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ADHD Linked to Poor Antihypertensive Adherence, Medication Improves Outcomes, Reveals Research
Sweden: Researchers have discovered in a new study that adults with attention-deficit/hyperactivity disorder (ADHD) are more likely to discontinue antihypertensive medications and show poor long-term treatment adherence. However, the use of ADHD medications is associated with significantly improved adherence to antihypertensive therapy among these individuals.
The multinational cohort study, published in BMC Medicine, provides good-quality evidence (Evidence Rating Level: 2) that effective management of ADHD can positively influence adherence to cardiovascular treatments.
Hypertension control relies not only on lifestyle modification but also on sustained use of prescribed medications. ADHD, a common neurodevelopmental condition, has been linked to elevated cardiovascular risk, including hypertension. At the same time, certain ADHD medications have been associated with increases in blood pressure, raising clinical concerns. Until now, however, little was known about whether ADHD itself—or its treatment—affects long-term persistence with antihypertensive therapy.
To address this gap, Honghui Yao from the Department of Medical Epidemiology and Biostatistics at Karolinska Institute, Stockholm, and colleagues conducted a large multinational cohort study using electronic health records from seven countries across Europe, North America, and Australia. The study included adults who began antihypertensive treatment between 2010 and 2020. ADHD status was determined through recorded diagnoses or prescriptions for ADHD medications.
The researchers evaluated two primary outcomes: time to first discontinuation of antihypertensive therapy and poor adherence, defined as a proportion of days covered (PDC) below 80% during follow-up periods of one, two, and five years. Statistical analyses adjusted for age, sex, and calendar year, with country-specific findings combined using random-effects meta-analysis.
The key findings were as follows:
- The study included over 12.1 million adults who initiated antihypertensive therapy, of whom approximately 320,000 (2.6%) had ADHD.
- Over a five-year follow-up, adults with ADHD had a 14% higher rate of discontinuing antihypertensive medications compared to those without ADHD (HR 1.14).
- Age-stratified analysis revealed a significantly higher discontinuation risk among middle-aged and older adults, but not among younger adults.
- ADHD was associated with consistently poorer adherence to antihypertensive medications.
- One year after treatment initiation, adults with ADHD had 45% higher odds of poor adherence compared to those without ADHD (OR 1.45).
- The gap in adherence widened over time, with 64% higher odds of poor adherence at five years among individuals with ADHD (OR 1.64).
- Among individuals with ADHD, those receiving ADHD medications demonstrated better adherence to antihypertensive therapy.
- ADHD pharmacotherapy was associated with significantly lower odds of poor adherence at one year (OR 0.66) and at five years (OR 0.58).
The authors caution that the findings are observational and may be influenced by unmeasured factors such as socioeconomic status or comorbidities. Additionally, the study drew data exclusively from high-income countries, which may limit the generalizability of its findings. However, the results highlight the need for clinicians to recognize the challenges faced by adults with ADHD in maintaining consistent medication use.
“Targeted interventions—including structured follow-up, patient education, and practical adherence tools—may help improve long-term cardiovascular outcomes in this vulnerable population,” the study stated.
Reference:
Yao, H., Zhou, Y., Li, L. et al. ADHD and adherence to antihypertensive medication treatment: a multinational cohort study. BMC Med 24, 122 (2026). https://doi.org/10.1186/s12916-026-04714-1
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