This Article Full Text Full Text (PDF) All Versions of this Article: 46/2/398    most recent 01.HYP.0000174990.46027.70v1 Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Grassi, D. Articles by Ferri, C. Search for Related Content PubMed PubMed Citation Articles by Grassi, D. Articles by Ferri, C. Related Collections Clinical Studies Endothelium/vascular type/nitric oxide Risk Factors Hypertension - basic studies

(Hypertension. 2005;46:398.)
© 2005 American Heart Association, Inc.

Original Articles

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

Davide Grassi; Stefano Necozione; Cristina Lippi; Giuseppe Croce; Letizia Valeri; Paolo Pasqualetti; Giovambattista Desideri; Jeffrey B. Blumberg; Claudio Ferri

From the Department of Internal Medicine and Public Health (D.G., S.N., C.L., G.C., L.V., P.P., G.D., C.F.), University of L’Aquila, Italy; and Jean Mayer USDA Human Nutrition Research Center on Aging (J.B.B.), Tufts University, Boston, Mass.

Correspondence to Claudio Ferri, MD, Dipartimento MISP, Università di L’Aquila, Piazzale Salvatore Tommasi 1, 67100 Coppito, L’Aquila, Italy. E-mail claudio.ferri{at}cc.univaq.it

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; 43.7±7.8 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. Noninvasive 24-hour ambulatory BP, FMD, OGTT, serum cholesterol, and markers of vascular inflammation were evaluated at the end of each treatment. The homeostasis model assessment of insulin resistance (HOMA-IR), quantitative insulin sensitivity check index (QUICKI), and insulin sensitivity index (ISI) were calculated from OGTT values. Ambulatory BP decreased after DC (24-hour systolic BP –11.9±7.7 mm Hg, P<0.0001; 24-hour diastolic BP –8.5±5.0 mm Hg, P<0.0001) but not WC. DC but not WC decreased HOMA-IR (P<0.0001), but it improved QUICKI, ISI, and FMD. DC also decreased serum LDL cholesterol (from 3.4±0.5 to 3.0±0.6 mmol/L; P<0.05). In summary, DC decreased BP and serum LDL cholesterol, improved FMD, and ameliorated insulin sensitivity in hypertensives. These results suggest that, while balancing total calorie intake, flavanols from cocoa products may provide some cardiovascular benefit if included as part of a healthy diet for patients with EH.

Key Words: endothelium • insulin • hypertension, essential

This article has been cited by other articles:

				J. Balzer, T. Rassaf, C. Heiss, P. Kleinbongard, T. Lauer, M. Merx, N. Heussen, H. B. Gross, C. L. Keen, H. Schroeter, et al. Sustained benefits in vascular function through flavanol-containing cocoa in medicated diabetic patients a double-masked, randomized, controlled trial. J. Am. Coll. Cardiol., June 3, 2008; 51(22): 2141 - 2149. [Abstract] [Full Text] [PDF]

				U. Campia and J. A. Panza Flavanol-rich cocoa a promising new dietary intervention to reduce cardiovascular risk in type 2 diabetes? J. Am. Coll. Cardiol., June 3, 2008; 51(22): 2150 - 2152. [Full Text] [PDF]

				W D. Crews Jr, D. W Harrison, and J. W Wright A double-blind, placebo-controlled, randomized trial of the effects of dark chocolate and cocoa on variables associated with neuropsychological functioning and cardiovascular health: clinical findings from a sample of healthy, cognitively intact older adults Am. J. Clinical Nutrition, April 1, 2008; 87(4): 872 - 880. [Abstract] [Full Text] [PDF]

				R. R. Allen, L. Carson, C. Kwik-Uribe, E. M. Evans, and J. W. Erdman Jr Daily Consumption of a Dark Chocolate Containing Flavanols and Added Sterol Esters Affects Cardiovascular Risk Factors in a Normotensive Population with Elevated Cholesterol J. Nutr., April 1, 2008; 138(4): 725 - 731. [Abstract] [Full Text] [PDF]

				I. Erlund, R. Koli, G. Alfthan, J. Marniemi, P. Puukka, P. Mustonen, P. Mattila, and A. Jula Favorable effects of berry consumption on platelet function, blood pressure, and HDL cholesterol Am. J. Clinical Nutrition, February 1, 2008; 87(2): 323 - 331. [Abstract] [Full Text] [PDF]

				A. J. Flammer, F. Hermann, I. Sudano, L. Spieker, M. Hermann, K. A. Cooper, M. Serafini, T. F. Luscher, F. Ruschitzka, G. Noll, et al. Dark Chocolate Improves Coronary Vasomotion and Reduces Platelet Reactivity Circulation, November 20, 2007; 116(21): 2376 - 2382. [Abstract] [Full Text] [PDF]

				G. E. Mann, D. J. Rowlands, F. Y.L. Li, P. de Winter, and R. C.M. Siow Activation of endothelial nitric oxide synthase by dietary isoflavones: Role of NO in Nrf2-mediated antioxidant gene expression Cardiovasc Res, July 15, 2007; 75(2): 261 - 274. [Abstract] [Full Text] [PDF]

				D. Taubert, R. Roesen, C. Lehmann, N. Jung, and E. Schomig Effects of Low Habitual Cocoa Intake on Blood Pressure and Bioactive Nitric Oxide: A Randomized Controlled Trial JAMA, July 4, 2007; 298(1): 49 - 60. [Abstract] [Full Text] [PDF]

				S. Baba, M. Natsume, A. Yasuda, Y. Nakamura, T. Tamura, N. Osakabe, M. Kanegae, and K. Kondo Plasma LDL and HDL Cholesterol and Oxidized LDL Concentrations Are Altered in Normo- and Hypercholesterolemic Humans after Intake of Different Levels of Cocoa Powder J. Nutr., June 1, 2007; 137(6): 1436 - 1441. [Abstract] [Full Text] [PDF]

				D. Taubert, R. Roesen, and E. Schomig Effect of Cocoa and Tea Intake on Blood Pressure: A Meta-analysis Arch Intern Med, April 9, 2007; 167(7): 626 - 634. [Abstract] [Full Text] [PDF]

				W. S. da-Silva, J. W. Harney, B. W. Kim, J. Li, S. D.C. Bianco, A. Crescenzi, M. A. Christoffolete, S. A. Huang, and A. C. Bianco The Small Polyphenolic Molecule Kaempferol Increases Cellular Energy Expenditure and Thyroid Hormone Activation Diabetes, March 1, 2007; 56(3): 767 - 776. [Abstract] [Full Text] [PDF]

				B. Buijsse, E. J. M. Feskens, F. J. Kok, and D. Kromhout Cocoa intake, blood pressure, and cardiovascular mortality: the zutphen elderly study. Arch Intern Med, February 27, 2006; 166(4): 411 - 417. [Abstract] [Full Text] [PDF]

				A. Alonso, C. de la Fuente, J. J. Beunza, A. Sanchez-Villegas, M. A. Martinez-Gonzalez, A. Alonso, A. Sanchez-Villegas, D. Grassi, J. B. Blumberg, and C. Ferri Chocolate Consumption and Incidence of Hypertension Hypertension, December 1, 2005; 46(6): e21 - e22. [Full Text] [PDF]

				P. Meisel, D. Grassi, J. B. Blumberg, G. Desideri, and C. Ferri Hypertension, Diabetes Hypertension, November 1, 2005; 46(5): e17 - e18. [Full Text] [PDF]