Effect of Cocoa Beverage and Dark Chocolate Consumption on Blood Pressure in Those with Normal and Elevated Blood Pressure: A Systematic Review and Meta-Analysis

Abstract

Cocoa is a major dietary source of polyphenols, including flavanols, which have been associated with reduced blood pressure (BP). While earlier systematic reviews and meta-analyses have shown significant effects of cocoa consumption on systolic BP, limitations include small sample sizes and study heterogeneity. Questions regarding food matrix and dose of polyphenols, flavanols, or epicatechins remain. This systematic review and meta-analysis aimed to investigate the effects of ≥2 weeks of cocoa consumption as a beverage or dark chocolate in those with normal or elevated (< or ≥130 mmHg) systolic BP measured in the fasted state or over 24-h. A systematic search conducted on PubMed and Cochrane Library databases up to 26 February 2022 yielded 31 suitable articles. Independent of baseline BP, cocoa consumption for ≥2 weeks was associated with reductions in systolic and diastolic BP (p < 0.05, all). Compared with cocoa, chocolate lowered the weighted mean of resting systolic BP (−3.94 mmHg, 95% CI [−5.71, −2.18]) more than cocoa beverage (−1.54 mmHg, 95% CI [−3.08, 0.01]). When the daily dose of flavanols was ≥900 mg or of epicatechin ≥100 mg, the effect was greater. Future, adequately powered studies are required to determine the optimal dose for a clinically significant effect.

Cocoa flavanol supplementation preserves early and late radial artery function after transradial catheterization

“…The amount of (-)epicatechin as a reliable marker of total flavanol content in commercially available chocolate products shows large variation. To achieve comparable amounts to the flavanols used in the present supplement, approximately 240 -900 g of dark chocolate would be required [38][39][40] . Cocoa flavanols have been shown…”

“…To achieve comparable amounts to the flavanols used in the present supplement, approximately 240-900 g of dark chocolate would be required. [38][39][40] Cocoa flavanols have been shown to improve CVD risk biomarkers, including FMD and blood pressure, in individuals of different CVD risk categories ranging from healthy to established CVD. 16 Potential mechanisms include modulation of the inflammatory response through NF-κB, TNFα, and IL-1β cascades.…”

role of antioxidants in disease prevention

“…The types of antioxidants based on their solubility can be found in Table (3). A fatsoluble antioxidant acts primarily on the membranes of cells, whereas a watersoluble antioxidant acts both within and outside the cell.…”

“…The effects of cocoa consumption were examined in one meta-analysis in which researchers compared the effects of cocoa consumption on patients with normal and high blood pressure. It has been shown that dark chocolate, which contains a high concentration of cocoa, is more effective than cocoa beverages at lowering blood pressure (Amoah et al, 2022).…”

Antioxidant Activity and Resveratrol Content of Cocoa and Chocolate Samples

“…მუქმა შოკოლადმა შეამცირა სისტოლური არტერიული წნევა უფრო მეტად, ვიდრე კაკაოს სასმელმა. ფლავანოლების ან ეპიკატექინის დღიური დოზის მატება კაკაოს და შოკოლადის პროდუქტებში, აძლიერებდა წნევაზე ზემოქმედების ეფექტს [4]. შოკოლადის და კაკაოს ნიმუშების კვლევის დროს აღინიშნება დადებითი კორელაცია პოლიფენოლების რაოდენობასა და ანტიოქსიდანტურ აქტივობას შორის [5] მასალა და მეთოდები.…”