(CSPOT08) The Relationships Between ADHD/ADHD Medication and the Persistence of Anti-Hypertensive Medication?

Background: The persistence of anti-hypertensive medication use is crucial for management of hypertension. Attention deficit hyperactivity disorder (ADHD) is a common neurodevelopmental disorder associated with a wide range of cardiovascular diseases, including hypertension. ADHD medication is also found to be associated with an increased risk of hypertension. However, the influence of ADHD and ADHD medication on the discontinuation of anti-hypertensive treatments remains unexplored.

Objectives: This study aims to investigate the influence of ADHD and ADHD medication use on the discontinuation of anti-hypertensive medication among adults.

Methods: Design
A multi-country cohort study.
Setting
Utilizing data from national registers and electronic health records spanning January 1, 2009, to December 31, 2020, from eight countries, including adults aged 18 and above who commenced anti-hypertensive medication (ATC codes: C03, C08, C09) between 2010 and 2020, with a minimum 1-year washout period prior to initiation. Individuals who received a diagnosis of major adverse cardiovascular events (MACE) before or at baseline were excluded.
Exposure and interventions
ADHD (ICD codes: F90) and ADHD medications (ATC codes: N06BA01, N06BA02, N06BA04, N06BA09, N06BA12, C02AC02).
Main outcome measures
Time to first discontinuation of anti-hypertensive medication and the proportion of days covered (PDC).
Statistical analysis
Cox regression to assess the link between ADHD and antihypertensive treatment discontinuation; logistic regression for evaluating ADHD/ADHD medication impact on medication persistence. Poor persistence is indicated by a PDC under 80%. A meta-analysis will synthesize results across countries.

Results: Preliminary results from Sweden showed that Individuals with ADHD exhibited a 4% higher rate of initial anti-hypertensive medication discontinuation (HR 1.04, 95% CI 1.03-1.06) and a 37% higher rate of poor medication adherence (HR 1.37, 95% CI 1.32-1.43). Sex-stratified analyses showed a 43% increase in risk for males and 40% for females with ADHD (Male: HR 1.43, 95% CI 1.35-1.52; Female: HR 1.40, 95% CI 1.32-1.49). ADHD medication usage was associated with a significantly lower risk of poor persistence (OR 0.64, 95% CI 0.50-0.82).

Conclusions: ADHD significantly increases the risk of discontinuing anti-hypertensive medication and poor adherence. Conversely, ADHD medication use is associated with improved persistence in anti-hypertensive medication use.