ADHD and adherence to antihypertensive medication treatment: a multinational cohort study

Honghui Yao; Yiling Zhou; Lin Li; Malcolm B. Gillies; Isabell Brikell; Le Gao; Theresa Wimberley; Tian Xie; Yanli Zhang-James; Aske Astrup; Søren Dalsgaard; Birgitte Dige Semark; Anders Engeland; Stephen V. Faraone; Kari Klungsøyr; Henrik Larsson; Kenneth K. C. Man; Harold Snieder; Ian C. K. Wong; Andrew S. C. Yuen; Helga Zoega; Catharina Hartman; Zheng Chang

doi:10.1186/s12916-026-04714-1

ADHD and adherence to antihypertensive medication treatment: a multinational cohort study

Honghui Yao
, Yiling Zhou
, Lin Li
, Malcolm B. Gillies
, Isabell Brikell
, Le Gao
, Theresa Wimberley
, Tian Xie
, Yanli Zhang-James
, Aske Astrup
, Søren Dalsgaard
, Birgitte Dige Semark
, Anders Engeland
, Stephen V. Faraone
, Kari Klungsøyr
, Henrik Larsson
, Kenneth K. C. Man
, Harold Snieder
, Ian C. K. Wong
, Andrew S. C. Yuen

Helga Zoega, Catharina Hartman, Zheng Chang^*

^*Corresponding author for this work

Research output: Contribution to journal › Article › peer-review

Abstract

Background:
Adherence to antihypertensive medication, alongside lifestyle modifications, is fundamental to managing hypertension and reducing the risk of cardiovascular disease. Attention-deficit/hyperactivity disorder (ADHD) is a common neurodevelopmental disorder associated with a range of cardiovascular diseases, including hypertension. ADHD medication has also been associated with hypertension. However, the influence of ADHD and ADHD medication on discontinuation and adherence to antihypertensive treatments is unknown.

Methods:
We conducted a multinational cohort study using electronic health databases from seven countries, which included adults who initiated antihypertensive medication between 2010 and 2020. ADHD was identified by a diagnosis of ADHD or dispensation of ADHD medications. The outcomes were (1) time to the first discontinuation of antihypertensive medication and (2) poor adherence, defined as the proportion of days covered (PDC) below 80% during 1-, 2-, and 5-year follow-up periods. We used Cox proportional hazards models and logistic regression to estimate associations, adjusting for age, sex, and calendar year of antihypertensive medication initiation. We pooled results from different countries via random-effects meta-analysis.

Results:
We identified 12,174,321 adults who initiated antihypertensive medication during the study period, including 320,691 (2.6%) with ADHD. In the pooled analysis across all countries, ADHD was associated with an increased rate of discontinuation in 5-year follow-up of antihypertensive medication (hazard ratio [HR] 1.14; 95% CI, 1.02–1.27). In age-stratified analyses, ADHD was associated with a higher rate of antihypertensive medication discontinuation in middle-aged (HR, 1.11; 95% CI, 1.01–1.23) and older adults (HR, 1.14; 95% CI, 1.01–1.29), but not in young adults. Individuals with ADHD also had higher odds of poor adherence across 1 year after treatment initiation (odds ratio [OR] 1.45, 95% CI 1.26–1.67) to 5 years (OR 1.64, 95% CI 1.34–2.00). Among those with ADHD, use of ADHD medications was associated with lower odds of poor adherence (1 year OR 0.66, 95% CI 0.60–0.73; 5 years OR 0.58, 95% CI 0.46–0.72).

Conclusions:
Adults with ADHD are more likely to discontinue antihypertensive treatment and exhibit poor medication adherence. However, ADHD medication use appears to be associated with better adherence among individuals with ADHD.

Original language	English
Article number	122
Number of pages	13
Journal	BMC Medicine
Volume	24
Issue number	1
Early online date	20 Feb 2026
DOIs	https://doi.org/10.1186/s12916-026-04714-1
Publication status	E-pub ahead of print - 20 Feb 2026

Bibliographical note

Copyright © The Author(s) 2026. This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this
licence, visit https://creativecommons.org/licenses/by/4.0/

Data Access Statement

Country‑specific regulations and laws prohibit sharing or making the
individual‑level data in this study publicly available. Access to these data is not
possible without the permission of the relevant approving human research
ethics committees or the data custodians. Details and country‑specific data
sharing statements are provided in the supplementary materials.

Funding

Open access funding provided by Karolinska Institute. This research is supported by the European Union Horizon 2020 Research and Innovation Programme (grant 965381). This study was additionally supported by the Australian National Health and Medical Research Council HMRC‑European Union (EU) Collaborative Research Grant (ID: APP2007048), the NHMRC Centre of Research Excellence in Medicines Intelligence (ID: 1196900), the UNSW Research Infrastructure Scheme, Swedish Heart‑Lung Foundation (20230452), Söderström König Foundation, Fredrik och Ingrid Thurings Stiftels, and Karolinska Institutet Research Foundation. Dr. Dalsgaard’s research is supported by grants from the Sawmill‑owner Jeppe Juhl’s and wife Ovita Juhl’s Fund, The Capital Region (grant No 22042850), and from Greater Copenhagen Health Science Partners (CAG Precision Psychiatry, A7763). Henrik Larsson acknowledges financial support from the Swedish Research Council (2022‑01119; 2024‑06592). Zheng Chang acknowledges financial support from theSwedish Research Council (2024‑02766). Dr. Faraone’s research is supported by grants from the European Union’s Horizon 2020 research and innovation programme under grant agreement 965381; NIH/NIMH grants U01AR076092, R01MH116037, 1R01NS128535, R01MH131685, 1R01MH130899, U01MH135970, 5R01AG064955, Massachusetts General, Otsuka Pharmaceuticals OAK‑ISS‑2023‑001796, Oregon Health & Science University and Supernus Pharmaceuticals. His continuing medical education programs are supported by Noven, Supernus Pharmaceuticals, and The Upstate Foundation.

Keywords

ADHD
Antihypertensive agents
Medication adherence

Access to Document

10.1186/s12916-026-04714-1Licence: CC BY 4.0

H Yao et al_ADHD and adherence to antihypertensive medication treatment_multinational cohort study
Copyright © The Author(s) 2026. This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit https://creativecommons.org/licenses/by/4.0/
Final published version, 1.58 MBLicence: CC BY 4.0

Cite this

Yao, H., Zhou, Y., Li, L., Gillies, M. B., Brikell, I., Gao, L., Wimberley, T., Xie, T., Zhang-James, Y., Astrup, A., Dalsgaard, S., Semark, B. D., Engeland, A., Faraone, S. V., Klungsøyr, K., Larsson, H., Man, K. K. C., Snieder, H., Wong, I. C. K., ... Chang, Z. (2026). ADHD and adherence to antihypertensive medication treatment: a multinational cohort study. BMC Medicine, 24(1), Article 122. Advance online publication. https://doi.org/10.1186/s12916-026-04714-1

@article{c1f59d137cf2433e8489060da8e20417,

title = "ADHD and adherence to antihypertensive medication treatment: a multinational cohort study",

abstract = "Background: Adherence to antihypertensive medication, alongside lifestyle modifications, is fundamental to managing hypertension and reducing the risk of cardiovascular disease. Attention-deficit/hyperactivity disorder (ADHD) is a common neurodevelopmental disorder associated with a range of cardiovascular diseases, including hypertension. ADHD medication has also been associated with hypertension. However, the influence of ADHD and ADHD medication on discontinuation and adherence to antihypertensive treatments is unknown. Methods: We conducted a multinational cohort study using electronic health databases from seven countries, which included adults who initiated antihypertensive medication between 2010 and 2020. ADHD was identified by a diagnosis of ADHD or dispensation of ADHD medications. The outcomes were (1) time to the first discontinuation of antihypertensive medication and (2) poor adherence, defined as the proportion of days covered (PDC) below 80\% during 1-, 2-, and 5-year follow-up periods. We used Cox proportional hazards models and logistic regression to estimate associations, adjusting for age, sex, and calendar year of antihypertensive medication initiation. We pooled results from different countries via random-effects meta-analysis. Results: We identified 12,174,321 adults who initiated antihypertensive medication during the study period, including 320,691 (2.6\%) with ADHD. In the pooled analysis across all countries, ADHD was associated with an increased rate of discontinuation in 5-year follow-up of antihypertensive medication (hazard ratio [HR] 1.14; 95\% CI, 1.02–1.27). In age-stratified analyses, ADHD was associated with a higher rate of antihypertensive medication discontinuation in middle-aged (HR, 1.11; 95\% CI, 1.01–1.23) and older adults (HR, 1.14; 95\% CI, 1.01–1.29), but not in young adults. Individuals with ADHD also had higher odds of poor adherence across 1 year after treatment initiation (odds ratio [OR] 1.45, 95\% CI 1.26–1.67) to 5 years (OR 1.64, 95\% CI 1.34–2.00). Among those with ADHD, use of ADHD medications was associated with lower odds of poor adherence (1 year OR 0.66, 95\% CI 0.60–0.73; 5 years OR 0.58, 95\% CI 0.46–0.72). Conclusions: Adults with ADHD are more likely to discontinue antihypertensive treatment and exhibit poor medication adherence. However, ADHD medication use appears to be associated with better adherence among individuals with ADHD.",

keywords = "ADHD, Antihypertensive agents, Medication adherence",

author = "Honghui Yao and Yiling Zhou and Lin Li and Gillies, \{Malcolm B.\} and Isabell Brikell and Le Gao and Theresa Wimberley and Tian Xie and Yanli Zhang-James and Aske Astrup and S{\o}ren Dalsgaard and Semark, \{Birgitte Dige\} and Anders Engeland and Faraone, \{Stephen V.\} and Kari Klungs{\o}yr and Henrik Larsson and Man, \{Kenneth K. C.\} and Harold Snieder and Wong, \{Ian C. K.\} and Yuen, \{Andrew S. C.\} and Helga Zoega and Catharina Hartman and Zheng Chang",

note = "Copyright {\textcopyright} The Author(s) 2026. This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article{\textquoteright}s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article{\textquoteright}s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit https://creativecommons.org/licenses/by/4.0/",

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doi = "10.1186/s12916-026-04714-1",

language = "English",

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Yao, H, Zhou, Y, Li, L, Gillies, MB, Brikell, I, Gao, L, Wimberley, T, Xie, T, Zhang-James, Y, Astrup, A, Dalsgaard, S, Semark, BD, Engeland, A, Faraone, SV, Klungsøyr, K, Larsson, H, Man, KKC, Snieder, H, Wong, ICK, Yuen, ASC, Zoega, H, Hartman, C & Chang, Z 2026, 'ADHD and adherence to antihypertensive medication treatment: a multinational cohort study', BMC Medicine, vol. 24, no. 1, 122. https://doi.org/10.1186/s12916-026-04714-1

TY - JOUR

T1 - ADHD and adherence to antihypertensive medication treatment: a multinational cohort study

AU - Yao, Honghui

AU - Zhou, Yiling

AU - Li, Lin

AU - Gillies, Malcolm B.

AU - Brikell, Isabell

AU - Gao, Le

AU - Wimberley, Theresa

AU - Xie, Tian

AU - Zhang-James, Yanli

AU - Astrup, Aske

AU - Dalsgaard, Søren

AU - Semark, Birgitte Dige

AU - Engeland, Anders

AU - Faraone, Stephen V.

AU - Klungsøyr, Kari

AU - Larsson, Henrik

AU - Man, Kenneth K. C.

AU - Snieder, Harold

AU - Wong, Ian C. K.

AU - Yuen, Andrew S. C.

AU - Zoega, Helga

AU - Hartman, Catharina

AU - Chang, Zheng

N1 - Copyright © The Author(s) 2026. This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit https://creativecommons.org/licenses/by/4.0/

PY - 2026/2/20

Y1 - 2026/2/20

N2 - Background: Adherence to antihypertensive medication, alongside lifestyle modifications, is fundamental to managing hypertension and reducing the risk of cardiovascular disease. Attention-deficit/hyperactivity disorder (ADHD) is a common neurodevelopmental disorder associated with a range of cardiovascular diseases, including hypertension. ADHD medication has also been associated with hypertension. However, the influence of ADHD and ADHD medication on discontinuation and adherence to antihypertensive treatments is unknown. Methods: We conducted a multinational cohort study using electronic health databases from seven countries, which included adults who initiated antihypertensive medication between 2010 and 2020. ADHD was identified by a diagnosis of ADHD or dispensation of ADHD medications. The outcomes were (1) time to the first discontinuation of antihypertensive medication and (2) poor adherence, defined as the proportion of days covered (PDC) below 80% during 1-, 2-, and 5-year follow-up periods. We used Cox proportional hazards models and logistic regression to estimate associations, adjusting for age, sex, and calendar year of antihypertensive medication initiation. We pooled results from different countries via random-effects meta-analysis. Results: We identified 12,174,321 adults who initiated antihypertensive medication during the study period, including 320,691 (2.6%) with ADHD. In the pooled analysis across all countries, ADHD was associated with an increased rate of discontinuation in 5-year follow-up of antihypertensive medication (hazard ratio [HR] 1.14; 95% CI, 1.02–1.27). In age-stratified analyses, ADHD was associated with a higher rate of antihypertensive medication discontinuation in middle-aged (HR, 1.11; 95% CI, 1.01–1.23) and older adults (HR, 1.14; 95% CI, 1.01–1.29), but not in young adults. Individuals with ADHD also had higher odds of poor adherence across 1 year after treatment initiation (odds ratio [OR] 1.45, 95% CI 1.26–1.67) to 5 years (OR 1.64, 95% CI 1.34–2.00). Among those with ADHD, use of ADHD medications was associated with lower odds of poor adherence (1 year OR 0.66, 95% CI 0.60–0.73; 5 years OR 0.58, 95% CI 0.46–0.72). Conclusions: Adults with ADHD are more likely to discontinue antihypertensive treatment and exhibit poor medication adherence. However, ADHD medication use appears to be associated with better adherence among individuals with ADHD.

AB - Background: Adherence to antihypertensive medication, alongside lifestyle modifications, is fundamental to managing hypertension and reducing the risk of cardiovascular disease. Attention-deficit/hyperactivity disorder (ADHD) is a common neurodevelopmental disorder associated with a range of cardiovascular diseases, including hypertension. ADHD medication has also been associated with hypertension. However, the influence of ADHD and ADHD medication on discontinuation and adherence to antihypertensive treatments is unknown. Methods: We conducted a multinational cohort study using electronic health databases from seven countries, which included adults who initiated antihypertensive medication between 2010 and 2020. ADHD was identified by a diagnosis of ADHD or dispensation of ADHD medications. The outcomes were (1) time to the first discontinuation of antihypertensive medication and (2) poor adherence, defined as the proportion of days covered (PDC) below 80% during 1-, 2-, and 5-year follow-up periods. We used Cox proportional hazards models and logistic regression to estimate associations, adjusting for age, sex, and calendar year of antihypertensive medication initiation. We pooled results from different countries via random-effects meta-analysis. Results: We identified 12,174,321 adults who initiated antihypertensive medication during the study period, including 320,691 (2.6%) with ADHD. In the pooled analysis across all countries, ADHD was associated with an increased rate of discontinuation in 5-year follow-up of antihypertensive medication (hazard ratio [HR] 1.14; 95% CI, 1.02–1.27). In age-stratified analyses, ADHD was associated with a higher rate of antihypertensive medication discontinuation in middle-aged (HR, 1.11; 95% CI, 1.01–1.23) and older adults (HR, 1.14; 95% CI, 1.01–1.29), but not in young adults. Individuals with ADHD also had higher odds of poor adherence across 1 year after treatment initiation (odds ratio [OR] 1.45, 95% CI 1.26–1.67) to 5 years (OR 1.64, 95% CI 1.34–2.00). Among those with ADHD, use of ADHD medications was associated with lower odds of poor adherence (1 year OR 0.66, 95% CI 0.60–0.73; 5 years OR 0.58, 95% CI 0.46–0.72). Conclusions: Adults with ADHD are more likely to discontinue antihypertensive treatment and exhibit poor medication adherence. However, ADHD medication use appears to be associated with better adherence among individuals with ADHD.

KW - ADHD

KW - Antihypertensive agents

KW - Medication adherence

UR - https://link.springer.com/article/10.1186/s12916-026-04714-1

UR - https://www.scopus.com/pages/publications/105030999112

U2 - 10.1186/s12916-026-04714-1

DO - 10.1186/s12916-026-04714-1

M3 - Article

SN - 1741-7015

VL - 24

JO - BMC Medicine

JF - BMC Medicine

IS - 1

M1 - 122

ER -

ADHD and adherence to antihypertensive medication treatment: a multinational cohort study

Abstract

Bibliographical note

Data Access Statement

Funding

Keywords

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