NIMH, Bethesda, MD, USA.
Am J Psychiatry. 2012 Feb;169(2):167-77. doi: 10.1176/appi.ajp.2011.10111705.
It is unknown whether prolonged childhood exposure to stimulant medication for the treatment of attention deficit hyperactivity disorder (ADHD) increases the risk for developing abnormalities in blood pressure or heart rate. The authors examined the association between stimulant medication and blood pressure and heart rate over 10 years.
A total of 579 children, ages 7–9, were randomly assigned to 14 months of medication treatment, behavioral therapy, the combination of the two, or usual community treatment. The controlled trial was followed by naturalistic treatment with periodic assessments. Blood pressure and heart rate data were first analyzed with linear regression models based on an intent-to-treat approach, using raw data and the blood pressure categories of prehypertension and hypertension. Currently medicated patients were then compared with never or previously medicated patients. Associations between cumulative stimulant exposure and blood pressure or heart rate were assessed.
No treatment effect on either systolic or diastolic blood pressure could be detected. Children who were treated with stimulants had a higher heart rate (mean=84.2 bpm [SD=12.4] on medication alone and mean=84.6 bpm [SD=12.2] on medication plus behavioral therapy) than those who were treated with behavioral therapy alone (mean=79.1 bpm [SD=12.0]) or those who received usual community treatment (mean=78.9 bpm [SD=12.9]) at the end of the 14-month controlled trial, but not thereafter. Stimulant medication did not increase the risk for tachycardia, but greater cumulative stimulant exposure was associated with a higher heart rate at years 3 and 8.
Stimulant treatment did not increase the risk for prehypertension or hypertension over the 10-year period of observation. However, stimulants had a persistent adrenergic effect on heart rate during treatment.
目前尚不清楚儿童长期接受治疗注意缺陷多动障碍（ADHD）的兴奋剂药物治疗是否会增加血压或心率异常的风险。作者研究了兴奋剂药物与 10 年期间血压和心率之间的关联。
共有 579 名年龄在 7-9 岁的儿童被随机分配接受 14 个月的药物治疗、行为治疗、两者的联合治疗或常规社区治疗。该对照试验随后进行了自然治疗，并定期进行评估。首先使用线性回归模型基于意向治疗方法分析血压和心率数据，使用原始数据和高血压前期和高血压的血压类别。然后将目前正在接受药物治疗的患者与从未接受过药物治疗或以前接受过药物治疗的患者进行比较。评估累积兴奋剂暴露与血压或心率之间的关联。
未检测到治疗对收缩压或舒张压的任何影响。单独接受兴奋剂治疗的儿童心率较高（药物治疗时平均为 84.2 bpm [SD=12.4]，药物治疗加行为治疗时平均为 84.6 bpm [SD=12.2]），而单独接受行为治疗的儿童（平均为 79.1 bpm [SD=12.0]）或接受常规社区治疗的儿童（平均为 78.9 bpm [SD=12.9]）在 14 个月的对照试验结束时，但此后并非如此。兴奋剂药物治疗并未增加心动过速的风险，但累积兴奋剂暴露量越大，在第 3 年和第 8 年的心率越高。
在 10 年的观察期间，兴奋剂治疗并未增加高血压前期或高血压的风险。然而，兴奋剂在治疗期间对心率有持续的肾上腺素能作用。
