Cardiovascular and Cutaneous Responses to the Combination of Alcohol and Soft Drinks: The Way to Orthostatic Intolerance?

Abstract

Aim: Acute ingestion of alcohol is often accompanied by cardiovascular dysregulation, malaise and even syncope. The full hemodynamic and cutaneous responses to the combination of alcohol and sugar (i.e., alcopops), a common combination in young people, and the mechanisms for the propensity to orthostatic intolerance are not well established. Thus, the purpose of this study was to evaluate the cardiovascular and cutaneous responses to alcopops in young subjects. Methods: Cardiovascular and cutaneous responses were assessed in 24 healthy young subjects (12 men, 12 women) sitting comfortably and during prolonged active standing with a 30-min baseline and 130 min following ingestion of 400 mL of either: water, water + 48 g sugar, water + vodka (1.28 mL.kg^-1 of body weight, providing 0.4 g alcohol.kg^-1), water + sugar + vodka, according to a randomized cross-over design. Results: Compared to alcohol alone, vodka + sugar induced a lower breath alcohol concentration (BrAC), blood pressure and total peripheral resistance (p < 0.05), a higher cardiac output and heart rate (p < 0.05) both in sitting position and during active standing. In sitting position vodka + sugar consumption also led to a greater increase in skin blood flow and hand temperature (p < 0.05) and a decrease in baroreflex sensitivity (p < 0.05). We observed similar results between men and women both in sitting position and during active standing. Conclusion: Despite lower BrAC, ingestion of alcopops induced acute vasodilation and hypotension in sitting position and an encroach of the hemodynamic reserve during active standing. Even if subjects did not feel any signs of syncope these results could be of clinical importance with higher doses of alcohol or if combined to other hypotensive challenges.

Keywords: active standing; alcohol; cutaneous blood flow; hemodynamics; sugar.

Figure 1

(A) Study design including the different periods of sitting and active standing. (B) Time course of the changes in breath alcohol concentration (BrAC) after drinking water + vodka () or water + vodka + sugar (). BrAC at 15 min includes 21 subjects because BrAC at this timepoint was not measured in the first three subjects included in the study. All other timepoints include 24 subjects. ^*p < 0.05 significant differences over time from baseline values; ^$p < 0.05 significant different between responses to the drinks.

Figure 2

Correlation between mean BrAC_30−120min for 12 men (, – –) and 12 women (Δ, ……) and body mass index (A), weight (B), and percent body fat (C) after drinking vodka (left panel) and vodka + sugar (right panel).

Figure 3

(A–D) Left panel: time course of the changes in mean blood pressure (A), cardiac output (CO) (B), total peripheral resistance (TPR) (C), and heart rate (D). Right panel: mean responses averaged over 40–60 and 100–120 min relative to baseline values and presented as a delta (i.e., average over 40–60 and 100–120 min post-drink period, respectively, minus the average over the 30 min baseline period). Drinks: water (W) , ; water + sugar (S) , ; water + vodka (V) , ; water + vodka + sugar (V+S) , . ^*p < 0.05 significant differences over time from baseline values; ^$p < 0.05 significant differences between responses to the drinks.

Figure 4

(A–D) Left panel: time course of the changes in double product (A), contractility index (B), baroreflex sensitivity (BRS) (C), and high frequency power components of RR intervals (HF_RRI) (D). Right panel: mean responses averaged over 40–60 and 100–120 min relative to baseline values and presented as a delta (i.e., average over 40–60 and 100–120 min post-drink period, respectively, minus the average over the 30 min baseline period). Drinks: water (W) , ; water + sugar (S) , ; water + vodka (V) , ; water + vodka + sugar (V+S) , . ^*p < 0.05 significant differences over time from baseline values; ^$p < 0.05 significant differences between responses to the drinks.

Figure 5

(A–D) Left panel: time course of the changes in skin blood flow (SkBf) by laser speckle contrast imaging (LSCI) (A), by laser Doppler flowmetry (LDF) (B), in finger temperature (C), and hand temperature (D). Right panel: mean responses averaged over 40–60 and 100–120 min relative to baseline values and presented as a delta (i.e., average over 40–60 and 100–120 min post-drink period, respectively, minus the average over the 30-min baseline period). Drinks: water (W) , ; water + sugar (S) , ; water + vodka (V) , ; water + vodka + sugar (V+S) , . ^*p < 0.05 significant differences over time from baseline values; ^$p < 0.05 significant differences between responses to the drinks.

Figure 6

Time course of the changes in mean blood pressure (A), cardiac output (CO) (B), total peripheral resistance (TPR) (C), and heart rate (D) 4 min before standing and during the first 8 min of active standing during baseline and after 60 and 120 min post-ingestion. Data are relative to baseline values prior to drink ingestion. Drinks: water (W) , ; water + sugar (S) , ; water + vodka (V) , ; water + vodka + sugar (V+S) , .