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The Association of Caffeinated Beverages with Blood Pressure in Adolescents

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The Association of Caffeinated Beverages with Blood Pressure in Adolescents ARTICLE The Association of Caffeinated Beverages With Blood Pressure in Adolescents Margaret R. Savoca, PhD; Conner D. Evans, BA; Martha E. Wilson, MA; Gregory A. Harshfield, PhD; David A. Ludwig, PhD Objective: To assess the association between the con- feine had higher systolic blood pressure readings than the sumption of caffeinated beverages and blood pressure in groups consuming 0 to 50 mg/d (mean difference, 6.0 African American and white adolescents. mm Hg; 95% confidence interval [CI], 2.3 to 9.7) or more than 50 to 100 mg/d (mean difference, 7.1 mm Hg; 95% Design: This study was part of ongoing research exam- CI, 3.4 to 10.7). The effect on diastolic blood pressure was ining stress-induced hemodynamic responses in adoles- less pronounced (P=.08). The diastolic blood pressure of cents. African American and white adolescents (n=159) the group consuming more than 100 mg/d was 3.7 mm selected foods and beverages for a 3-day sodium- Hg (95% CI, 0.41 to 7.0) higher than the group consum- controlled diet. Caffeine in these foods was used to stratify ing more than 50 to 100 mg/d and was not statistically dif- participants into 3 categories (0-50 mg/d, Ͼ50-100 mg/d, ferent from the group consuming 0 to 50 mg/d (mean dif- and Ͼ100 mg/d). Before menu selection, blood pres- ference, 2.4 mm Hg; 95% CI, −0.9 to 5.8). There was no sure readings were obtained. evidence that the association between diastolic blood pres- sure and caffeine intake varied by race (P=.80). Statistical Analysis: A general linear model (mul- tiple regression with both categorical and continuous vari- Conclusions: For adolescents, especially African Ameri- ables) was developed to assess the effects of race, cat- can adolescents, caffeine intake may increase blood pres- egory of caffeine intake, and interaction of race and sure and thereby increase the risk of hypertension. Al- caffeine intake on systolic and diastolic blood pressure ternatively, caffeinated drink consumption may be a controlling for sex and body mass index (calculated as marker for dietary and lifestyle practices that together in- weight in kilograms divided by height in meters squared). fluence blood pressure. Additional research is needed ow- ing to rising rates of adolescent hypertension and soft Results: The association between systolic blood pres- drink consumption. sure and caffeine category varied by race (P=.001). Af- rican Americans consuming more than 100 mg/d of caf- Arch Pediatr Adolesc Med. 2004;158:473-477 HE PREVALENCE OF HYPER- aged 12 to 17 years drink 1 or more soft tension among youth is ris- drinks daily and that 21% of boys and 22% ing.1 By adolescence, Afri- of girls consume coffee or tea on a daily can American girls and basis.5 The percentage of adolescents boys have higher systolic drinking caffeinated soft drinks is more blood pressure than white individuals.2 To than double the percentage of those who T 6 reduce the risk of hypertension among this consume noncaffeinated soft drinks. The vulnerable group, a better understanding question of whether caffeine in the quan- is needed of the environmental (includ- tities consumed by many adolescents can ing dietary) and genetic factors that con- affect blood pressure has not been exten- tribute to the blood pressure differences sively evaluated. between African American and white adolescents.3 One such dietary factor is For editorial comment caffeine consumption. Caffeine is con- see page 418 sidered a preventable risk factor for hy- pertension and cardiovascular disease.4 In In a preliminary evaluation of the caf- From the Georgia Prevention adults the primary source of caffeine is cof- feinated beverage consumption of a sample Institute, Department of fee, whereas in adolescents the major of African American adolescents, we found Pediatrics, Medical College source is caffeinated soft drinks. It is es- a higher increase in diastolic blood pres- of Georgia, Augusta. timated that 68% of boys and 62% of girls sure in response to competitive stress (REPRINTED) ARCH PEDIATR ADOLESC MED/ VOL 158, MAY 2004 WWW.ARCHPEDIATRICS.COM 473 ©2004 American Medical Association. All rights reserved. Downloaded From: https://jamanetwork.com/ on 10/01/2021 among the participants who consumed the largest quan- The total amount of foods and beverages selected minus tity of caffeinated drinks.7 The purpose of the present study the amount returned was used to determine subjects’ dietary was to extend our earlier finding and examine the asso- intake during the 3 days. Caffeine content for all foods and bev- erages on the menu was determined using the University of Min- ciation between the consumption of caffeinated bever- 12 ages and blood pressure in a sample of both African Ameri- nesota nutrient database. The amount of caffeine consumed during the 3 days was calculated for each subject based on the can and white adolescents. amount of caffeine in each food and the quantity of each food consumed by that subject. Examination of the distribution of METHODS caffeine intake showed a skewed distribution due to the large Data for this investigation were obtained in the course of an numbers of subjects consuming less than 50 mg/d of caffeine. ongoing research program to examine hemodynamic re- For this reason, caffeine intake was treated as a categorical vari- sponses to competitive stress in healthy adolescents.8 Subjects able by stratifying subjects into 3 caffeine-intake categories based completed the study protocol between February 2, 2002, and on their mean daily caffeine intake. May 8, 2003. The protocol was approved by the Human As- A general linear model (multiple regression including both surance Committee of the Medical College of Georgia (Augusta). continuous and categorical variables) was used to assess the Subjects were volunteers throughout the public and private high effects of race and category of caffeine intake on systolic and schools in Richmond County and Columbia County, Georgia. diastolic blood pressure and determine if the association be- Subjects were recruited according to their interest in partici- tween caffeine intake and blood pressure varied by race. Sex pating via school announcements, flyers, and handouts to 1 high and body mass index were controlled for in the model. The 2 school (900 students) and through word of mouth from sub- amount of variance explained (R ) by the model and the unique jects who had already participated in similar research projects. contribution of each variable in the model are provided. We Interested subjects contacted research assistants and were used t tests to compute individual pairwise comparisons of least screened by telephone. Inclusion criteria were African Ameri- squares regression means in the model. Differences between can or white ethnicity, aged 15 to 19 years, not taking any medi- least squares regression means were reported using mean dif- cations including contraceptives, and having no food allergies ferences and 95% confidence intervals (CIs). by parental and self-report as well as the ability to meet the di- etary and testing requirements of the protocol. Written in- RESULTS formed parental consent and subject assent were obtained from 194 subjects prior to participation. Of these, 35 were excluded The sample (n=159) included 32 African American boys, before testing as a result of exceeding the age requirement be- tween consent and their availability for testing, rescheduling 49 African American girls, 56 white boys, and 22 white owing to conflicts, relocation out of the area, pregnancy as de- girls with a mean±SD age of 16.4±1.0 years. Girls and termined by urine pregnancy testing, illness on test day, fail- boys were similar in regard to age, with a mean differ- ure to comply with the dietary protocol (determined by daily ence of 0.14 years (95% CI, −0.2 to 0.5). African Ameri- overnight urine samples), or withdrawal of parental consent cans were younger than white adolescents, with a mean or subject assent. difference of −0.58 year (95% CI, −0.88 to −0.27). Afri- Measurements, which included systolic and diastolic blood can American girls had a higher body mass index com- pressure readings as well as height and weight, were obtained pared with white girls (25.9 vs 22.4; mean difference, 3.5; during an initial orientation session. Trained research assis- 95% CI, 0.7 to 6.2). African American boys and white tants measured blood pressure levels using a mercury manom- boys had a similar body mass index (23.6 vs 23.4) with eter. Normotensive status and values used in subsequent sta- tistical analyses were determined using the mean of 3 successive a mean difference of 0.19 (95% CI, −2.1 to 2.4). blood pressure readings. Subjects were considered normoten- Participants were stratified into 3 caffeine-intake cat- sive if their mean blood pressure reading was lower than the egories (0-50 mg/d, Ͼ50-100 mg/d, and Ͼ100 mg/d). The 95th percentile based on weight, height, and age norms.9,10 A Table provides a summary by race of the 3 caffeine- digital eye-level scale with a height rod (Detecto 6439; Cardi- intake categories according to sex, age, body mass in- nal Scale Manufacturing Company, Webb City, Mo) was used dex, and caffeine intake. Based on the amount of caf- to measure weight in kilograms and standing height in centi- feine in a 12-oz regular cola (37.2 mg of caffeine), the meters. Body mass index was calculated as weight in kilo- mean caffeine intake in each successive category was grams divided by height in meters squared. Race was based on equivalent to 0.75 can, 2 cans, and 3.9 cans per day.
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