Attention deficit hyperactivity disorder (ADHD) is a condition that can make it difficult for individuals to focus and manage daily task. It is also linked to a higher risk of high blood pressure and other heart problems. Control of high blood pressure often requires taking medications regularly, however, people with ADHD may find this challenging due to symptoms like impulsivity and inattention. This study aims to understand how ADHD and its treatments affect how well people adhere to their blood pressure medications.
We will investigate if individuals with ADHD are more likely to stop taking their blood pressure medications compared to those without ADHD. Additionally, we will also examine if ADHD medications can improve adherence to blood pressure treatments among people with ADHD.
Using data from CPRD, we will follow a large group of adults who began taking blood pressure medications between 2001 and 2020. We will analyse how long it takes for patients to stop their medications and how consistently they take them over different periods.
Understanding these relationships can help doctors better support patients with ADHD in managing their blood pressure, potentially leading to improved health outcomes. Given the widespread use of blood pressure medications and increasing recognition of ADHD, our findings could influence clinical practices and health policies globally, ultimately helping patients make better-informed decisions about their treatments.
Attention deficit hyperactivity disorder (ADHD) poses long-lasting and debilitating impact in various aspects of an individual’s life. In adulthood, the more overtly disruptive ADHD symptoms experienced in childhood often shift into more subtle symptoms such as inner restlessness, inattention, disorganisation, and difficulties in executive functioning. ADHD is also associated with a wide range of cardiovascular diseases, including hypertension.
This study aims to evaluate the impact of ADHD and ADHD medication on adherence to antihypertensive medications. Hypertension management critically depends on medication adherence, yet individuals with ADHD may struggle due to symptoms, potentially leading to poorer outcomes.
We will employ a population-based cohort design using data from the Clinical Practice Research Datalink (CPRD). Our study will include adults aged 18 or above who initiated antihypertensive medication between 1st January, 2001 and 31st December, 2020.
The primary objective is to assess the association between ADHD and the time to first discontinuation of antihypertensive medication. We will also evaluate the persistence of antihypertensive medication, measured by the proportion of days covered (PDC) over 1-, 2-, and 5-year follow-up periods, with PDC < 80% defined as "poor persistence". Additionally, we will investigate the impact of ADHD medication on antihypertensive persistence in individuals with ADHD.
We will use Cox regression to estimate hazard ratios (HRs) for the time to first discontinuation, and logistic regression to analyse patients with PDC defined as “poor persistence”, adjusting for relevant covariates such as age, sex, ethnicity, other cardiometabolic medications and conditions, and comorbid psychiatric conditions. Subgroup and sensitivity analyses will be conducted to provide a comprehensive understanding of the relationships between ADHD, ADHD medication, and antihypertensive medication adherence.
This research will provide insights into how ADHD impact the management of hypertension, potentially informing targeted interventions to improve medication adherence and overall clinical outcomes in patients prescribed with antihypertensive medications.
Primary outcome:
First antihypertensive medication discontinuation: It will be defined as a gap of more than 30 days between consecutive prescriptions1 in the primary analysis.
Secondary outcome:
Proportion of days covered (PDC): PDC will be calculated by calculating the proportion of days in which a person has access to the antihypertensive medication over a given period of interest.2 PDC = (Sum of days covered by antihypertensive medication in time frame) ÷ (number of days in time frame) × 100%. PDC will be calculated over 1-, 2- and 5-years follow-up lengths after the first prescription start date. PDC < 80% will be defined as "poor persistence".3-6
Kenneth Man - Chief Investigator - University College London ( UCL )
Siu Chung Andrew Yuen - Corresponding Applicant - University College London ( UCL )
Ian Wong - Collaborator - University College London ( UCL )
HES Admitted Patient Care;ONS Death Registration Data;Patient Level Index of Multiple Deprivation;Practice Level Index of Multiple Deprivation