Adults with attention-deficit/hyperactivity disorder are at higher risk of poor long-term adherence to antihypertensive therapy

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.

Click here to read this study in BMC Medicine

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