Low vs. Higher-Dose Dark Chocolate and Blood Pressure in Cardiovascular High-Risk Patients

Desch, Steffen; Kobler, Daniela; Schmidt, Jan Peter; Sonnabend, Melanie; Adams, Volker; Sareban, Mahdi; Eitel, Ingo; Blüher, Matthias; Schuler, Gerhard; Thiele, Holger

doi:10.1038/ajh.2010.29

Cited by 73 publications

(68 citation statements)

References 17 publications

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“…In one study, a daily dose of 25 g (125 kcal) of dark chocolate slightly increased body weight after 3 months, but a 6 g dose (30 kcal) was not associated with any weight change. In both doses, the 24-h mean ambulatory BP decreased (55).…”

Section: Effects On Obesitymentioning

confidence: 99%

Cocoa and Chocolate in Human Health and Disease

Katz

Doughty

Ali

2011

Antioxidants & Redox Signaling

346

256

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Cocoa contains more phenolic antioxidants than most foods. Flavonoids, including catechin, epicatechin, and procyanidins predominate in antioxidant activity. The tricyclic structure of the flavonoids determines antioxidant effects that scavenge reactive oxygen species, chelate Fe2+ and Cu+, inhibit enzymes, and upregulate antioxidant defenses. The epicatechin content of cocoa is primarily responsible for its favorable impact on vascular endothelium via its effect on both acute and chronic upregulation of nitric oxide production. Other cardiovascular effects are mediated through anti-inflammatory effects of cocoa polyphenols, and modulated through the activity of NF-jB. Antioxidant effects of cocoa may directly influence insulin resistance and, in turn, reduce risk for diabetes. Further, cocoa consumption may stimulate changes in redox-sensitive signaling pathways involved in gene expression and the immune response. Cocoa can protect nerves from injury and inflammation, protect the skin from oxidative damage from UV radiation in topical preparations, and have beneficial effects on satiety, cognitive function, and mood. As cocoa is predominantly consumed as energy-dense chocolate, potential detrimental effects of overconsumption exist, including increased risk of weight gain. Overall, research to date suggests that the benefits of moderate cocoa or dark chocolate consumption likely outweigh the risks. Antioxid. Redox Signal. 15, 2779-2811.

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Section: Effects On Obesitymentioning

confidence: 99%

Cocoa and Chocolate in Human Health and Disease

Katz

Doughty

Ali

2011

Antioxidants & Redox Signaling

346

256

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“…Based on data from a previous trial in mildly hypertensive patients, the presumed SD was set at 8 mm Hg for both groups. 8 Thus, 29 patients per treatment arm needed to be analyzed to reject the null hypothesis of equal means between the 2 groups to provide a statistical power of 80% (2-sided test, α=0.05). To account for potential dropouts or nonanalyzable ABPM recordings, an additional 20% of patients were randomized in each arm.…”

Section: Sample Sizementioning

confidence: 99%

Randomized Sham-Controlled Trial of Renal Sympathetic Denervation in Mild Resistant Hypertension

et al. 2015

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R esistant hypertension is defined as a blood pressure (BP) of ≥140/90 mm Hg despite the intake of ≥3 antihypertensive drugs, including a diuretic at maximally tolerated doses. 1 Its prevalence has been reported to be 12.8% in a US population.2 Sympathetic overactivity contributes to the development and perpetuation in a subset of patients with resistant hypertension.3 Its negative effects include sodium and water retention, increased renin release, and alterations of renal blood flow. 3Afferent and efferent sympathetic nerves that travel in the renal artery walls mediate pathological interactions between the central nervous system and the kidneys. Recently, catheterbased disruption of these renal sympathetic nerve fibers using radiofrequency energy has been introduced as a new treatment against resistant hypertension. Initial nonrandomized and randomized, nonblinded trials demonstrated a dramatic reduction in systolic and diastolic BP after renal sympathetic denervation (RSD). 4,5 In contrast, in the recent sham-controlled Simplicity HTN-3 trial of patients with severe treatment-resistant hypertension, RSD led to no significant improvement in BP when compared with the sham group.6 Some think that the results of this trial with the so far most rigorous design commenced the beginning of the end of RSD for resistant hypertension. Proponents of RSD argue that the negative outcome is a consequence of inefficient denervation procedures and suboptimal selection of patients. One aspect that deserves further consideration is that patients recruited into the Simplicity HTN-3 study might represent a population at the most advanced spectrum of the disease with marked and in many cases long-standing hypertension. One could argue that in such patients, RSD might be less effective because of irreversible alterations of the anatomic structures and physiological processes supporting chronic BP elevations. The present trial was conducted to test the hypothesis that RSD is superior to a sham intervention in patients with only mild resistant arterial hypertension. Methods Design OverviewThe trial's main objective was to study a possible blood-pressure lowering effect of RSD in patients with resistant hypertension and mildly elevated BP. Eligible patients between 18 and 75 years of age were randomized to RSD or a sham procedure. Resistant hypertension with mildly elevated BP was defined as (1) a stable antihypertensive drug Abstract-Few data are available with regard to the effectiveness of renal sympathetic denervation in patients with resistant hypertension yet only mildly elevated blood pressure (BP). Patients with resistant hypertension and slightly elevated BP (day-time systolic pressure, 135-149 and diastolic pressure, 90-94 mm Hg on 24-hour ambulatory measurement) were randomized in a 1:1 ratio to renal sympathetic denervation with the Symplicity Flex Catheter (Medtronic) or an invasive sham procedure. The primary efficacy end point was the change in 24-hour systolic BP at 6 months between groups in the intention to treat po...

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“…Chronic unbalanced intake of chocolate may increase energy intake which in turn may increase body weight known to adversely affect blood pressure and vascular health. In a recent study, an increase in bodyweight (0.8 kg over 3 month) due to the consumption of 25 g chocolate per day was evident [23]. Weight gain may also result in changes in metabolic parameters which in turn may counteract the blood pressure lowering effects of chocolate.…”

mentioning

confidence: 95%

Chocolate: (un)healthy source of polyphenols?

Rimbach¹,

Egert

Pascual‐Teresa³

2010

Genes Nutr

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There is recent epidemiological evidence that chocolate consumption may improve vascular health. Furthermore, several small-scale human intervention studies indicate that habitual chocolate intake enhances the production of vasodilative nitric oxide and may lower blood pressure. It is hypothesized that potential beneficial effects of chocolate on vascular health are at least partly mediated by cocoa polyphenols including procyanidins. Based on cell culture studies, molecular targets of chocolate polyphenols are endothelial nitric oxide synthetase as well as arginase. However, human bioavailability studies suggest that the plasma concentrations of cocoa polyphenols are manifold lower than those concentrations used in cultured cells in vitro. The experimental evidence for beneficial vascular effects of chocolate in human interventions studies is yet not fully convincing. Some human intervention studies on chocolate and its polyphenols lack a stringent study design. They are sometimes underpowered and not always placebo controlled. Dietary chocolate intake in many of these human studies was up to 100 g per day. Since chocolate is a rich source of sugar and saturated fat, it is questionable whether chocolate could be recommended as part of a nutrition strategy to promote vascular health.

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Low vs. Higher-Dose Dark Chocolate and Blood Pressure in Cardiovascular High-Risk Patients

Abstract: The findings are consistent with the hypothesis that dark chocolate may be associated with a reduction in blood pressure (BP). However, due to the lack of a control group, confounding may be possible and the results should be interpreted with caution.

Cited by 73 publications

References 17 publications

Cocoa and Chocolate in Human Health and Disease

Cocoa and Chocolate in Human Health and Disease

Randomized Sham-Controlled Trial of Renal Sympathetic Denervation in Mild Resistant Hypertension

Chocolate: (un)healthy source of polyphenols?

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