Cocoa Reduces Blood Pressure and Insulin Resistance and Improves Endothelium-Dependent Vasodilation in Hypertensives
Open accessAbstract
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.
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Dietary flavanol consumption induces vasodilation of the peripheral and cerebral vascular system and increases brain blood flow and perfusion.
“In this regard, dietary flavanol consumption has been shown to reduce blood pressure and improve insulin sensitivity, 17,18 as well as to induce vasodilation of the peripheral 17,18 and cerebral vascular system, 19 increasing brain blood flow and perfusion.19,20”
Dietary flavanol consumption has been shown to reduce blood pressure and improve insulin sensitivity.
“In this regard, dietary flavanol consumption has been shown to reduce blood pressure and improve insulin sensitivity, 17,18 as well as to induce vasodilation of the peripheral 17,18 and cerebral vascular system, 19 increasing brain blood flow and perfusion.19,20”
The blood pressure reductions are consistent with previous findings in normotensive, hypertensive, and medicated individuals.
“The current demonstration of significant reductions in both systolic and diastolic blood pressure levels after regular cocoa flavanol consumption is consistent with previous findings obtained both in normotensives and in hypertensive subjects, as well as medicated individuals.17,18,29,30”
Flavonoids improve nitric oxide bioavailability in the vasculature, which in turn plays a pivotal role in modulating cerebrovascular tone.
“In this regard, although we did not specifically evaluate the effect of cocoa flavanols on endothelial function, a number of studies, some also from our group, clearly demonstrated the ability of flavonoids to improve NO bioavailability in vasculature, 17,18,25 which, in turn, plays a pivotal role in modulating cerebrovascular tone.28”
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- Authors
- Grassi, D., Necozione, S., Lippi, C., Croce, G., Valeri, L., Pasqualetti, P., Desideri, G., Blumberg, J. B., & Ferri, C.
- Affiliations
- Tufts University (US)
- ORCID
- Venue
- Hypertension
- Published
- 2005-08
- Volume
- 46
- Issue
- 2
- Pages
- 398-405
- ISSN
- 0194-911X (ISSN-L)
- 1524-4563
- OpenAlex
- W2135690475
- Cited by
- 546
- References
- 59
- Citations by year
- 2026: 9 · 2025: 9 · 2024: 14 · 2023: 13 · 2022: 11 · 2021: 18 · 2020: 16 · 2019: 17 · 2018: 26 · 2017: 26 · 2016: 35 · 2015: 31 · 2014: 35 · 2013: 34 · 2012: 59
- FWCI
- 19.06
- Type
- journal article
- Language
- en
- Open access
- Licence
- other-oa
- Locations
- Hypertension (publishedVersion)
- PubMed (publishedVersion)
- IRIS Research product catalog (Sapienza University of Rome) (submittedVersion)
- Archivio Istituzionale della Ricerca - Università degli Studi dell Aquila (submittedVersion)
- INFM-OAR (INFN Catania) (submittedVersion, other-oa)
- Topics
- Health Sciences › Medicine › Biochemistry › Phytochemicals and Antioxidant Activities
- Life Sciences › Agricultural and Biological Sciences › Food Science › Food Chemistry and Fat Analysis
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Blood Pressure and Hypertension Studies
- Keywords
- Theobroma cacao, dark chocolate, flavan-3-ols, essential hypertension, blood pressure, insulin resistance, endothelium-dependent vasodilation, flow-mediated dilation, glucose tolerance, LDL cholesterol, vascular inflammation, dietary intervention
- MeSH terms
- Adult, Blood Pressure, Brachial Artery, Cacao, Endothelium, Vascular, Female, Glucose Tolerance Test, Humans, Hypertension, Insulin Resistance, Cholesterol, LDL, Male, Middle Aged, Vasodilation, Cross-Over Studies, Blood Pressure Monitoring, Ambulatory
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
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