Monitoring the Cardiovascular Effects for Children Taking Medication for Attention Deficit/Hyperactivity Disorder (ADHD): Are We following The NICE Guidelines?

Background: Many children and adolescents with attention deficit/hyperactivity disorder (ADHD) are treated with stimulant and non-stimulant medication. These medications may be associated with cardiovascular effects. Thus, patients should be monitored for changes in blood pressure and pulse during treatment as per NICE guidelines.

Objectives: To assess whether cardiovascular effects for children receiving ADHD medication are monitored according to the NICE guidelines.

Methods: A retrospective analysis of clinic letters was undertaken for cardiovascular monitoring of heart rate and blood pressure of ADHD patients diagnosed between March 2018 and March 2020.

Results: 50 patients had baseline assessment at the time of first prescription of ADHD medications.37/50 (74%) were males while 13/50(26%) were females. Median age: 10 years ±2.38. Methylphenidate hydrochloride prescribed in 94% of patients whilst Guanfacine and Lisdexamfetamine prescribed in 4% and 2% respectively.

Blood pressure (BP) was not recorded in 10/50 (20%). BP recorded but not plotted on centile charts in 11/50 (22%). BP plotted on centile charts in 29/50 (58%). Heart rate was monitored in only 31/50 (62%) of patients.

30/50 patients had first follow-up after 6 months of starting ADHD medication. Blood pressure was not recorded in 6/30(20%). BP recorded but not plotted on centile charts in 5/30 (17%). BP plotted on centile charts in 19/30 (63%). Heart rate was monitored in 19/30 (63%).

17/50 patients had a second follow-up after 12 months. Blood pressure was not recorded in 2/17 (12%). BP recorded but not plotted on centile charts in 3 /17 (18%) and 12/17 (70%) of patients had their BP plotted on centile charts. Heart rate was monitored in 13/17 (76%).

Conclusion: Despite clear national guidelines for monitoring cardiovascular effects of ADHD medication, there is still a wide variation in practice among clinicians.