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2 Minute Medicine Rewind February 23, 2026
ADHD and adherence to antihypertensive medication treatment: a multinational cohort study
1. Adults with attention-deficit/hyperactivity disorder are more likely to discontinue antihypertensive therapy and demonstrate poor long-term adherence.
2. Use of attention-deficit/hyperactivity disorder medication is associated with improved adherence to antihypertensive treatment among affected individuals
Evidence Rating Level: 2 (Good)
This multinational cohort study examined whether attention-deficit/hyperactivity disorder (ADHD) is associated with discontinuation and poor adherence to antihypertensive medication among adults. Hypertension affects approximately one-third of adults worldwide and requires sustained pharmacologic treatment to reduce cardiovascular risk. ADHD, a neurodevelopmental disorder characterized by inattention and impulsivity, has been linked to increased cardiovascular risk, but its impact on antihypertensive adherence has not been well studied. Using administrative and registry data from seven countries (2010–2020), the authors identified 12,174,321 adults initiating antihypertensive therapy, including 320,691 (2.6%) with ADHD. ADHD was defined by diagnosis or ADHD medication dispensation. Outcomes included time to first discontinuation (gap >120 days) and poor adherence, defined as the proportion of days covered below 80% at 1, 2, and 5 years. Adjusted Cox and logistic regression models were pooled using random-effects meta-analysis. ADHD was associated with a higher risk of discontinuation over 5 years (hazard ratio 1.14, 95% confidence interval 1.02–1.27) and higher odds of poor adherence at 1 year (odds ratio 1.45, 95% confidence interval 1.26–1.67), persisting at 5 years (odds ratio 1.64, 95% confidence interval 1.34–2.00). Among individuals with ADHD, concurrent ADHD medication use was associated with significantly lower odds of poor adherence. The authors conclude that adults with ADHD are at higher risk of suboptimal antihypertensive adherence, and ADHD treatment may mitigate this risk.
1. In adults with overweight or obesity, performing at least 150 minutes of moderate-to-vigorous physical activity per week reduces cardiovascular risk, whether activity is concentrated in 1–2 days or distributed throughout the week.
2. Flexible activity patterns may offer a pragmatic strategy to improve adherence while preserving cardiovascular benefit in high-risk populations.
Evidence Rating Level: 2 (Good)
Cardiovascular disease (CVD) remains the leading global cause of mortality, with overweight and obesity substantially increasing risk. While current guidelines recommend at least 150 minutes per week of moderate-to-vigorous physical activity (MVPA), they emphasize distributing activity across multiple days. Whether concentrating activity within 1–2 days (“weekend warrior” pattern) confers similar benefit in adults with overweight or obesity remains uncertain. This prospective cohort study analyzed 49,368 overweight or obese UK Biobank participants (mean age 63.5 years; 51.4% women) with accelerometer-measured activity and no baseline CVD. Participants were categorized as inactive (<150 minutes/week MVPA), regularly active (≥150 minutes/week distributed over ≥3 days), or concentrated activity (≥150 minutes/week with ≥50% performed on 1–2 days). Median follow-up was 7.9 years. The primary outcome was incident fatal or nonfatal CVD (myocardial infarction, atrial fibrillation, heart failure, stroke). In fully adjusted Cox models, both concentrated and regularly active patterns were associated with similar reductions in composite CVD risk compared with inactivity (HR 0.79 [0.74–0.85] and 0.76 [0.70–0.83], respectively). Protective associations were observed across individual CVD subtypes and were consistent across subgroups and sensitivity analyses. These findings suggest that accumulating guideline-recommended MVPA—even if concentrated within 1–2 days—is associated with substantial cardiovascular benefit in adults with overweight or obesity.
1. Non-immersive virtual reality rehabilitation was feasible and safe but did not demonstrate superiority over equally intensive conventional physiotherapy for upper extremity recovery after subacute ischemic stroke.
2. Both rehabilitation approaches resulted in clinically meaningful improvements in motor function, activities of daily living, and quality of life.
Evidence Rating Level: 1 (Excellent)
Upper extremity impairment persists in 30–60% of stroke survivors at six months and significantly affects independence and quality of life. Virtual reality-based rehabilitation has been proposed as an engaging, high-intensity alternative to conventional physiotherapy, but evidence regarding its superiority remains conflicting. This multicenter, open-label, parallel-group randomized controlled trial evaluated the feasibility and efficacy of a non-immersive virtual reality-based comprehensive rehabilitation gaming system in comparison with equally intensive conventional physiotherapy in subacute ischemic stroke patients. Sixty first-ever ischemic stroke patients (1–6 months post-stroke) with mild-to-moderate upper extremity impairment were randomized to 12 weeks of therapy (45 minutes, three times weekly). The primary feasibility outcome was treatment compliance. Primary efficacy outcomes were motor function assessed by the Fugl-Meyer Assessment and Wolf Motor Function Test. Secondary outcomes included the Barthel Index and SF-36. Treatment adherence was similar between groups. Both interventions produced significant within-group improvements in motor function, activities of daily living, and quality of life. However, no statistically significant between-group differences were observed for any primary or secondary outcomes. No serious intervention-related adverse events occurred. The non-immersive virtual reality system was feasible, safe, and as effective as conventional physiotherapy, but not superior. Interpretation is limited by early trial termination and inadequate sample size.
1. In adults with cervical spinal cord injury, better self-reported fine motor ability is associated with higher life satisfaction and fewer life problems.
2. The strongest associations were observed between fine motor ability and reduced social isolation and fewer health-related problems.
Evidence Rating Level: 2 (Good)
This cross-sectional study evaluated associations between self-reported upper limb fine motor ability and quality of life in adults with cervical spinal cord injury (SCI) living in the community. Using data from a long-standing longitudinal SCI cohort, 279 individuals with injury at T1 or above completed the Spinal Cord Injury Functional Index–Fine Motor Short Form and the Life Situation Questionnaire–Revised, which measures life satisfaction and life problems. Fine motor ability demonstrated modest but statistically significant associations with quality-of-life outcomes. Better fine motor ability correlated positively with total life satisfaction (r=0.16, p=0.02) and negatively with total life problems (r=−0.18, p=0.01), particularly health problems (r=−0.24, p<0.01) and social isolation (r=−0.27, p<0.01). In multivariable regression models controlling for age, sex, race/ethnicity, and injury level, higher fine motor ability remained significantly associated with greater life satisfaction (β=0.25, p=0.02), fewer life problems (β=−0.40, p<0.01), less social isolation (β=−0.11, p<0.01), and fewer health problems (β=−0.10, p<0.01). Although effect sizes were modest, findings support a meaningful relationship between fine motor function and patient-reported well-being. The authors conclude that fine motor ability may contribute to life satisfaction and reduced secondary complications, warranting longitudinal and interventional research to explore potential causal relationships.
1. Blood pressure ≥140/90 mmHg at discharge predicts earlier postpartum admission but does not predict severity of hypertensive disease at readmission.
2. De novo postpartum hypertensive disorders account for a substantial proportion of admissions and frequently present with severe disease.
Evidence Rating Level: 2 (Good)
Hypertensive disorders of pregnancy (HDP) are a leading cause of postpartum admission (PPA), yet it is unclear whether blood pressure (BP) at discharge from delivery hospitalization predicts the severity of subsequent postpartum hypertensive complications. In this retrospective cohort study (2016–2021), 132 individuals admitted postpartum for hypertension were evaluated. The exposure was the highest BP within 24 hours prior to delivery discharge, categorized as normal (<140/90 mmHg) or elevated (≥140/90 mmHg). The primary outcome was HDP severity at PPA, measured using a composite Severity Score incorporating sustained severe BP, laboratory abnormalities, pulmonary edema, posterior reversible encephalopathy syndrome, and eclampsia. Severity of HDP at PPA did not differ between patients discharged with normal versus elevated BP (adjusted β −0.11, 95% CI −0.33 to 0.11). However, elevated discharge BP was associated with earlier readmission (median 3 vs 5 days; adjusted β −1.59, 95% CI −3.06 to −0.12). Severe presentations were common in both groups, and 49% experienced worsening HDP diagnoses. Notably, 27% of admissions represented de novo postpartum HDP. These findings suggest that discharge BP ≥140/90 mmHg predicts earlier, but not more severe, postpartum hypertensive admissions, and highlight the substantial burden of newly presenting postpartum hypertension.
Image: PD
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