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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

    • 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


    • 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.