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Recommendations Summary

HTN: Cocoa and Chocolate 2008

Click here to see the explanation of recommendation ratings (Strong, Fair, Weak, Consensus, Insufficient Evidence) and labels (Imperative or Conditional). To see more detail on the evidence from which the following recommendations were drawn, use the hyperlinks in the Supporting Evidence Section below.

• Recommendation(s)

  Cocoa and Chocolate

  Consumption of cocoa or chocolate may or may not be beneficial for the reduction of blood pressure, since the current evidence is inconclusive regarding its effect on blood pressure.

  Rating: Weak
  Imperative

  • Risks/Harms of Implementing This Recommendation

    It is important to note that the dark chocolate used in research may be different than the majority of commercially available cocoa and chocolate.  Given the clinical significance of the decrease in blood pressure, caution is needed when considering dietary recommendations for foods that are high in fat and calories.

  • Conditions of Application

    No conditions specified.

  • Potential Costs Associated with Application

    None.

  • Recommendation Narrative

    • Two randomized controlled trials and one non-randomized clinical trial on healthy subjects report no significant differences in systolic or diastolic blood pressure at consumption levels of 100g dark chocolate for one day, 46g per day dark chocolate for two weeks or 920ml per day cocoa for five days (Fisher et al, 2003; Engler et al, 2004; Vlachopoulos et al, 2005). 
    • Two randomized controlled trials with hypertensive and normotensive subjects consuming 100g per day dark chocolate for 15 days reported a reduction in systolic blood pressure in the normotensive subjects and a reduction in total blood pressure in hypertensive subjects (Grassi, Lippi et al, 2005; Grassi, Necozione et al, 2005). 
    • One cohort study spanning 10 years reported that cocoa intake, at a level of 2.30g per day, was inversely associated with blood pressure (Buijsse et al, 2006).
       

  • Recommendation Strength Rationale

    • Conclusion Statement is Grade III

  • Minority Opinions

    Consensus reached.

• Supporting Evidence

  The recommendations were created from the evidence analysis on the following questions. To see detail of the evidence analysis, click the blue hyperlinks below (recommendations rated consensus will not have supporting evidence linked).

  What is the relationship between cocoa or chocolate intake and blood pressure in healthy and hypertensive adults?

  • References

    Buijsse B, Feskens EJM, Kok FJ, Kromhout D. Cocoa intake, blood pressure and cardiovascular mortality: the Zutphen Elderly Study. Arch Intern Med. 2006; 166 (4): 411-417.
    
    Engler MB, Engler MM, Chen CY, Malloy MJ, Browne A, Chiu EY, Kwak HK, Milbury P, Paul SM, Blumberg J, Mietus-Snyder ML. Flavonoid-rich dark chocolate improves endothelial function and increases plasma epicatechin concentrations in healthy adults. J Am Coll Nutr. 2004; 23 (3): 197-204.
    
    Fisher NDL, Hughes M, Gerhard-Herman M, Hollenberg NK. Flavanol-rich cocoa induces nitric-oxide dependent vasodilation in healthy humans. J Hypertens. 2003; 21 (12): 2,281-2,286.
    
    Grassi D, Lippi C, Necozione S, Desideri G, Ferri C. Short-term administration of dark chocolate is followed by a significant increase in insulin sensitivity and a decrease in blood pressure in healthy persons. Am J Clin Nutr. 2005; 81 (3): 611-614.  
    
    Grassi D, Necozione S, Lippi C, Croce G, Valeri L, Pasqualetti P, Desideri G, Blumberg JB, Ferri C. Cocoa reduces blood pressure and insulin resistance and improves endothelium-dependent vasodilation in hypertensives. Hypertension. 2005; 46 (2): 398-405.
    
    Vlachopoulos C, Aznaouridis K, Alexopoulos N, Economou E, Andreadou I, Stefanidis C. Effect of dark chocolate on arterial function in healthy individuals. Am J Hypertens. 2005; 18 (6): 785-791.