Comparison of the Effects of Energy Drink Versus

Cardiology

Comparison of the Effects of Energy Drink Versus Caffeine Supplementation on Indices of 24-Hour Ambulatory Blood Pressure Amy M Franks, Julia M Schmidt, Keith R McCain, and Mony Fraer

ed Bull Energy Drink was introBACKGROUND: Cardiovascular events associated with energy drink consumption duced to the US in 1997, spawning a have been reported, but few data exist to delineate the hemodynamic effects of 1 new category within the beverage market. energy drinks. Energy drink is a broad term encompassOBJECTIVE: To compare the effects of an energy drink versus caffeine suppleing numerous manufacturers, brands, and mentation on blood pressure (BP) indices as measured by 24-hour ambulatory BP formulations of caffeine-containing drinks. monitoring (ABPM). While hundreds of energy drink products METHODS: Healthy, nonsmoking, normotensive volunteers (aged 18-45 years) exist, Red Bull Energy Drink captures the taking no medications were enrolled in a single-center, open-label, 2-period crossover pilot study. During each study period, subjects received either an energy largest share of the US market.2 Nontradidrink (Red Bull Energy Drink, each dose containing 80 mg of caffeine and 1000 mg tional grassroots marketing strategies are of taurine in an 8.3-oz serving) or a control (compounded caffeine solution, each directed primarily toward a young condose containing 80 mg of caffeine solution in 8 oz of bottled water) at 0800, 1100, sumer base with taglines promoting the 1500, and 1900 hours and underwent 24-hour ABPM. The study periods were stimulant effects of energy drinks (eg, “it separated by a washout period (4-30 days). Mean 24-hour, daytime, and nighttime systolic (SBP), diastolic (DBP), and mean arterial (MAP) BP; BP load; and percent gives you wings”).1 Such marketing has nocturnal dipping were compared between study periods. proven successful, as 34% of young adults RESULTS: Nine subjects (5 females, mean [SD] age 27.7 [5.0] years) completed the 2 report regular consumption and 51% of study. Mean 24-hour SBP (123.2 vs 117.4 mm Hg, p = 0.04), DBP (73.6 vs 68.2 college students report at least monthly mm Hg, p = 0.02), and MAP (90.1 vs 84.8 mm Hg, p = 0.03) were significantly use of energy drinks.3 College students rehigher during energy drink supplementation versus caffeine supplementation. Dayport using energy drinks to compensate for time DBP (77.0 vs 72.0 mm Hg, p = 0.04) also was significantly higher with the energy drink versus caffeine supplementation. Trends in higher daytime SBP (127.0 inadequate sleep (67%), to increase energy vs 121.9 mm Hg, p = 0.05) and MAP (93.6 vs 88.6 mm Hg, p = 0.05) were recorded (65%), to drink with alcohol while partywith energy drink supplementation versus caffeine supplementation. Nighttime SBP ing (54%), to study or complete a major and DBP loads were significantly higher with the energy drink, but nocturnal dipping project (50%), and while driving for long did not differ significantly between study periods. periods (45%).3 Manufacturers publicize CONCLUSIONS: Single-day energy drink supplementation increased mean 24-hour claims that energy drinks improve cogniand daytime BP compared to caffeine control in this pilot study. Additional research is warranted to better understand the hemodynamic effects of energy drink tive skills, short-term memory, and athletic consumption. performance. Limited studies support KEY WORDS: ambulatory blood pressure, blood pressure, caffeine, energy drink. these claims, reporting improved choice Ann Pharmacother 2012;46:192-9. reaction time, concentration, memory, alertness, and aerobic and anaerobic enPublished Online, 31 Jan 2012, theannals.com, DOI 10.1345/aph.1Q555 durance with energy drink supplementation.4-6 rest, stroke, seizures, psychiatric disorder exacerbations, The health risks associated with consumption of energy postural tachycardia syndrome, palpitations, headaches, drinks are not known. Myocardial infarction, cardiac arand “jolt and crash” episodes (defined as increased alertness followed by a sudden drop in energy) have been reported following their use.3,7-14 Additional serious adverse Author information provided at end of text.

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effects and deaths have been described in the news media.15-19 No data exist to causally link these effects to energy drinks. Furthermore, little is known about the effects of energy drinks on blood pressure (BP). It is not known whether the effects of energy drinks on BP are similar to those of other caffeine-containing drinks such as cola, tea, or coffee. While caffeine is a common ingredient in energy drinks, these supplements contain a variety of ingredients in their proprietary blends, and it is possible that other stimulant-type compounds are included. In addition, many consumers use the products to increase alertness or to finish projects,3,4 and one half of college student energy drink users report consuming 2 or more servings in a single setting.3 Thus, it is likely that multiple servings of energy drinks are consumed within relatively short periods of time, often during late evening or nighttime hours to delay sleep. It is not known how the ingestion of several servings throughout the day and into the evening affects circadian BP variations, BP load, or nocturnal dipping patterns. The purpose of this pilot study was to describe the effects of energy drinks on BP as measured by 24-hour ambulatory BP monitoring (ABPM) and compare these effects to those of an equivalently dosed caffeine control supplementation. Methods PARTICIPANTS

Healthy men and women were eligible to participate in the study if they were between the ages of 18 and 45 years, normotensive, taking no prescription or nonprescription medications, and had no known medical conditions. Potential subjects were excluded if they had a history of cardiovascular, renal, or hepatic disease or had used tobacco products within the previous 6 months. Pregnant or breastfeeding women were excluded from the study. Subjects were recruited via posted advertisements around an academic medical center campus. DESIGN

This open-label, randomized, controlled, 2-period crossover pilot study was approved by the institutional review board of the University of Arkansas for Medical Sciences and conducted in compliance with the board’s requirements. All subjects provided written informed consent before participating in the study. Participants received $50 gift cards upon study completion in exchange for study-related time and travel. Baseline evaluation of all subjects included medical and medication histories and completion of a caffeine intake questionnaire adapted from Landrum20 to estimate usual daily caffeine consumption. Normotensive status was verified using the mean of 3 successive casual BP readings obtained using a standard manual sphygmomanometer after 5 theannals.com

minutes of rest. Individuals whose mean BP reading exceeded 140/90 mm Hg were excluded from the study. Following baseline evaluations, participants reported to the study laboratory for two 24-hour ABPM periods separated by a minimum of 4 days and a maximum of 30 days. During these study visits, measurements of casual BP, heart rate, height, and weight were recorded. Casual BP was recorded as the mean of 2 successive readings measured in the sitting position using a standard manual sphygmomanometer. Negative pregnancy tests were obtained from all female subjects before each ABPM period. Each subject was fitted with an ABPM cuff on the nondominant arm and provided instructions on proper use of the monitor. The ABPM monitors (model 90207, Spacelabs Healthcare, Issaquah, WA) were programmed to obtain readings every 20 minutes during the day (0700-2200) and every 30 minutes during the night (2200- 0700). Subjects were asked to refrain from caffeine, alcohol, and all prescription and nonprescription drugs other than acetaminophen during the 48 hours immediately preceding the ABPM period, the 24-hour ABPM monitoring period, and the 24 hours following the ABPM period. Subjects were asked to maintain normal activities but refrain from strenuous physical activity (ie, weight-lifting, aerobic exercise, or other exertional activities) during each 24-hour ABPM monitoring period. Supplementation with a compounded caffeine solution (80 mg of caffeine in an 8-oz bottle of water) or energy drink (8.3-oz can of Red Bull Energy Drink containing 80 mg of caffeine and 1000 mg taurine; Red Bull North America, Inc., Santa Monica, CA) was randomly assigned for each subject’s two 24-hour ABPM study periods. Red Bull Energy Drink was chosen for study because of its popularity and widespread use. All subjects received supplementation from the same lots of energy drink and caffeine solution. During each ABPM period, participants were permitted to consume other noncaffeinated beverages ad libitum; however, each one was required to consume the study beverage at the 4 scheduled times (0800, 1100, 1500, and 1900). Study beverage supplementation was designed to approximate acute consumption of energy drinks as described in recent literature.3 During each 24-hour ABPM period, subjects recorded in study diaries the time and description of activities completed, including approximate times of sleep and awakening. In addition, they noted the time when each supplement (energy drink or caffeine solution) was consumed and the occurrence of any perceived adverse effects. Adherence was assessed following the return of empty and unused supplement containers at the end of the monitoring period. DATA ANALYSIS

ABPM data were downloaded and edited using the ABPM Report Management System (Spacelabs Health-


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care, Inc., Issaquah, WA). ABPM records were considered acceptable if at least 80% of programmed BP readings were successfully obtained during the 24-hour period. Individual daytime and nighttime periods were defined according to each subject’s recorded sleep and wake times from study diaries. Mean, minimum, and maximum systolic BP (SBP), diastolic BP (DBP), mean arterial BP (MAP), and heart rate were calculated for the 24-hour, daytime, and nighttime periods. Estimated MAP was calculated using the formula MAP = (1/3)SBP + (2/3)DBP. BP load was defined as the percent of BP readings that exceeded a given BP threshold established by the Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure.21 SBP loads were determined using thresholds of 140 mm Hg during the 24-hour period, 135 mm Hg during the daytime period, and 120 mm Hg during the nighttime period. DBP loads were determined using thresholds of 90 mm Hg during the 24-hour period, 85 mm Hg during the daytime period, and 75 mm Hg during the nighttime period. Percent nocturnal dipping was determined for each ABPM period by calculating the percent difference between mean daytime and nighttime BP ([mean daytime BP – mean nighttime BP]/mean daytime BP). Dipping status (dipper vs nondipper) was determined using the generally accepted definition for dipping in adults of a decline of 10% or more in nighttime BP.22 STATISTICAL ANALYSIS

Descriptive statistics were used to characterize demographic characteristics and ABPM indices during each supplementation period. Values for SBP, DBP, MAP, heart rate, SBP load, DBP load, and percent nocturnal dipping during energy drink and caffeine ABPM periods were compared using 1-sample paired t-tests without sequence effect. Nonparametric alternatives (Wilcoxon signed-rank tests) were used when data were not normally distributed. Nocturnal dipping status was compared between ABPM periods using χ2 analyses. Post hoc comparisons of energy drink and caffeine BP indices between habitual (defined as daily intake of caffeine-containing beverages and over-thecounter products) and nonhabitual (less than daily intake) caffeine users were conducted using repeated measures analyses of variance. Significance in all analyses was indicated by p values less than 0.05. Results Twelve individuals enrolled and underwent study procedures during March and April 2009. Two subjects withdrew from the study after completing the first ABPM period because of adverse effects (palpitations) and lack of interest in the study. Data from an additional subject were 194

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excluded from the analysis because less than 80% of programmed BP measurements were recorded during the second ABPM period. Baseline characteristics of the 9 subjects who completed the study are presented in Table 1. Their ages ranged from 23 to 40 years. Three subjects were considered to be of normal weight, 4 were overweight, and 2 were obese according to body mass index calculations. Average usual daily caffeine intake was estimated to be from 4 to 379 mg/day. Four participants reported habitual caffeine intake. ABPM indices during supplementation with caffeine solution and energy drink are shown in Table 2. Baseline measurements of BP and heart rate were not significantly different between the 2 supplementation periods. Mean 24hour SBP, DBP, and MAP measurements were significantly increased during energy drink supplementation. Mean daytime DBP was significantly elevated during energy drink supplementation, and similar trends were observed with mean daytime SBP and MAP and nighttime DBP during energy drink supplementation. In addition, nighttime SBP load and DBP load were significantly higher during energy drink supplementation. Percent nocturnal dipping did not differ significantly between the 2 supplementation periods. Figure 1 shows mean SBP and DBP patterns during each 24-hour ABPM. No significant differences in heart rate were observed between the supplementation periods. Likewise, no significant differences in any ABPM indices were found between habitual and nonhabitual caffeine users. The energy drink and caffeine solution were generally well tolerated by subjects completing both supplementation period, with 7 (58%) and 5 (42%) individuals reporting no adverse effects during each supplementation period, respectively. Adverse effects are shown in Table 3.

Table 1. Demographic Characteristics of Subjects Completing the Studya Characteristic

Result

Age (y), mean (SD)

27.7 (5.0)

Male, n (%)

4 (44.4)

Race, n (%) white

5 (55.6)

African American

3 (33.3)

Asian American

1 (11.1)

Body mass index (kg/m2), mean (SD)

27.8 (7.4)

Caffeine intake (mg/day), mean (SD)

98.9 (131.4)

100 mg/day, n (%)

2 (22.2)

a

N = 9.


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Effects of Energy Drink vs Caffeine on Ambulatory BP

Discussion

increases in epinephrine, norepinephrine, and renin activity.23 Caffeine-naïve individuals experience an acute inIn this study, single-day energy drink supplementation crease in BP when given a 250- to 300-mg dose of caffeine increased BP in normotensive healthy volunteers as demoncompared to placebo, and these pressor effects may be exagstrated by significant increases in 24-hour SBP, DBP, and gerated in those who are hypertensive or prehypertensive. MAP, as well as daytime DBP and nighttime SBP and DBP Habitual users of caffeine generally show no pressor reloads, compared to supplementation with an equivalently sponse to acute doses, and even caffeine-naïve people rapidly dosed caffeine control. A trend toward increased nighttime develop tolerance to pressor effects over 2-3 days.24 Caffeine DBP was also seen with energy drink consumption. Nocturhas also been shown to additively increase BP during stress nal dipping and HR did not differ significantly between enerin those with high and low risk for hypertension.25 gy drink and caffeine supplementation. Although Red Bull Energy Drink contains approximately The ingredients in energy drinks may vary, but many the same amount of caffeine as a cup of coffee (80 mg), it is contain common substances such as caffeine and taurine. not known whether other ingredients in energy drinks affect Caffeine acts as an adenosine receptor blocker, leading to the rate and/or extent of caffeine absorption. Data from the current study suggest that other ingredients in Red Bull Energy Drink may potentiate the BP response to caffeine through a pharmacodynamic interaction (eg, other stimulant-type comTable 2. Comparison of Blood Pressure Indices During Caffeine and pounds) or a pharmacokinetic interaction (eg, alEnergy Drink Supplementationa teration in caffeine absorption, metabolism, Caffeine Energy Mean and/or elimination). Alternatively, many energy Parameter Solution Drink Difference p Value drinks are packaged in relatively small volumes SBP, mm Hg and consumers are encouraged to consume the casual (baseline) 120.0 (8.0) 120.9 (10.4) 0.9 (8.7) 0.77 drinks rapidly.26,27 This may lead to higher caf0.04 5.8 (7.0) 117.4 (10.0) 123.2 (9.8) 24-hour feine consumption over a short time and more daytime 121.9 (10.9) 127.0 (10.5) 5.1 (6.5) 0.05 pronounced physiologic effects of caffeine. Furnighttime 107.9 (11.0) 113.6 (8.8) 5.7 (9.7) 0.12 thermore, risk for serious adverse effects may be DBP, mm Hg higher when energy drinks are combined with casual (baseline) 74.6 (8.1) 78.3 (5.6) 3.8 (9.7) 0.28 other stimulants, alcohol, or strenuous physical 24-hour 68.2 (5.3) 73.6 (3.8) 5.3 (5.7) 0.02 activity, since the adrenergic effects and diuretic daytime 72.0 (6.7) 77.0 (4.8) 5.0 (6.2) 0.04 65.3 (4.8) 4.9 (6.5) 0.05 60.4 (4.9) nighttime and natriuretic actions of energy drinks may be MAP, mm Hg exaggerated. These uses of energy drinks are casual (baseline) 89.7 (7.6) 92.5 (7.0) 2.8 (9.1) 0.38 most concerning since additive effects on BP, 24-hour 84.8 (6.4) 90.1 (4.2) 5.3 (6.1) 0.03 heart rate, and cardiovascular workload can ocdaytime 88.6 (7.5) 93.6 (5.4) 5.0 (6.4) 0.05 cur, and many energy drinks are specifically nighttime 77.3 (6.2) 81.2 (3.9) 3.9 (6.5) 0.11 marketed for use during such situations. HR, beats/min Taurine is a naturally occurring sulfonic acid 71.8 (6.8) 73.1 (7.1) 1.3 (7.3) 0.60 casual (baseline) generated via sulfur metabolism and found in 24-hour 74.2 (6.5) 73.3 (10.3) 0.89 (9.2) 0.78 high concentrations in mammalian brain, heart, daytime 77.2 (7.0) 75.9 (11.0) 1.3 (9.9) 0.70 and muscle tissue.28 Dietary sources of taurine 70.2 (9.9) 65.3 (8.0) 4.9 (10.5) 0.20 nighttime are estimated to range from negligible amounts SBP load, % readings in vegetarian diets to as high as 400 mg/day in 24-hour (>140 mm Hg) 7.8 (15.4) 11.5 (21.7) 3.7 (9.0) 0.25 omnivorous diets.29 Preliminary studies sug14.0 (21.6) 25.6 (29.4) 11.6 (20.1) 0.07 daytime (>135 mm Hg) nighttime (>120 mm Hg) 16.6 (19.4) 36.0 (26.8) 19.4 (18.5) 0.01 gest that taurine exerts several potentially carDBP load, % readings dioprotective actions, including modulation of 24-hour (>90 mm Hg) 2.7 (5.7) 6.1 (6.6) 3.4 (8.3) 0.26 intracellular sodium and calcium concentra19.5 (17.0) 10.0 (22.3) 0.21 9.5 (14.5) daytime (>85 mm Hg) tions, positive inotropy, decreased BP, denighttime (>75 mm Hg) 4.4 (6.1) 21.1 (16.5) 16.7 (18.2) 0.02 creased platelet aggregation, antioxidant efNocturnal dipping, % fects, antihyperlipidemic effects, and mem1.0 (5.4) 0.59 10.5 (3.6) 11.5 (4.6) SBP brane stabilization.30 These actions remain to DBP 15.7 (6.8) 15.0 (6.4) 0.7 (6.9) 0.76 be confirmed, as does the safety of taurine supDBP = diastolic blood pressure; HR = heart rate; MAP = mean arterial pressure; plementation. In addition, it is not known what SBP = systolic blood pressure. effects taurine has in combination with other a Values represent mean (SD). energy drink ingredients, including caffeine. theannals.com


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The purported effect of taurine on cardiac force of contraction may be enhanced further when supplemented in combination with caffeine and may therefore contribute to acute increases in BP. It is also possible that toxicities may develop when nutritional supplementation of taurine is achieved with energy drinks. In the current study, BP indices were increased during energy drink supplementation compared to an equivalent-dose caffeine control; however, it is not possible to determine whether these effects are a result of the taurine component of the energy drink.

Few data exist to delineate the effects of energy drinks on hemodynamic parameters, and data derived from casual BP measurement are inconsistent. Steinke et al. reported that BP and heart rate maximally increased within 4 hours of consuming 2 cans of energy drink (500 mL; 100 mg caffeine and 1000 mg taurine/can).31 However, no BP measurements were taken after 4 hours, so sustained effects on BP are unknown. When supplementation continued for 7 days, no additional increases in BP on subsequent days were found, suggesting that tolerance may have occurred. MAP significantly increased with energy drink compared to carbonated water supplementation in another study.32 Similarly, Bichler and colleagues reported that oral administration of caffeine (100 mg) and taurine (1000 mg) tablets resulted in an increase in MAP and decrease in heart rate that were not observed following placebo administration.33 However, 2 additional studies found no increase in casual BP with energy drink supplementation in healthy volunteers.4,34 Energy drink supplementation also did not enhance the BP increase during stress from a cold pressor test.34 No previous studies have compared indices of BP as measured by 24-hour ABPM. Post hoc analyses conducted in our study found no differences in ABPM indices between habitual and nonhabitual caffeine users. Others have found that supplementation with caffeine alone evokes similar changes in BP in habitual and nonhabitual caffeine users,35,36 but coffee ingestion results in a greater increase in BP in nonhabitual users than in habitual users,34-37 leading some to postulate that the effect may be dependent on other ingredients in coffee.35,36 Interestingly, the results of our study indicate that additional components of the energy drink may contribute to the BP increases seen in our study, given that equivalent doses of caffeine were provided in each supplementation arm. Worthley et al. reported a significant increase in adenosine diphosphate–induced platelet aggregation and a significant decrease in endothelial function when healthy subjects were given 250 mL of energy drink compared to a carbonated water control.32 Together with the observed effects on BP response, these effects have the potential to contribute to the cardiovascular and cerebrovascular ischemic events reported in association with energy drink consumption. Our findings in this study are limited by the Figure 1. SBP (A) and DBP (B) means derived from 24-hour ambulatory blood pressmall sample size of healthy normotensive volsure monitoring during supplementation with caffeine solution and energy drink. Supunteers who received, in an unblinded manner, plementation occurred at 0800, 1100, 1500, and 1900 during each period. DBP = diastolic blood pressure; SBP = systolic blood pressure. single-day supplementation with a single ener196

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gy drink compared to a caffeine control solution. We cannot extrapolate our results to other energy drinks, as compositions vary among the products. Furthermore, our data are insufficient to allow us to identify a single pharmacodynamic or pharmacokinetic mechanism by which these effects occurred. These hypotheses can be explored further in subsequent studies. We also cannot suggest that the BP effects observed in our study would be sustained with chronic energy drink supplementation. However, we believe that the conditions approximated in our study occur frequently when users of energy drinks consume multiple servings in a short period of time to extend wakefulness or complete a physically or mentally exhausting task.3,4 We did not directly observe subjects’ consumption of energy drink and caffeine solution doses, and rates of dose consumption have the potential to affect pharmacokinetic parameters of caffeine or other energy drink ingredients. It is possible that additional significant changes in daytime and/or nighttime BP were not found because of limited power to detect such changes. It remains to be seen what hemodynamic effects result from energy drink consumption by individuals with greater cardiovascular risk (eg, hypertension) or by those engaging in strenuous physical activity. Finally, we did not conduct an independent analysis of the caffeine content of the energy drink but rather relied on the quantity reported by the company (80 mg/250 mL). It is possible that the actual caffeine content varied from the composition reported, since one analytical study reported a caffeine content of 66.7 mg/250 mL can of Red Bull Energy Drink.38 In summary, single-day supplementation with energy drink significantly increased mean 24-hour and daytime ABPM indices compared to an equivalently dosed caffeine control. Mean nighttime SBP and DBP were not significantly increased, but nighttime BP loads were increased. It is unknown whether these BP effects translate into clinical-

Table 3. Adverse Effects Reported by Subjectsa Adverse Effect

Caffeine Solution

Energy Drink

Dizzy/lightheaded

1

1

Headache

1

0

Insomnia

1

1

Loss of appetite

0

1

Palpitations

0

1b

Shortness of breath

1

0

Skin irritation

1

1

Stomach upset/heartburn

1

2

None

5

7

a

Values represent the number of subjects reporting each adverse effect. b Subject withdrew from study because of adverse effect.

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ly meaningful risk to consumers of energy drinks; however, it is reasonable to advise patients with hypertension and those consuming other stimulant compounds to avoid use of these products. Further analyses are needed to delineate the effects of energy drink supplementation in individuals with higher cardiovascular risk and in those engaging in strenuous activities and to identify ingredients in the energy drink that contribute to the BP response observed. Finally, investigations involving supplementation over a longer time are needed to study the hemodynamic effects of habitual consumption of energy drinks. Amy M Franks PharmD, Associate Professor, Department of Pharmacy Practice, College of Pharmacy, University of Arkansas for Medical Sciences, Little Rock Julia M Schmidt PharmD, at time of writing, Pharmacy Practice Resident, University of Arkansas for Medical Sciences; now, Pharmacy Director, Arkansas Hospice, Little Rock, AR Keith R McCain PharmD, Assistant Professor, Department of Pharmacy Practice, College of Pharmacy, University of Arkansas for Medical Sciences Mony Fraer MD FACP FASN, Assistant Professor, Department of Internal Medicine, University of Iowa Hospitals and Clinic, Iowa City Correspondence: Dr. Franks, [email protected] Reprints/Online Access: www.theannals.com/cgi/reprint/aph.1Q555

Conflict of interest: Authors reported none

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of habitual versus nonhabitual drinking. Circulation 2002;106:2935- 40. DOI 10.1161/01.CIR.0000046228.97025.3A 36. Sudano I, Spieker L, Binggeli C, et al. Coffee blunts mental stress-induced blood pressure increase in habitual but not in nonhabitual coffee drinkers. Hypertension 2005;46:521-6. DOI 10.1161/01.HYP.0000177448.56745.c7 37. Kennedy MD, Galloway AV, Dickau LJ, Hudson MK. The cumulative effect of coffee and a mental stress task on heart rate, blood pressure, and mental alertness is similar in caffeine-naïve and caffeine-habituated females. Nutr Res 2008;28:609-14. 38. McCusker RR, Goldberger BA, Cone EJ. Caffeine content of energy drinks, carbonated sodas, and other beverages. J Anal Toxicol 2006;30:112-4.

Comparación de los Efectos de Bebidas Energizantes con los Suplementos de Cafeína con Índices de 24 Horas de Presión Sanguínea a Nivel Ambulatorio AM Franks, JM Schmidt, KR McCain, y M Fraer Ann Pharmacother 2012;46:192-9. EXTRACTO

Se ha reportado que el consumo de bebidas energizantes está asociado a eventos cardiovasculares pero existe muy poca evidencia para delinear los efectos hemodinámicos de las bebidas energizantes. OBJETIVO: Comparar los efectos de las bebidas energizantes con los suplementos de cafeína en los índices de la presión sanguínea medidos en un monitoreo de 24 horas a nivel ambulatorio. METODOLOGÍA: Voluntarios saludables, no-fumadores, que no tomen medicamentos y con presión sanguínea normal (18- 45 años) fueron incluídos en un estudio piloto en un solo centro donde los individuos sabían lo que tomaban en dos períodos cruzados. Durante cada período del estudio, los individuos recibieron una bebida energizante (Red Bull Energy Drink, cada dosis contiene 80 mg de cafeína y 1000 mg de taurina en 8.3 onzas) o el control (una solución compuesta de cafeína en que cada dosis contiene 80 mg de cafeína en una solución de 8 onzas de agua embotellada) en dosis al horario de 08:00, 11:00,15:00, y 19:00 horas; y se sometieron a el monitoreo de 24 horas de presión sanguínea a nivel ambulatorio. Los 2 períodos del estudio fueron separados por un período sin bebidas (4-30 días). Se compararon entre períodos de estudio un promedio de 24 horas, la presión sanguínea sistólica por el día y la noche, la presión sanguínea diastólica y el promedio de la presión sanguínea arterial, la carga de la presión sanguínea y el porciento de bajas nocturnas. RESULTADOS: Nueve individuos (5 mujeres, 27.7 ± 5.0 años) completaron el estudio. El promedio de la presión sanguínea sistólica en 24 horas (117.4 vs 123.2 mm Hg, p = 0.04), presión sanguínea diastólica (68.2 vs 73.6 mm Hg, p = 0.02) y el promedio de la presión sanguínea arterial (84.8 vs 90.1 mm Hg; p = 0.03) fueron significativamente más altos con el suplemento de bebidas energizantes. La presión sanguínea diastólica durante el día (72.0 vs 77.0 mm Hg, p = 0.04) fue significativamente más alto con el suplemento de bebidas energizantes. Hay mayores tendencias en aumentos en la presión sanguínea sistólica durante el día (121.9 vs 127.0 mm Hg, p = 0.05) y un promedio de presión sanguínea (88.6 vs 93.6 mm Hg, p = 0.05) con el suplemento de bebidas energizantes. La presión sanguínea sistólica durante la noche y las cargas de la presión sanguínea diastólica fueron significativamente altas con las bebidas energizantes; sin embargo, en las bajadas nocturnas no se encontraron diferencias significativas entre períodos del estudio. CONCLUSIONES: El uso diario de bebidas energizantes aumenta el promedio de 24 horas y la presión sanguínea durante el día comparado con el control de cafeína en este estudio piloto. Se necesita investigación adicional para garantizar un mejor entendimiento de los efectos hemodinámicos cuando se consumen bebidas energizantes. TRANSFONDO:


Traducido por Wilma M Guzmán-Santos

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Comparaison des Effets des Boissons Énergisantes par Rapport à la Caféine sur les Paramètres du Monitorage Ambulatoire de la Tension Artérielle de 24 Heures AM Franks, JM Schmidt, KR McCain, et M Fraer Ann Pharmacother 2012;46:192-9. RÉSUMÉ INTRODUCTION: Des événements cardiovasculaires associés à la consommation de boissons énergisantes ont été rapportés, mais peu d’informations sont disponibles pour décrire les effets hémodynamiques de ces boissons. OBJECTIFS: Comparer les effets des boissons énergisantes à la supplémentation en caféine sur la pression artérielle (PA) mesurée par le monitorage ambulatoire de 24 heures (MAPA). MÉTHODE: Des volontaires sains, non-fumeurs de 18 à 45 ans, ne prenant aucun médicament ont été enrôlés dans un essai ouvert, réalisé dans un seul centre, avec un devis en chassé-croisé sur 2 périodes. Durant chaque période, les sujets recevaient soit une boisson énergisante (RedBull), chaque dose renfermant 80 mg de caféine et 1000 mg de taurine par portion de 8.3 onces ou soit une solution maison de caféine renfermant 80 mg de caféine dans 8 onces d’eau embouteillée. Les doses étaient administrées à 0800, 1100, 1500, et 1900 heures. Les sujets ont été

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soumis au MAPA sur 24 heures. Les 2 périodes de l’étude étaient espacées de 4 à 30 jours. La PA systolique (PAS) moyenne sur 24 heures, la PAS diurne et la PAS nocturne, la PA diastolique (PAD), et la PA moyenne (PAM), la charge tensionnelle, et le pourcentage de chute nocturne ont été comparés entre les 2 périodes. RÉSULTATS: Neuf sujets (5 femmes, 27.7 ± 5.0 ans) ont complété l’étude. La PAS moyenne sur 24 heures (117.4 vs 123.2 mm Hg, p = 0.04), la PAD (68.2 vs 73.6 mm Hg, p = 0.02), et la PAM (84.8 vs 90.1 mm Hg, p = 0.03) étaient significativement plus élevée avec la prise de la boisson énergisante. La PAD diurne (72.0 vs 77.0 mm Hg, p = 0.04) étaient significativement plus élevée avec la prise de la boisson énergisante. Des tendances à la hausse ont été notées pour la PAS diurne (121.9 vs 127.0 mm Hg, p = 0.05) et la PAM (88.6 vs 93.6 mm Hg, p = 0.05) avec la prise de la boisson énergisante. La PAS nocturne et la charge tensionelle diastolique étaient significativement plus élevées avec la boisson énergisante, mais la chute tensionnelle nocturne n’a pas variée de façon significative entre les 2 périodes d’observation. CONCLUSIONS: Cette étude pilote démontre que la prise d’une boisson énergisante sur une journée a augmenté de façon significative la PAM sur 24 et la TA diurne en comparaison avec la caféine seule. Des études additionnelles sont requises pour mieux comprendre les effets hémodynamiques associés à la consommation de boissons énergisantes.


Traduit par Marc Parent

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