Caffeine Consumption and Heart Rate and Blood Pressure Response to Regadenoson

Abbas Bitar,Claudio Borghi,Rolf P. Kreutz,Ronald Mastouri

doi:10.1371/journal.pone.0130487

Abstract

BackgroundCurrent guidelines recommend that caffeinated products should be avoided for at least 12 hours prior to regadenoson administration. We intended to examine the effect of caffeine consumption and of timing of last dose on hemodynamic effects after regadenoson administration for cardiac stress testing.Methods332 subjects undergoing regadenoson stress testing were enrolled. Baseline characteristics, habits of coffee/caffeine exposure, baseline vital signs and change in heart rate, blood pressure, percent of maximal predicted heart rate, and percent change in heart rate were prospectively collected.ResultsNon-coffee drinkers (group 1) (73 subjects) and subjects who last drank coffee >24 hours (group 3) (139 subjects) prior to regadenoson did not demonstrate any difference in systolic blood pressure, heart rate change, maximal predicted heart rate and percent change in heart rate. Systolic blood pressure change (15.2±17.1 vs. 7.2±10.2 mmHg, p = 0.001), heart rate change (32.2±14 vs. 27.3±9.6 bpm, p = 0.038) and maximal predicted heart rate (65.5±15.6 vs. 60.7±8.6%, p = 0.038) were significantly higher in non-coffee drinkers (group 1) compared to those who drank coffee 12–24 hours prior (group 2) (108 subjects). Subjects who drank coffee >24 hours prior (group 3) exhibited higher systolic blood pressure change (13±15.8 vs. 7±10.2, p = 0.007), and heart rate change (32.1±15.3 vs. 27.3±9.6, p = 0.017) as compared to those who drank coffee 12–24 hours prior to testing (group 2).ConclusionsCaffeine exposure 12–24 hours prior to regadenoson administration attenuates the vasoactive effects of regadenoson, as evidenced by a blunted rise in heart rate and systolic blood pressure. These results suggest that caffeine exposure within 24 hours may reduce the effects of regadenoson administered for vasodilatory cardiac stress testing.

Highlights

Myocardial perfusion imaging (MPI) has been extensively used for detecting coronary artery disease, assessing viable myocardium, and evaluating the effect of different therapeutic interventions [1]
Non-coffee drinkers (73 subjects) and subjects who last drank coffee >24 hours (139 subjects) prior to regadenoson did not demonstrate any difference in systolic blood pressure, heart rate change, maximal predicted heart rate and percent change in heart rate
Systolic blood pressure change (15.2±17.1 vs. 7.2±10.2 mmHg, p = 0.001), heart rate change (32.2±14 vs. 27.3±9.6 bpm, p = 0.038) and maximal predicted heart rate (65.5±15.6 vs. 60.7±8.6%, p = 0.038) were significantly higher in non-coffee drinkers compared to those who drank coffee 12–24 hours prior (108 subjects)

Summary

Introduction

Myocardial perfusion imaging (MPI) has been extensively used for detecting coronary artery disease, assessing viable myocardium, and evaluating the effect of different therapeutic interventions [1]. Vasodilator stress testing accounts for up to 45% of MPI studies [2]. Adenosine and dipyridamole have been the main vasodilators used for stress testing until 2008 when regadenoson was approved by the FDA [3]. Regadenoson is a selective adenosine A2A receptor agonist. Regadenoson’s selectivity for A2A receptors results in increased vasodilation and subsequently increased coronary blood flow (CBF). It is administered at a fixed dose of 0.4mg as an intravenous bolus. We intended to examine the effect of caffeine consumption and of timing of last dose on hemodynamic effects after regadenoson administration for cardiac stress testing

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