: A Meta-Analysis," IJERPH, MDPI, vol. 16(24), pages 1-10, December.

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