315\u2005Longitudinal study of blood pressure among children and adolescents with ADHD suggests high levels of stress and anxiety during the COVID-19 pandemic lockdown

Abstract

BackgroundThe whole world is experiencing an unprecedented period of severe social disruption and economic downturn due to global spread of a rare new strain of Severe Acute Respiratory Syndrome (SARS) virus called Coronavirus. Children and Young people (CYP) are less likely to have severe symptoms from acute COVID-19 infections, but they are more prone to possible several adverse mental health outcomes. Social isolation (eg, marital status, number of close friends and relatives, religious or other group affiliations) is known to be a major cause of stress and risk factor for cardiovascular disease including elevated Blood Pressure (BP) and Heart rates (HR).ObjectivesThis study aimed to analyse the effect of the UK pandemic national lockdown on the cardiovascular health (CVH) of CYP with ADHD regularly followed up in a North West England Community Child Health Clinic. We compared the BP and HR measurements for the CYP before and after the COVID-19 pandemic lockdown (CPL) to assess its effects on their CVH.MethodsThe CVH of 57 CYP with ADHD was prospectively studied during their clinic reviews, before and after the official commencement of the national UK lockdown on the 26th March 2020. Pre-Hypertension (PreHT)/Elevate BP (EBP) and Hypertension (HT) were defined using both the Great Britain reference charts (between 91st and 98th centile or above 98th centile for age) and the US-based recommendations (between 90th and 95th centile or above 95 percentile for gender, age and height) respectively. The centiles for HR measurements were derived from the published reference data from existing international studies of normal children. Student paired T-test was used for comparison of pre/post CPL BP/HR data.ResultsThe clinical characteristics of CYP seen before and after the CPL were similar in terms of average age, number of co-morbidities, use of medications and gender distribution.The HR, diastolic and systolic BP of all the CYP with ADHD significantly increased during the CPL (p<0.001). There was two- to four-fold increase in the number of the CYP with HT, PreHT/EBP measured after the CPL (figure 1). Diastolic BP elevation accounted for 89% to 100% of the abnormal BP measurements. This increase in measured BP and HR could not be attributed to any prescribed ADHD medications as the patients had been on the same medications and unchanged dosage for an average of more than 16 months, all within the lower range of normal doses.There was statistically significant correlation between the elevated systolic and diastolic BP, and the number of weeks from the inception of the CPL.All the CYP with elevated BP are being closely monitored in the clinic and at home. The elevated BP measurements have gradually resolved as the lockdown was eased and no long-term negative consequences have been observed.ConclusionsWe conclude that the CPL was associated with transient and reversible increase in the BP and HR of CYP with background diagnosis of ADHD and other co-morbid neurodevelopmental disorders. This is probably an indication of the psychological distress associated with the pandemic affecting CYP, as also previously described for adults.