Effect of Cocoa Products on Blood Pressure: Systematic Review and Meta-Analysis

Desch, Steffen; Schmidt, Jan Peter; Kobler, Daniela; Sonnabend, Melanie; Eitel, Ingo; Sareban, Mahdi; Rahimi, Kazem; Schuler, Gerhard; Thiele, Holger

doi:10.1038/ajh.2009.213

Cited by 233 publications

(185 citation statements)

References 24 publications

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“…Some studies have indicated that the antihypertensive effect is greater in subjects with higher baseline BP. 5,20 Therefore, it may be more difficult to reduce a slightly elevated BP than to reduce a highly elevated BP. However, including subjects with a much higher BP without giving them established antihypertensive medication was considered unethical.…”

Section: Discussionmentioning

confidence: 99%

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Effects of anthocyanins on blood pressure and stress reactivity: a double-blind randomized placebo-controlled crossover study

et al. 2011

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High intakes of flavonoids are associated with reduced cardiovascular risk, and flavonoids such as cocoa and soy protein isolate have shown beneficial effects on blood pressure (BP). Anthocyanins constitute a flavonoid subgroup consumed in regular diets, but few studies have assessed the antihypertensive potential of anthocyanins. We aimed to assess whether high concentrations of relatively pure anthocyanins reduce BP and alter cardiovascular and catecholamine reactivity to stress. A total of 31 healthy men between 35-51 years of age with screening BP 4140/90 mm Hg, not on antihypertensive or lipid-lowering medication, were randomised in a double-blind crossover study to placebo versus 320-mg anthoycanins twice daily. Treatment duration was 4 weeks, with a 4-week washout.Sitting and supine BP measurements, ambulatory BP recording and stress reactivity were assessed and analyzed by a paired sample t-test. In all, 27 patients completed all visits. Sitting systolic BP (primary endpoint) was 133 mm Hg after placebo versus 135 mm Hg after anthocyanin treatment (P ¼ 0.25). Anthocyanins did neither affect semiautomatic oscillometric BP measurements in the sitting or supine position nor 24-h ambulatory BP. No significant differences in stress reactivity were found across treatment periods. Overall, we conclude that high concentrations of these relatively pure anthocyanins do not reduce BP in healthy men with a high normal BP.

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Section: Discussionmentioning

confidence: 99%

“…20 Bogaard et al 24 commented that most of these studies did not include adequate placebo groups, and among the three studies that did provide placebo groups, no antihypertensive effects was found. Further, Bogaard et al…”

Section: Discussionmentioning

confidence: 99%

Effects of anthocyanins on blood pressure and stress reactivity: a double-blind randomized placebo-controlled crossover study

et al. 2011

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“…Desch and coworkers also provided a metaanalysis including 10 randomized controlled trials involving either healthy subjects or patients with prehypertension/stage 1 hypertension (297 individuals). Cocoa consumption was associated with a 4.5 mmHg reduction (95% CI, −5.9 to −3.2, p < 0.001) for SBP and a 2.5 mmHg reduction (95% CI, −3.9 to −1.2, p < 0.001) for DBP (59). In the same year, a Cochrane review showed that flavanol-rich chocolate and cocoa products may have a statistically significant effect in lowering BP by …”

Section: Epidemiological Evidencementioning

confidence: 97%

Cocoa, Blood Pressure, and Vascular Function

et al. 2012

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Cardiovascular disease (CVD) represents the most common cause of death worldwide. The consumption of natural polyphenol-rich foods, and cocoa in particular, has been related to a reduced risk of CVD, including coronary heart disease and stroke. Intervention studies strongly suggest that cocoa exerts a beneficial impact on cardiovascular health, through the reduction of blood pressure (BP), improvement of vascular function, modulation of lipid and glucose metabolism, and reduction of platelet aggregation. These potentially beneficial effects have been shown in healthy subjects as well as in patients with risk factors (arterial hypertension, diabetes, and smoking) or established CVD (coronary heart disease or heart failure). Several potential mechanisms are supposed to be responsible for the positive effect of cocoa; among them activation of nitric oxide (NO) synthase, increased bioavailability of NO as well as antioxidant, and anti-inflammatory properties. It is the aim of this review to summarize the findings of cocoa and chocolate on BP and vascular function.

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“…6,7 Current experimental and epidemiological studies provide evidence for a protective role for polyphenol-rich dark chocolate (DC) and cocoa polyphenols on markers of glucose regulation, blood pressure and lipid profile. [8][9][10][11][12][13][14][15][16][17][18] This protective role has been ascribed to the antioxidant properties of DC and cocoa polyphenols and their ability to modulate nitric oxide bioavailability. 14,17 However, few studies have examined the involvement of the endocrine system in mediating the cardiometabolic health-effects of polyphenols.…”

Section: -5mentioning

confidence: 99%

Differential effect of polyphenol-rich dark chocolate on biomarkers of glucose metabolism and cardiovascular risk factors in healthy, overweight and obese subjects: a randomized clinical trial

et al. 2012

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The association between excess cortisol and various parameters of metabolic syndrome including hypertension, insulin resistance and dyslipidaemia is increasingly recognised. The present single-blind randomised placebo-controlled cross-over study compared the effect of polyphenol-rich dark chocolate (DC) on biomarkers of glucose metabolism, lipid profile, and blood pressure (BP) in females with BMI $ 25 kg m À2 (n ¼ 21) and females with BMI < 25 kg m À2 (n ¼ 21). Volunteers consumed 20 g of DC containing 500 mg polyphenols or a placebo DC with negligible polyphenol-content daily for 4 weeks, separated by a 2-week washout period. Systolic BP and diastolic BP decreased after 4 weeks of polyphenol-rich DC. Placebo raised fasting insulin, homeostasis model assessment of insulin resistance (HOMA-IR) and salivary cortisol, an effect that was significantly different from polyphenol-rich DC which had a negligible effect on fasting insulin, HOMA-IR and salivary cortisol. Females with BMI $ 25 kg m À2 responded less favourably to placebo than lean females and consequently had higher fasting insulin and HOMA-IR, in addition to a lower quantitative sensitivity check index (QUICKI) after ingestion of placebo compared to polyphenol-rich DC. No significant changes in lipid profile were observed. This study provides evidence for the metabolic benefits of consuming polyphenol-rich dark chocolate while demonstrating the possibility of adverse effects occurring with polyphenol-poor chocolate placebo. Methods DesignThe study used a single-blind randomised placebo-controlled cross-over design where each subject acted as their own control. Following a 1-week run-in phase, eligible subjects were randomly assigned to receive 20 g DC containing 500 mg polyphenols or

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Effect of Cocoa Products on Blood Pressure: Systematic Review and Meta-Analysis

Cited by 233 publications

References 24 publications

Effects of anthocyanins on blood pressure and stress reactivity: a double-blind randomized placebo-controlled crossover study

Effects of anthocyanins on blood pressure and stress reactivity: a double-blind randomized placebo-controlled crossover study

Cocoa, Blood Pressure, and Vascular Function

Differential effect of polyphenol-rich dark chocolate on biomarkers of glucose metabolism and cardiovascular risk factors in healthy, overweight and obese subjects: a randomized clinical trial

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