Chocolate and Blood Pressure in Elderly Individuals With Isolated Systolic Hypertension

Taubert, Dirk; Berkels, Reinhard; Roesen, Renate; Klaus, W.

doi:10.1001/jama.290.8.1029

Cited by 264 publications

(212 citation statements)

References 4 publications

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“…Numerous randomized controlled trials have shown that the consumption of dark chocolate or cocoa has favorable effects on blood pressure24, 38 and endothelial function measured by FMD 35, 39. These reports are inconsistent with our findings that there were no treatment effects on blood pressure and measures of vascular function.…”

Section: Discussioncontrasting

confidence: 99%

Effects of Dark Chocolate and Almonds on Cardiovascular Risk Factors in Overweight and Obese Individuals: A Randomized Controlled‐Feeding Trial

Lee

Berryman

West

et al. 2017

JAHA

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BackgroundConsumption of almonds or dark chocolate and cocoa has favorable effects on markers of coronary heart disease; however, the combined effects have not been evaluated in a well‐controlled feeding study. The aim of this study was to examine the individual and combined effects of consumption of dark chocolate and cocoa and almonds on markers of coronary heart disease risk.Methods and ResultsA randomized controlled, 4‐period, crossover, feeding trial was conducted in overweight and obese individuals aged 30 to 70 years. Forty‐eight participants were randomized, and 31 participants completed the entire study. Each diet period was 4 weeks long, followed by a 2‐week compliance break. Participants consumed each of 4 isocaloric, weight maintenance diets: (1) no treatment foods (average American diet), (2) 42.5 g/d of almonds (almond diet [ALD]), (3) 18 g/d of cocoa powder and 43 g/d of dark chocolate (chocolate diet [CHOC]), or (4) all 3 foods (CHOC+ALD). Compared with the average American diet, total cholesterol, non–high‐density lipoprotein cholesterol, and low‐density lipoprotein cholesterol after the ALD were lower by 4%, 5%, and 7%, respectively (P<0.05). The CHOC+ALD decreased apolipoprotein B by 5% compared with the average American diet. For low‐density lipoprotein subclasses, compared with the average American diet, the ALD showed a greater reduction in large buoyant low‐density lipoprotein particles (−5.7±2.3 versus −0.3±2.3 mg/dL; P=0.04), whereas the CHOC+ALD had a greater decrease in small dense low‐density lipoprotein particles (−12.0±2.8 versus −5.3±2.8 mg/dL; P=0.04). There were no significant differences between diets for measures of vascular health and oxidative stress.ConclusionsOur results demonstrate that consumption of almonds alone or combined with dark chocolate under controlled‐feeding conditions improves lipid profiles. Incorporating almonds, dark chocolate, and cocoa into a typical American diet without exceeding energy needs may reduce the risk of coronary heart disease.Clinical Trial RegistrationURL: https://www.clinicaltrials.gov. Unique identifier: NCT01882881.

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Section: Discussioncontrasting

confidence: 99%

Effects of Dark Chocolate and Almonds on Cardiovascular Risk Factors in Overweight and Obese Individuals: A Randomized Controlled‐Feeding Trial

Lee

Berryman

West

et al. 2017

JAHA

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“…The 500 mg dose was previously shown to reduce fasting glucose (FG) levels and BP by Grassi et al (4,5) and Taubert et al (26) . However, due to the great variation in epicatechin and catechin levels between the chocolate used in the present study and the one used by Grassi et al (4,5) , a higher DC dose of 1000 mg was also chosen.…”

Section: Methodsmentioning

confidence: 99%

The effect of polyphenol-rich dark chocolate on fasting capillary whole blood glucose, total cholesterol, blood pressure and glucocorticoids in healthy overweight and obese subjects

Almoosawi

Fyfe

et al. 2009

Br J Nutr

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Numerous studies indicate that polyphenol-rich chocolate reduces fasting blood glucose, blood pressure (BP) and total cholesterol in healthy individuals and hypertensives with or without glucose intolerance. The aim of the present study was to investigate the effect of two doses of polyphenol-rich dark chocolate (DC) on fasting capillary whole blood glucose, total cholesterol and BP and to examine whether improvements in these parameters are associated with changes in adrenocorticoid excretion in overweight and obese individuals. The study used a randomised, single-blind, cross-over design where fourteen overweight and obese subjects were randomised to either take 20 g DC with 500 mg polyphenols then 20 g DC with 1000 mg polyphenols or vice-versa. Participants followed each diet for 2 weeks separated by a 1-week washout period. It was observed that the 500 mg polyphenol dose was equally effective in reducing fasting blood glucose levels, systolic BP (SBP) and diastolic BP (DBP) as the 1000 mg polyphenol dose suggesting that a saturation effect might occur with increasing dose of polyphenols. There was also a trend towards a reduction in urinary free cortisone levels with both groups although it did not reach statistical significance. No changes in anthropometrical measurements were seen. We suggest that more research is required to investigate the mechanism(s) by which polyphenol-rich foods influence health.Dark chocolate: Glucose: Blood pressure: Cholesterol: Glucocorticoids: Obesity Epidemiological studies link high polyphenol intake with reduced risk of oxidative stress-related diseases like diabetes, hypertension and CVD (1 -3) . In particular, consumption of cocoa and dark chocolate (DC) has been shown to improve endothelium function, insulin sensitivity, blood pressure (BP) in healthy individuals, hypertensives with or without glucose intolerance (4 -6) and obese subjects (7) . Cocoa and DC are rich sources of polyphenols providing on average more polyphenols per serving than red wine, green tea or black tea (8) . These polyphenols confer potent antioxidant properties to cocoa and DC (8,9) in addition to the ability to regulate NO (4 -7) .Obesity is known to be associated with insulin resistance and elevated BP (10) . One of the underlying factors linked to these cardiovascular risk factors is abnormal cortisol metabolism (11,12) . Cortisol is a counterregulatory hormone that is essential in the long-term maintenance of blood glucose (13) and which could also unfavourably influence BP and lipid profile (12 -15) . When present in excess, cortisol induces overproduction of reactive oxygen species (16,17) leading to reduced endothelial NO synthase expression (18) . In obesity, particularly abdominal obesity, postprandial hypercortisolism and enhanced peripheral metabolism of cortisol, characterised by increased urinary cortisone-to-cortisol ratio, are observed which are linked to insulin resistance and increased fasting insulin (11) . Increased expression of subcutaneous adipose tissue 11b-hydroxysteroid ...

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“…All participants were asked to continue their usual physical activity throughout the study period and were found to comply with this instruction based on self-reports in daily physical activity diaries. Similar to the trial described by Taubert et al 18 on elderly patients with isolated systolic hypertension, our patients and reference group entered a 7-day run-in phase, which excluded all cocoa foods. At the end of the run-in period, both groups were assigned randomly to receive daily either 100-g DC bars (Ritter Sport Halbbitter; Alfred Ritter GmbH & Co.) which, by our determination, contained 21.91 mg catechin, 65.97 mg epicatechin, 0.59 mg quercetin, 0.03 mg kaempferol, and 0.31 mg isorhamnetin, or 90-g flavanol-free white chocolate (WC) bars absent of any flavonoids (Milka; Kraft Foods) over a period of 15 days.…”

Section: Experimental Protocolmentioning

confidence: 99%

“…DC and WC bars contained 480 kcal energy and similar amounts of cocoa butter, macronutrients, fiber, electrolytes, and vitamins. 18 At the end of the first phase of intervention, patients and controls entered a second 7-day chocolate-free phase. After this period, all participants were crossed over to the other treatment ( Figure 1).…”

Section: Experimental Protocolmentioning

confidence: 99%

Cocoa Reduces Blood Pressure and Insulin Resistance and Improves Endothelium-Dependent Vasodilation in Hypertensives

Grassi

Necozione²,

Lippi³

et al. 2005

Hypertension

489

393

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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).

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Chocolate and Blood Pressure in Elderly Individuals With Isolated Systolic Hypertension

Cited by 264 publications

References 4 publications

Effects of Dark Chocolate and Almonds on Cardiovascular Risk Factors in Overweight and Obese Individuals: A Randomized Controlled‐Feeding Trial

Effects of Dark Chocolate and Almonds on Cardiovascular Risk Factors in Overweight and Obese Individuals: A Randomized Controlled‐Feeding Trial

The effect of polyphenol-rich dark chocolate on fasting capillary whole blood glucose, total cholesterol, blood pressure and glucocorticoids in healthy overweight and obese subjects

Cocoa Reduces Blood Pressure and Insulin Resistance and Improves Endothelium-Dependent Vasodilation in Hypertensives

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