Drugs for attention deficit-hyperactivity disorder do not increase the mid-term risk of sudden death in children: A meta-analysis of observational studies

Attention-deficit/hyperactivity disorder (ADHD) is a chronic neuro-behavioralconditionthattypicallymanifestsinchildhoodandischarac-terized by a wide range of emotional, functional, and neurocognitiveimpairments that interfere with social and emotional quality of life.According to the fourth edition of the Diagnostic and Statistical Manualof Mental Disorders (DSM-IV), the diagnosis is made by confirmingnumerous symptoms in the inattention domain or the hyperactivity–impulsivity domain or both.Stimulant medications have been demonstrated to be efficaciousand are considered the first-line pharmacological therapy for ADHD[1].BecauseoftheincreasingrecognitionofADHDasachronicdisorder,theuseofmedicationsforthetreatmentofthisdiseasehasconsiderablyexpanded over the last decade, becoming common also among adoles-cents and adults in addition to prepubertal children [2].Bothstimulantsandatomoxetinehavecardiovasculareffectswithin-crease in heart rate and blood pressure. It has been calculated that theseagents can increase systolic and diastolic blood pressures (on average1–4 mm Hg) and heart rate (on average 3 –8bpm)[3].Thesechangesare not usually clinically signi ficant in the short-term, but their possiblesignificance for the long-term deserves further investigation. Besides,while a causal link between therapeutic stimulant use and sudden car-diac death has not been established, there are concerns that treatment