Use of psychostimulants in adult ADHD: Cardiovascular safety assessment in clinical practice

Adult Attention-Deficit/Hyperactivity Disorder (ADHD) is increasingly recognized as a persistent neurodevelopmental condition, leading to a substantial rise in psychostimulant prescriptions among adults. Although methylphenidate and amphetamine derivatives are highly effective in controlling core ADHD symptoms through catecholaminergic modulation, their sympathomimetic effects raise concerns regarding cardiovascular safety. This narrative and integrative review synthesized evidence from randomized controlled trials, observational studies, meta-analyses, and international clinical guidelines retrieved from PubMed/MEDLINE, Scopus, and Web of Science to evaluate the cardiovascular risk profile associated with psychostimulant use in adults. Available data consistently demonstrate modest, dose-dependent increases in systolic and diastolic blood pressure and heart rate. In adults without pre-existing structural heart disease, the absolute risk of major adverse cardiovascular events remains low. However, emerging longitudinal evidence suggests that cumulative exposure may be associated with an increased risk of hypertension and arterial disease. Comprehensive pre-treatment cardiovascular assessment, individualized risk stratification, and regular monitoring of hemodynamic parameters are essential to optimize safety. A multidisciplinary approach is recommended for patients with pre-existing cardiovascular conditions. Overall, psychostimulants can be used safely in most adults with appropriate screening and long-term vigilance.