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Drinking 32 ounces of energy drink is associated with potentially harmful changes in blood pressure and heart function that are beyond those seen with caffeine alone, according to a new study.

There are more than 500 energy drink products on the market, and their increased popularity is matched by a significant rise in energy drink-associated emergency department visits and deaths.

Manufacturers and fans of these products claim they are as safe as caffeine, but there is little evidence to support that claim.

Caffeine in doses up to 400 mg (about five cups of coffee) is generally recognized as safe by the Food and Drug Administration. While energy drinks usually contain caffeine, little is known about the safety of some of their other ingredients the study team writes in the Journal of the American Heart Association.

To see what effects these other components have, researchers compared physical changes in a group of 18 healthy men and women after consuming a commercially available energy drink and after drinking another concoction with the same amount of caffeine but none of the other ingredients.

Besides 320 mg of caffeine – the amount in about four cups of coffee – the energy drink contained 4 ounces of sugar, several B vitamins and a proprietary “energy blend” of taurine and other ingredients that are often found drinks like Monster Energy, Red Bull and 5-Hour Energy.

Sachin A. Shah of David Grant Medical Center on Travis Air Force Base and University of the Pacific in Stockton, California, and colleagues measured the participants’ blood pressure and used an electrocardiogram (often called an ECG or EKG) to measure heart electrical activity for 24 hours after the subjects consumed the drinks.

An ECG change known as QTc prolongation and sometimes associated with life-threatening irregularities in the heartbeat was seen after drinking the energy drink, but not after drinking the caffeine beverage, the study team reports.

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