The Relationship Between Energy Drinks A and B with Blood Pressure and Pulse Rate Increase Among College Students

Energy drinks are popular among various groups of people, such as teenagers and working individuals. These beverages are consumed to provide additional energy and improve focus. This research investigates the relationship between energy drinks and blood pressure and heart rate in students of the Faculty of Medicine at Universitas Airlangga, Surabaya, Indonesia. The study used the open trial – randomized cross-over study method and collected primary data through experiments. The sample consisted of students from the Faculty of Medicine at Universitas Airlangga, aged 19 to 22 years, with a normal body mass index ranging from 18.5 to 24.9. The systolic, diastolic, and heart rate values were measured before and after consuming energy drinks. A total of 38 research samples were used, including 22 males (57.8%) and 16 females (42.1%). Energy drinks such as Kratingdaeng and Extra Joss showed a significant increase in blood pressure. However, no significant changes were observed in heart rate. The results of the Wilcoxon statistical test, comparing systolic and diastolic conditions before and after consuming Extra Joss, showed p<0.0001. A significance level of p<0.05 indicates a significant effect of energy drinks on the students. The Wilcoxon test for Kratingdaeng also yielded a p<0.0001. For the p-value through the Wilcoxon test on diastolic values before and after consuming Extra Joss and Kratingdaeng, the result was p<0.05. However, the Wilcoxon test for heart rate before and after consuming Kratingdaeng and Extra Joss had a at p<0.05. In the Mann-Whitney statistical test, a p<0.05 was found only in the post-systolic condition, while other conditions had at p≥0.05. In conclusion, energy drinks significantly affected blood pressure, but no significant changes were observed in heart rate.

INTRODUCTION

Around 1.28 billion adults aged 30-79 worldwide suffer from hypertension, with a significant portion residing in low- and middle-income countries. Approximately 46% of those with hypertension are unaware of their condition. Hypertension is a leading cause of premature death globally¹¹. Basic Health Research of Indonesia reported that the prevalence of hypertension in Indonesia was 34.1% in 2018, up from 25.8% in 2013. Various conditions, such as kidney disease, thyroid disorders, tumors, adrenal gland abnormalities, or vascular issues, can cause hypertension²².Unhealthy lifestyles, including energy drink consumption, can also contribute to increased blood pressure³³.

There are cases of palpitations in a 16-year-old boy consuming energy drinks thrice daily for two weeks, even though his blood pressure remains normal⁴⁴.A 28-year-old athlete experienced a heart attack linked to excessive caffeine-containing energy drink intake⁵⁵.Deaths and seizures due to excessive energy drink consumption have also been reported⁶⁶.

A previous study on 27 healthy children and adolescents, averaging 14.53 ± 2.4 years old, showed a significant increase in systolic and diastolic blood pressure after consuming energy drinks⁷⁷. However, the study indicated a minimal impact on heart rate⁷.Another study with 44 adults aged 15-30 showed no significant blood pressure changes post-energy drink consumption but a notable decrease in heart rate 30 minutes later⁸⁸.

Indonesia's energy drink consumption fluctuates yearly, as evident in South Jakarta, where it increased from 19% in 2019 to 26% in 2021⁹⁹. Popular brands like Kratingdaeng, Hemaviton, Extra Joss, Fit-up, and others contain stimulants like caffeine, taurine, and various vitamins¹⁰¹⁰.Statistics from 2007 show that Extra Joss and Kratingdaeng were favored brands in Indonesia⁹⁹.

Kratingdaeng and Extra Joss have similar compositions, differing mainly in the presence of royal jelly in Extra Joss. Royal jelly has pharmacological effects, including blood pressure reduction and pulse rate through increased nitric oxide production^11,121112.Caffeine triggers adrenaline production, leading to increased blood pressure by competitively antagonizing adenosine receptors. Adenosine, a neuromodulator, affects central nervous system functions, causing vasoconstriction and elevated peripheral resistance¹³¹³. Exceeding 400 mg of caffeine, equivalent to four to five cups of coffee daily for healthy adults, can have adverse effects on blood pressure and heart rate¹⁴¹⁴. The effects of caffeine consumption, felt within 5-30 minutes, can last up to 12 hours, with dosage influencing blood pressure changes¹⁵¹⁵. With the presence of these issues, the researcher intended to investigate the relationship between energy drinks A (Extra Joss) and B (Kratingdaeng) with the increase in blood pressure and pulse rate in students.

MATERIALS AND METHODS

This study employed the open trial – randomized cross-over study method to investigate the relationship between Extra Joss and Kratingdaeng concerning blood pressure and heart rate in university students. The sample consisted of 38 medical students from Universitas Airlangga in Surabaya, aged between 19 and 22 years, with a normal BMI range of 18.5 – 24.9 from July 2022 to March 2023. The inclusion criteria included students aged 19-22 years with a normal BMI of 18.5 – 24.9. The exclusion criteria involved students with a history of hypertension and habitual energy drink consumption. This research received approval from the Ethical Health Research Committee of Faculty Medicine of Universitas Airlangga, Surabaya, Indonesia, with reference number 246/EC/KEPK/FKUA/2022 on 7 December 2022. The data collected in this study were primary data and obtained directly from the examination of the research subjects. Later, the two groups were subjected to randomization process. Each research subject was assigned a number that was randomly generated using a random number generator. Numbers 1 to 20 were assigned to Group A, while numbers 21 to 38 were assigned to Group B. Subsequently, Group A received Extra Joss, while Group B received Kratingdaeng initially. A washout process was conducted for two weeks to eliminate the caffeine effects in the research participants. Afterward, the given drinks were switched, with Group A receiving Kratingdaeng and Group B receiving Extra Joss. The studied caffeine effect was acuted, lasting for 15 minutes. During data collection, the researcher obtained informed consent from the research subjects. Data analysis used the Wilcoxon and Mann-Whitney tests to analyze the correlation between independent and dependent variables due to different treatments given to the same subjects. Data processing and analysis were conducted using SPSS software (IBM SPSS Statistics) version 26.

RESULTS

In total, 38 students from the Faculty of Medicine, Universitas Airlangga, participated in this research and were included in the analysis. Among these 38 samples, none were taking medications or had any specific medical conditions. The energy drinks consumed by the samples were taken appropriately and did not cause any side effects.

Table 1.Participant Characteristics

Characteristics (n=38)	Total
Sex, n (%)
Male	22 (57.8)
Female	16 (42.1)
Age, mean ± SD	20.02 (0.28)
Habit, n (%)
Rare	30 (78.9)
Sometimes	8 (21.0)
Systole, mean ± SD	116.39 ± 6.69
Diastole, mean ± SD	70.97 ± 6.28
Pulse rate, mean ± SD	73.39 ± 9.66

The Kolmogorov-Smirnov test indicated a non-normal distribution of parameter values both before and after consuming energy drinks. Therefore, the data were tested using the Mann-Whitney and Wilcoxon tests to substantiate the research hypotheses.

	Extra Joss	Kratingdaeng	p-value
Pre Systole	118 (100–135)	115 (108-130)	p=0.372
Pre Diastole