The short-term and longer-term cardiovascular safety of high daily doses of OROS methylphenidate (MPH) of up to 1.5 mg/kg in 114 adolescents with ADHD is reported from Massachusetts General Hospital, Boston, MA. Small but statistically significant increase in diastolic BP and heart rate were observed at 6 weeks, without further increases up to 6 months’ follow-up. The mean total daily dose of OROS-MPH at 6 weeks was 63.1 +/- 25.0 mg; 50% of subjects were taking >72 mg daily; at month 6 these doses were 67.2 +/- 24.3 mg and >72 mg, respectively. A small but statistically significant increase in systolic BP was observed over time. No changes in ECG were observed and no serious cardiovascular adverse events occurred. 
COMMENT. Small but statistically significant increases in blood pressure and heart rate were observed in adolescents treated with relatively higher doses of OROS methylphenidate, without changes in the ECG. The CV effects noted in adolescents with higher doses were similar to the previously documented effects in children with lower doses of OROS-MPH. In an editorial, Dr Stephen R Daniels advises caution in patients with BP elevation or tachycardia .