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Cocoa, Chocolate and Hypertension

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Chocolate and Health

Abstract

Cardiovascular disease is the main cause of mortality both in developed and developing countries, killing an estimated 17 million people each year [1, 2]. In particular, hypertension is one of the most important cardiovascular disease risk factors, accounting for nearly two-thirds of all strokes and half of all ischemic heart disease [1–3]. It is also a major risk factor for dementia, chronic kidney disease and heart failure [2, 3]. Hypertension affects approximately 67 million US adults, and another 85 million have pre-hypertension [4, 5]. The most recent estimates suggest that 7.6 million premature deaths globally (13.5% of total global mortality) and 92 million disability-adjusted life years (6.0% of the global total) are attributable to hypertension [6]. Moreover, in developed countries, 90% of adults aged 55–65 years and with normal blood pressure will present with hypertension during their lifetime [7]. Conversely, lowering of an abnormally high blood pressure is associated with significant reductions in cardiovascular morbidity and mortality. However, blood pressure control requires extensive healthcare resources and, in clinical practice, most hypertensive patients are either undiagnosed, untreated or sub-optimally treated [8, 9]. Thus, considering the graded and continuous nature of the relation between blood pressure and vascular risk, international guidelines for the diagnosis and treatment of arterial hypertension [8, 9] introduced the concepts of “high-normal blood pressure” and “pre-hypertension.” The respective committees recommended the identification of these individuals as they are at increased risk for progression to hypertension and subsequently other cardiovascular diseases [8, 9]. Indeed, both conditions are very prevalent (especially in obese young people), are often associated with other cardiovascular risk factors and result in a 3.0-fold greater likelihood of progression to hypertension and a 1.4- to 2.0-fold greater risk of cardiovascular events [10].

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References

  1. World Health Organization (2005) Preventing chronic disease: a vital investment. WHO, Geneva

    Google Scholar 

  2. Lawes CM, Vander Hoorn S, Law MR et al (2006) Blood pressure and the global burden of disease 2000. Part II. Estimates of attributable burden. J Hypertens 24:423–430

    Article  PubMed  CAS  Google Scholar 

  3. Mohan S, Campbell NR (2009) Salt and high blood pressure. Clin Sci (Lond) 117:1–11

    Article  CAS  Google Scholar 

  4. Ostchega Y, Yoon SS, Highes J et al (2008) Hypertension awareness, treatment, and control: continued disparities in adults-United States, 2005–2006. NCHS Data Brief 3:1–8

    PubMed  Google Scholar 

  5. Egan BM, Laken MA, Donovan JL et al (2010) Does dark chocolate have a role in the prevention and management of hypertension? Commentary on the evidence. Hypertension 55(6):1289–1295

    Article  PubMed  CAS  Google Scholar 

  6. Lawes CM, Vander Hoorn S, Rodgers A (2008) International Society of Hypertension. Global burden of blood-pressure-related disease, 2001. Lancet 371:1513–1518

    Article  PubMed  Google Scholar 

  7. Vasan RS, Beiser A, Seshadri S et al (2002) Residual lifetime risk for developing hypertension in middle-aged women and men: the Framingham heart study. JAMA 287:1003–1010

    Article  PubMed  Google Scholar 

  8. Mancia G, De Backer G, Dominiczak A et al (2007) 2007 Guidelines for the management of arterial hypertension: the task force for the management of arterial hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). J Hypertens 25:1105–1187

    Article  PubMed  CAS  Google Scholar 

  9. Chobanian AV, Bakris GL, Black HR et al (2003) Seventh report of the Joint National Committee on Prevention, Evaluation, and Treatment of High Blood Pressure. Hypertension 42:1206–1252

    Article  PubMed  CAS  Google Scholar 

  10. Egan BM, Julius S (2008) Prehypertension: risk stratification and management considerations. Curr Hypertens Rep 10:359–366

    Article  PubMed  Google Scholar 

  11. Sacks FM, Svetkey LP, Vollmer WM et al DASH-Sodium Collaborative Research Group (2001) Effects on blood pressure of reduced dietary sodium and the Dietary Approaches to Stop Hypertension (DASH) diet. DASH-Sodium Collaborative Research Group. N Engl J Med 344(1):3–10

    Article  PubMed  CAS  Google Scholar 

  12. Hu FB, Willett WC (2002) Optimal diets for prevention of coronary heart disease. JAMA 288(20):2569–2578

    Article  PubMed  CAS  Google Scholar 

  13. Ferri C, Grassi G (2003) Mediterranean diet, cocoa and cardiovascular disease: a sweeter life, a longer life, or both? J Hypertens 21(12):2231–2234

    Article  PubMed  CAS  Google Scholar 

  14. Ortega RM (2006) Importance of functional foods in the Mediterranean diet. Public Health Nutr 9(8A):1136–1140

    Article  PubMed  CAS  Google Scholar 

  15. Grassi D, Desideri G, Croce G et al (2009) Flavonoids, vascular function and cardiovascular protection. Curr Pharm Des 15:1072–1084

    Article  PubMed  CAS  Google Scholar 

  16. Scalbert A, Manach C, Morand C et al (2005) Dietary polyphenols and the prevention of diseases. Crit Rev Food Sci Nutr 45:287–306

    Article  PubMed  CAS  Google Scholar 

  17. Lazarus SA, Adamson GE, Hammerstone JF et al (1999) High-performance liquid Chromatography/Mass spectrometry analysis of proanthocyanidins in foods and beverages. J Agric Food Chem. 47:3693–3701

    Article  PubMed  CAS  Google Scholar 

  18. Rusconi M, Conti A (2010) Theobroma cacao L., the food of the gods: a scientific approach beyond myths and claims. Pharmacol Res. 61(1):5–13

    Article  PubMed  CAS  Google Scholar 

  19. Visioli F, Bernaert H, Corti R et al (2009) Chocolate, lifestyle, and health. Crit Rev Food Sci Nutr 49(4):299–312

    Article  PubMed  Google Scholar 

  20. Wang JF, Schramm DD, Holt RR et al (2000) A dose-response effect from chocolate consumption on plasma epicatechin and oxidative damage. J Nutr 130: 2115S–2119S

    PubMed  CAS  Google Scholar 

  21. Hollenberg N, Martinez G, McCullough M et al (1997) Aging, acculturation, salt intake, and hypertension in the Kuna of Panama. Hypertension 29:171–176

    Article  PubMed  CAS  Google Scholar 

  22. Buijsse B, Feskens EJ, Kok FJ et al (2006) Cocoa intake, blood pressure, and cardiovascular mortality: the Zutphen Elderly Study. Arch Intern Med 166:411–417

    PubMed  Google Scholar 

  23. Buijsse B, Weikert C, Drogan D et al (2010) Chocolate consumption in relation to blood pressure and risk of cardiovascular disease in German adults. Eur Heart J 31(13):1616–1623

    Article  PubMed  CAS  Google Scholar 

  24. Cassidy A, O’Reillyé J, Kay C et al (2011) Habitual intake of flavonoid subclasses and incident hypertension in adults. Am J Clin Nutr 93(2):338–347

    Article  PubMed  CAS  Google Scholar 

  25. Alonso A, de la Fuente C, Beunza JJ et al (2005) Chocolate consumption and incidence of hypertension. Hypertension 46:e21–22

    Article  PubMed  CAS  Google Scholar 

  26. Cienfuegos-Jovellanos E, Quiñones Mdel M, Muguerza B et al (2009) Antihypertensive effect of a polyphenol-rich cocoa powder industrially processed to preserve the original flavonoids of the cocoa beans. J Agric Food Chem 57:6156–6162

    Article  PubMed  CAS  Google Scholar 

  27. Sánchez D, Quiñones M, Moulay L et al (2010) Changes in arterial blood pressure of a soluble cocoa fiber product in spontaneously hypertensive rats. J Agric Food Chem. 58:1493–1501

    Article  PubMed  Google Scholar 

  28. Grassi D, Desideri G, Ferri C (2010) Blood pressure and cardiovascular risk: what about cocoa and chocolate? Arch Biochem Biophys 501(1):112–115

    Article  PubMed  CAS  Google Scholar 

  29. Grassi D, Lippi C, Necozione S et al (2005) 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 81(3):611–614

    PubMed  CAS  Google Scholar 

  30. Grassi D, Necozione S, Lippi C et al (2005) Cocoa reduces blood pressure and insulin resistance and improves endothelium-dependent vasodilation in hypertensives. Hypertension 46(2):398–405

    Article  PubMed  CAS  Google Scholar 

  31. Grassi D, Desideri G, Necozione S et al (2008) Blood pressure is reduced and insulin sensitivity increased in glucose-intolerant, hypertensive subjects after 15 days of consuming highpolyphenol dark chocolate. J Nutr 138(9):1671–1676

    PubMed  CAS  Google Scholar 

  32. Taubert D, Roesen R, Lehmann C et al (2007) Effects of low habitual cocoa intake on blood pressure and bioactive nitric oxide: a randomized controlled trial. JAMA 298:49–60

    Article  PubMed  CAS  Google Scholar 

  33. Faridi Z, Njike VY, Dutta S et al (2008) Acute dark chocolate and cocoa ingestion and endothelial function: a randomized controlled crossover trial. Am J Clin Nutr 88:58–63

    PubMed  CAS  Google Scholar 

  34. Davison K, Berry NM, Misan G et al (2010) Dose-related effects of flavanol-rich cocoa on blood pressure. J Hum Hypertens 24(9):568–576

    Article  PubMed  CAS  Google Scholar 

  35. Berry NM, Davison K, Coates AM et al (2010) Impact of cocoa flavanol consumption on blood pressure responsiveness to exercise. Br J Nutr 19:1–5

    Google Scholar 

  36. Saftlas AF, Triche EW, Beydoun H et al (2010) Does chocolate intake during pregnancy reduce the risks of preeclampsia and gestational hypertension? Ann Epidemiol 20(8):584–591

    Article  PubMed  Google Scholar 

  37. Taubert D, Roesen R, Schömig E (2007) Effect of cocoa and tea intake on blood pressure: a meta-analysis. Arch Intern Med 167:626–634

    Article  PubMed  CAS  Google Scholar 

  38. Hooper L, Kroon PA, Rimm EB et al (2008) Flavonoids, flavonoid-rich foods, and cardiovascular risk: a meta-analysis of randomized controlled trials. Am J Clin Nutr 88:38–50

    PubMed  CAS  Google Scholar 

  39. Desch S, Schmidt J, Kobler D et al (2010) Effect of cocoa products on blood pressure: systematic review and meta-analysis. Am J Hypertens 23:97–103

    Article  PubMed  CAS  Google Scholar 

  40. Ried K, Sullivan T, Fakler P et al (2010) Does chocolate reduce blood pressure? A metaanalysis. BMC Med 8:39

    Article  PubMed  Google Scholar 

  41. Glynn RJ, L’Italien GJ, Sesso HD et al (2002) Development of predictive models for long-term cardiovascular risk associated with systolic and diastolic blood pressure. Hypertension 39:105–110

    Article  PubMed  CAS  Google Scholar 

  42. Egan BM, Laken MA, Donovan JL et al (2010) Does dark chocolate have a role in the prevention and management of hypertension? Commentary on the evidence. Hypertension 55(6):1289–1295

    Article  PubMed  CAS  Google Scholar 

  43. Grassi D, Desideri G, Ferri C (2011) Cardiovascular risk and endothelial dysfunction: the preferential route for atherosclerosis. Curr Pharm Biotechnol, 2011 Jan 11. [Epub ahead of print]

    Google Scholar 

  44. Actis-Goretta L, Ottaviani JI, Fraga CG (2006) Inhibition of angiotensin converting enzyme activity by flavanol-rich foods. J Agric Food Hem 54(1):229–234

    Article  CAS  Google Scholar 

  45. Schewe T, Steffen Y, Sies H (2008) How do dietary flavanols improve vascular function? A position paper. Arch Biochem Biophys 476:102–106

    Article  PubMed  CAS  Google Scholar 

  46. Persson IA, Josefsson M, Persson K et al (2006) Tea flavanols inhibit angiotensin-converting enzyme activity and increase nitric oxide production in human endothelial cells. J Pharm Pharmacol 58:1139–1144

    Article  PubMed  CAS  Google Scholar 

  47. Persson IA, Persson K, Hägg S et al (2011) Effects of cocoa extract and dark chocolate on angiotensin-converting enzyme and nitric oxide in human endothelial cells and healthy volunteers-a nutrigenomics perspective. J Cardiovasc Pharmacol 57(1):44–50

    Article  PubMed  CAS  Google Scholar 

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Author information

Authors and Affiliations

  1. Department of Internal Medicine and Public Health, University of L’Aquila, L’Aquila, Italy

    Claudio Ferri

Authors
  1. Davide Grassi
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  2. Claudio Ferri
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Corresponding author

Correspondence to Claudio Ferri .

Editor information

Editors and Affiliations

  1. Alpine Foundation for Life Sciences Olivone, Ticino, Switzerland

    Ario Conti

  2. Nutrition Foundation of Italy, Milan, Italy

    Rodolfo Paoletti  & Andrea Poli  & 

  3. Laboratory of Functional Foods, IMDEA-Food, Madrid, Spain

    Francesco Visioli

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Grassi, D., Ferri, C. (2012). Cocoa, Chocolate and Hypertension. In: Conti, A., Paoletti, R., Poli, A., Visioli, F. (eds) Chocolate and Health. Springer, Milano. https://doi.org/10.1007/978-88-470-2038-2_9

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