BackgroundCaffeine in doses <400 mg is typically not considered arrhythmogenic, but little is known about the additional ingredients in energy drinks. We evaluated the ECG and blood pressure (BP) effects of high‐volume energy drink consumption compared with caffeine alone.Methods and ResultsThis was a randomized, double‐blind, controlled, crossover study in 18 young, healthy volunteers. Participants consumed either 946 mL (32 ounces) of energy drink or caffeinated control drink, both of which contained 320 mg of caffeine, separated by a 6‐day washout period. ECG, peripheral BP, and central BP measurements were obtained at baseline and 1, 2, 4, 6, and 24 hours post study drink consumption. The time‐matched, baseline‐adjusted changes were compared. The change in corrected QT interval from baseline in the energy drink arm was significantly higher than the caffeine arm at 2 hours (0.44±18.4 ms versus −10.4±14.8 ms, respectively; P=0.02). The QTc changes were not different at other time points. While both the energy drink and caffeine arms raised systolic BP in a similar fashion initially, the systolic BP was significantly higher at 6 hours when compared with the caffeine arm (4.72±4.67 mm Hg versus 0.83±6.09 mm Hg, respectively; P=0.01). Heart rate, diastolic BP, central systolic BP, and central diastolic BP showed no evidence of a difference between groups at any time point. Post energy drink, augmentation index was lower at 6 hours.ConclusionsThe corrected QT interval and systolic BP were significantly higher post high‐volume energy drink consumption when compared with caffeine alone. Larger clinical trials validating these findings and evaluation of noncaffeine ingredients within energy drinks are warranted.Clinical Trial Registration URL: http://www.clinicaltrials.gov. Unique identifier: NCT02023723.

Elevated blood pressure (BP) is a leading modifiable risk factor for cardiovascular disease and continues to affect approximately 1 in 3 adults, or 66.9 million people, in the United States. 1 Traditionally, hypertension is diagnosed and treated by assessing the pressure at the brachial artery (peripheral BP), 2 but recent evidence suggests that central hemodynamics are better predictors of cardiovascular outcomes and mortality. 3,4 Central BP is indicative of the pressure directly exerted on target organs and often varies from peripheral BP. 2 Aortic and carotid arteries are more elastic than fibrous peripheral vasculature and the difference in peripheral and central pressures is thought to be a result of amplification due to wave reflections caused by the variance in arterial stiffness. 2,5 As a result of arterial stiffness increasing with distance from the heart, peripheral systolic BP (pSBP) tends to be greater than central systolic BP (cSBP). 6 Additionally, augmentation index (AI), which measures the degree of enhancement in the central pressure waveform due to reflected waves, has been shown to be an independent predictor of cardiovascular events. 4 Recent technology has increased the availability of several noninvasive techniques to estimate central BP allowing for incorporation of these parameters in a multitude of patient populations and disease states. [7][8][9][10] Differences between the various classes of antihypertensive agents regarding their effects on central hemodynamics have been identified. 11,12 The Conduit Artery Function Evaluation (CAFE) study 13 was one of the first trials to show differing clinical outcomes despite similar reductions in peripheral BP. In a previous meta-analysis, differing responses of β-blockers (BBs) and diuretics on central hemodynamics were implied but extrapolation of their finding was limited due to a modest number of included studies. 12 As a result of a greater number of new publications in the last few years assessing the effects of antihypertensives on central BP, we performed a meta-analysis analyzing the differential effects of antihypertensive agents on cSBP and AI. An assessment as such will help better determine the incorporation and place in therapy of the various antihypertensives in clinical practice. Impact of Antihypertensive Agents on BACKGROUNDNew evidence suggests that central systolic blood pressure (cSBP) and augmentation index (AI) are superior predictors of adverse cardiovascular outcomes compared to peripheral systolic BP (pSBP). We performed a meta-analysis assessing the impact of antihypertensives on cSBP and AI.

These results support the use of oral aloe vera for significantly reducing FBG (46.6 mg/dL) and HbA1c (1.05%). Further clinical studies that are more robust and better controlled are warranted to further explore these findings.