- A case report detailed a man's stroke and severe hypertension that was uncontrolled despite blood pressure medication.
- Further questioning revealed that he was a chronic drinker of energy drinks, averaging eight cans for just under 1.3 g of caffeine a day.
- Quitting the energy drinks resulted in his blood pressure being under control, though left-side numbness remains.
Excessive energy drink consumption may explain a person's hypertension and stroke, as illustrated by a case report from England.
A man in his 50s, otherwise fit and healthy, presented with sudden left-sided numbness and unsteadiness. Worryingly, his blood pressure (BP) read 254/150 mm Hg, which was brought down with antihypertensives to 170/80 mm Hg at discharge on the third day after admission. A diagnosis of a right thalamic lacunar stroke was made due to areas of focal spasm on the CT angiogram.
After the patient went home, he still had uncontrolled BP over the next 3 months, as systolic readings were consistently between 190 and 230 mm Hg. He was hospitalized again and put on more antihypertensive medication. It was at this point that he made a revelation to the care team.
"A more detailed lifestyle examination disclosed that the patient had an average daily consumption of eight cans of a high-potency [energy drink], each containing 160 mg caffeine per 16 fluid ounces per serving. This equated to 1.2-1.3 g of caffeine per day where NICE [National Institute for Health and Care Excellence] guidelines suggest a maximum daily intake of 400 mg," according to Martha Coyle, MBBS, and Sunil Munshi, MD, both of Nottingham University Hospitals NHS Trust in England, reporting in BMJ Case Reports.
A recommendation to take away the energy drinks did the trick.
"One week after stopping the drinks, his average BP readings showed 120-130 mm Hg systolic and 80-84 mm Hg diastolic. With the reduction of antihypertensives, it remained at healthy levels, and he was able to be completely weaned off all medications after 3 weeks," Coyle and Munshi wrote. "It was therefore thought to be likely that the patient's consumption of highly potent energy drinks was, at least in part, a contributive factor to his secondary hypertension and in turn his stroke."
"As our case and discussion illustrate, it is possible that both acute and chronic intake of [energy drinks] may increase CVD [cardiovascular disease] and stroke risk, and importantly, this may be reversible," the duo stressed.
Caffeine is a methylxanthine adenosine-receptor antagonist that blocks adenosine's centrally depressant effects and vasodilatory action. Coyle told MedPage Today that consuming an excessive amount of caffeine in any beverage may indeed have adverse health effects; energy drinks are said to average around 80 mg caffeine per 250 mL (~1 cup) serving versus tea's 30 mg and coffee's 90 mg.
However, it is not just the high caffeine content in energy drinks that may be an issue.
"With energy drinks, there are a few things which we particularly wanted to highlight: the other ingredients in them which interact and potentiate the caffeine effect, the high glucose content which has its own cardiovascular risks that contribute, and the very high content in small portions which is not advertised and importantly not known by the general public, especially being something that young people consume innocently as opposed to coffee," she said.
Inotropic ingredients in energy drinks, such as taurine and guarana, are of particular concern due to an amplified pressor response, Coyle and Munshi suggested.
As for regulation, the FDA has no formal upper limit on caffeine in energy drinks on the market, though it advises that 400 mg of caffeine a day is typically considered safe for most adults (with no safe limit assigned to children and adolescents). The agency does have a record of intervening when caffeinated products pose a health risk, such as when it removed some (but not all) products containing pure and highly concentrated caffeine.
Abroad, there are countries that do have formal caffeine caps, such as China (150 mg/L), Canada (180 mg per serving), and Australia and New Zealand (320 mg/L).
Acknowledging that "the current evidence is not conclusive," Coyle and Munshi nevertheless proposed increasing regulation of energy drink sales and advertising for public health. "Additionally, healthcare professionals should consider specific questioning related to [energy drink] consumption in young patients presenting with stroke or unexplained hypertension," they wrote.
In the case report, the patient was described as a non-smoker who did not drink alcohol and had no history of substance abuse.
He scored 4 on the National Institutes of Health Stroke Scale, indicating a mild stroke. Results of the carotid ultrasound and carotid angiogram both came out normal, hence the diagnosis of a right thalamic lacunar stroke.
The patient's secondary prevention regimen was selected to include 3 weeks of initial dual antiplatelet therapy (with aspirin and clopidogrel) followed by indefinite clopidogrel alone, atorvastatin, and losartan and amlodipine for BP management.
Months later, he was admitted to the hospital a second time for severe hypertension. More antihypertensives were introduced sequentially, and after 4 weeks he was taking amlodipine, losartan, indapamide, bisoprolol, and doxazosin.
The cessation of energy drink consumption saw the man's BP return to normal on further follow-up. He ultimately recovered enough to return to work, though some stroke symptoms remained 8 years later.
Disclosures
Coyle and Munshi declared no conflicts.
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