Abstract-Consumption of flavanol-rich dark chocolate (DC) has been shown to decrease blood pressure (BP) and insulin resistance in healthy subjects, suggesting similar benefits in patients with essential hypertension (EH). Therefore, we tested the effect of DC on 24-hour ambulatory BP, flow-mediated dilation (FMD), and oral glucose tolerance tests (OGTTs) in patients with EH. After a 7-day chocolate-free run-in phase, 20 never-treated, grade I patients with EH (10 males; 43.7Ϯ7.8 years) were randomized to receive either 100 g per day DC (containing 88 mg flavanols) or 90 g per day flavanol-free white chocolate (WC) in an isocaloric manner for 15 days. After a second 7-day chocolate-free period, patients were crossed over to the other treatment. O bservational studies suggest dietary flavonoids decrease the risk of death from coronary heart disease, 1 cancer, 1 and stroke. 2 Flavonoid-rich foods include fruits and vegetables as well as tea, red wine, and chocolate. 3 The high flavonoid content, particularly in flavanols (ie, catechins) and their procyanidin oligomers, of these foods may contribute to some of their putative cardiovascular benefits. 4,5 The antioxidant protection afforded by flavonoids in the vascular endothelium may reduce the risk for atherosclerosis, including their action of inhibiting the oxidative conversion of NO to peroxynitrite. 6 Accordingly, cocoa flavonoids decreased oxidant-induced peroxynitrite production in vitro 7 and increased NO synthase (NOS) expression and NO-dependent vasorelaxation in rabbit aortic rings. 8 In healthy adults, drinking flavanol-rich cocoa increased NO-dependent vasorelaxation in finger arteries, 9 and eating flavanol-rich dark chocolate (DC) improved flow-mediated dilation (FMD) in brachial arteries in association with an increase in plasma epicatechin. 10 Impaired NO-dependent vasorelaxation also contributes to a dysregulation of blood pressure (BP) 11 and a decrement of insulin-mediated glucose uptake. 12 In contrast, increased endothelial NOS expression and NO bioavailability ameliorate endothelial dysfunction, and thereby have the potential to decrease BP, increase insulin sensitivity, and slow down atherogenetic processes. In this regard, the anthocyanin cyanidin-3-glucoside was able to increase NOS expression and NO bioavailability in vascular endothelial cells. 13 We recently demonstrated decrements in BP and increments in insulin sensitivity in healthy volunteers after 15 days of DC intake. 14 Thus, we studied patients with essential hypertension (EH) to evaluate the effects of flavanol-rich DC on 24-hour ambulatory BP monitoring (ABPM), endotheliumdependent vasorelaxation via FMD of the brachial artery, insulin sensitivity via oral glucose tolerance tests (OGTTs), and 2 serum biomarkers of vascular inflammation: highsensitive C-reactive protein (hsCRP) and intercellular adhesion molecule-1 (ICAM-1).