Jan Schulz1, Franziska Huber1, Robert Schlack2, Heike Hölling2, Ulrike Ravens-Sieberer3, Thomas Meyer4,5, Luise Poustka1, Aribert Rothenberger1, Biyao Wang1,6, Andreas Becker1. 1. Department of Child and Adolescent Psychiatry and Psychotherapy, University Medical Center Göttingen, 37075 Göttingen, Germany. 2. Robert Koch Institute, Department of Epidemiology and Health Monitoring, Unit Mental Health, 13353 Berlin, Germany. 3. Department of Child and Adolescent Psychiatry, Psychotherapy and Psychosomatics, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany. 4. Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Göttingen, 37075 Göttingen, Germany. 5. German Centre for Cardiovascular Research, Partner Site Göttingen, 10115 Berlin, Germany. 6. Department of Clinical, Educational and Health Psychology, University College London, London WC1H 0AP, UK.
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.
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.
Authors: Mark Wolraich; Lawrence Brown; Ronald T Brown; George DuPaul; Marian Earls; Heidi M Feldman; Theodore G Ganiats; Beth Kaplanek; Bruce Meyer; James Perrin; Karen Pierce; Michael Reiff; Martin T Stein; Susanna Visser Journal: Pediatrics Date: 2011-10-16 Impact factor: 7.124
Authors: Guilherme Polanczyk; Maurício Silva de Lima; Bernardo Lessa Horta; Joseph Biederman; Luis Augusto Rohde Journal: Am J Psychiatry Date: 2007-06 Impact factor: 18.112
Authors: J Fayyad; R De Graaf; R Kessler; J Alonso; M Angermeyer; K Demyttenaere; G De Girolamo; J M Haro; E G Karam; C Lara; J-P Lépine; J Ormel; J Posada-Villa; A M Zaslavsky; R Jin Journal: Br J Psychiatry Date: 2007-05 Impact factor: 9.319
Authors: Sarah Durston; Hilleke E Hulshoff Pol; Hugo G Schnack; Jan K Buitelaar; Mark P Steenhuis; Ruud B Minderaa; René S Kahn; Herman van Engeland Journal: J Am Acad Child Adolesc Psychiatry Date: 2004-03 Impact factor: 8.829
Authors: H Hölling; P Kamtsiuris; M Lange; W Thierfelder; M Thamm; R Schlack Journal: Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz Date: 2007 May-Jun Impact factor: 1.513
Authors: Dorothee Busold-Hagenbeck; Julia Elmenhorst; Christoph Irtel von Brenndorff; Reinhard Hilgers; Martin Hulpke-Wette Journal: Gen Psychiatr Date: 2020-04-26
Authors: Susan M Hailpern; Brent M Egan; Kimberly D Lewis; Carol Wagner; Ghassan F Shattat; Doaa I Al Qaoud; Ibrahim F Shatat Journal: Front Pediatr Date: 2014-09-19 Impact factor: 3.418