Exploring the Association Between Attention-Deficit/Hyperactivity Disorder and Essential Hypertension in a Pediatric Population

<b>Objective</b>: Current data on the association between attention-deficit/hyperactivity disorder (ADHD) and essential hypertension (EH) in pediatric populations are very limited, as most research has focused on adults. This study investigated the long-term prevalence of EH in Israeli youth aged 5-18 years with ADHD, examining also trends in antihypertensive medication use. <b>Methods</b>: A retrospective cohort study was conducted using data from Leumit Health Services. The ADHD cohort (N = 18,558) was compared in a 1:2 ratio to controls (N = 37,116), who were strictly matched for age, gender, birth year and quarter, socioeconomic status (SES), sectors, region, and cumulative years of LHS membership up to the index date. Diagnoses of ADHD and EH were identified using ICD-9/10 codes, depending on the year of diagnosis. Logistic regression analyses were used to assess the associations between ADHD, EH and the use of antihypertensive medications over a 20-year follow-up. <b>Results</b>: ADHD-diagnosed children had a higher prevalence of EH, with odds ratios (ORs) of 3.17 (95% CI: 1.46-7.16, <i>p</i> = 0.0017) at 5 years, 2.94 (95% CI: 1.45-6.09, <i>p</i> = 0.0013) at 10 years, and 1.92 (95% CI: 1.26-2.93, <i>p</i> = 0.0015) at 20 years. ADHD patients showed a greater use of antihypertensive medications, including calcium channel blockers (OR 1.85, 95% CI: 1.02-3.35, <i>p</i> = 0.035), renin angiotensin system blockers (OR 2.20, 95% CI: 1.15-4.25, <i>p</i> = 0.013), and diuretics (OR 1.77, 95% CI: 1.21-2.60, <i>p</i> = 0.0028). <b>Conclusions</b>: These findings highlight an association between ADHD diagnosis and EH, suggesting regular cardiovascular monitoring of children with ADHD. Further studies are needed to uncover the role of stimulant medications and shared biological and behavioral factors involved in the pathogenesis.