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Cocoa Consumption and Blood Pressure in Middle-Aged and Elderly Subjects: a Meta-Analysis

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Abstract

Purpose of Review

The effect of cocoa consumption on blood pressure (BP) has been investigated in previous studies; however, to date, no meta-analysis has been conducted specific to middle-aged and elderly subjects. Thus, the aim of the present study was to evaluate the effect of cocoa consumption on indices of blood pressure, in middle-aged and elderly subjects.

Recent Findings

Pubmed/Medline™, Cochrane Library™, Google Scholar™, and Scopus™ were searched until March 2019. The quantitative Jadad scale was used as the systematic assessment of bias in the included trials. We used a random effects model to estimate the pooled weighted mean differences (WMDs) with 95% confidence intervals (CIs). We further conducted sensitivity analysis and stratified analysis by baseline blood pressure, follow-up duration, and mean age. Thirteen studies with 758 total participants were included in the present meta-analysis. A significant reduction in SBP by 2.77 (95% CI − 5.28, − 0.27, P = 0.03, I2 = 89%) and DBP by 1.47 mm/Hg (− 95% CI − 2.40, − 0.55, P = 0.001, I2 = 45%) were observed after cocoa consumption. Stratified analyses showed BP-lowering effects of cocoa consumption in longer-term duration and hypertensive subgroups.

Summary

Our meta-analysis showed a significant inverse association between cocoa consumption and SBP/DBP. However, the analysis could not conclude any beneficial effect of cocoa consumption on blood pressure in normotensive/elevated blood pressure subjects. Therefore, further studies are warranted to affirm the efficacy of cocoa consumption for the improvement of blood pressure in elderly subjects.

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References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. 1.

    Lawes CM, Vander Hoorn S, Rodgers A. Global burden of blood-pressure-related disease, 2001. Lancet. 2008;371(9623):1513–8.

  2. 2.

    Martiniuk AL, Lee CM, Lawes CM, Ueshima H, Suh I, Lam TH, et al. Hypertension: its prevalence and population-attributable fraction for mortality from cardiovascular disease in the Asia-Pacific region. J Hypertens. 2007;25(1):73–9.

  3. 3.

    Kelly R, Hayward C, Avolio A, O'Rourke M. Noninvasive determination of age-related changes in the human arterial pulse. Circulation. 1989;80(6):1652–9.

  4. 4.

    Seals DR, Esler MD. Human ageing and the sympathoadrenal system. J Physiol. 2000;528(3):407–17.

  5. 5.

    Volpe M, et al. Hypertension in the elderly: which are the blood pressure threshold values? Eur Heart J Suppl. 2019;21(Suppl B):B105.

  6. 6.

    McInnes GT. Lowering blood pressure for cardiovascular risk reduction. J Hypertens Suppl. 2005;23(1):S3–8.

  7. 7.

    • Lewington S, Clarke R, Qizilbash N, Peto R, Collins R, Prospective Studies Collaboration. Age-specific relevance of usual blood pressure to vascular mortality: a meta-analysis of individual data for one million adults in 61 prospective studies. Lancet. 2002;360(9349):1903–13. References which were used mostly for their methodological approaches.

  8. 8.

    Kraft K. Complementary/alternative medicine in the context of prevention of disease and maintenance of health. Prev Med. 2009;49(2–3):88–92.

  9. 9.

    Shen Y, et al. Fish red blood cells express immune genes and responses. Aquacult Fish. 2018;3(1):14–21.

  10. 10.

    Wang J, et al. Cloning and expression analysis of the nuclear factor erythroid 2-related factor 2 (Nrf2) gene of grass carp (Ctenopharyngodon idellus) and the dietary effect of Eucommia ulmoides on gene expression. Aquacult Fish. 2018;3(5):196–203.

  11. 11.

    Nahas R. Complementary and alternative medicine approaches to blood pressure reduction: an evidence-based review. Can Fam Physician. 2008;54(11):1529–33.

  12. 12.

    Ibrahim IR, Hassali MA, Saleem F, al Tukmagi HF. A qualitative insight on complementary and alternative medicines used by hypertensive patients. J Pharm Bioallied Sci. 2016;8(4):284–8.

  13. 13.

    •• Desch S, Schmidt J, Kobler D, Sonnabend M, Eitel I, Sareban M, et al. Effect of cocoa products on blood pressure: systematic review and meta-analysis. Am J Hypertens. 2010;23(1):97–103. Comprehensive reviews and studies which were used mostly for their association between cocoa consumption and blood pressure.

  14. 14.

    •• Taubert D, Roesen R, Schömig E. Effect of cocoa and tea intake on blood pressure: a meta-analysis. Arch Intern Med. 2007;167(7):626–34. Comprehensive reviews and studies which were used mostly for their association between cocoa consumption and blood pressure.

  15. 15.

    •• Ried K, et al. Does chocolate reduce blood pressure? A meta-analysis. BMC Med. 2010;8(1):39. Comprehensive reviews and studies which were used mostly for their association between cocoa consumption and blood pressure.

  16. 16.

    •• Ried K, Fakler P, Stocks NP. Effect of cocoa on blood pressure. Cochrane Database Syst Rev. 2017;4(4):CD008893. Comprehensive reviews and studies which were used mostly for their association between cocoa consumption and blood pressure.

  17. 17.

    Addison S, Stas S, Hayden MR, Sowers JR. Insulin resistance and blood pressure. Curr Hypertens Rep. 2008;10(4):319–25.

  18. 18.

    Actis-Goretta L, Ottaviani JI, Fraga CG. Inhibition of angiotensin converting enzyme activity by flavanol-rich foods. J Agric Food Chem. 2006;54(1):229–34.

  19. 19.

    Persson IA, Persson K, Hägg S, Andersson RG. 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. 2011;57(1):44–50.

  20. 20.

    •• Aronow WS, et al. ACCF/AHA 2011 expert consensus document on hypertension in the elderly: a report of the American College of Cardiology Foundation Task Force on Clinical Expert Consensus documents developed in collaboration with the American Academy of Neurology, American Geriatrics Society, American Society for Preventive Cardiology, American Society of Hypertension, American Society of Nephrology, Association of Black Cardiologists, and European Society of Hypertension. J Am Coll Cardiol. 2011;57(20):2037–114. Comprehensive reviews and studies which were used mostly for their association between cocoa consumption and blood pressure.

  21. 21.

    • Moher D, Liberati A, Tetzlaff J, Altman DG, PRISMA Group. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Ann Intern Med. 2009;151(4):264–9 w64. References which were used mostly for their methodological approaches.

  22. 22.

    • Higgins, J.P. and S. Green, Cochrane handbook for systematic reviews of interventions. 2008. References which were used mostly for their methodological approaches.

  23. 23.

    • Jadad AR, Moore RA, Carroll D, Jenkinson C, Reynolds DJ, Gavaghan DJ, et al. Assessing the quality of reports of randomized clinical trials: is blinding necessary? Control Clin Trials. 1996;17(1):1–12. References which were used mostly for their methodological approaches.

  24. 24.

    • Hozo SP, Djulbegovic B, Hozo I. Estimating the mean and variance from the median, range, and the size of a sample. BMC Med Res Methodol. 2005;5(1):13. References which were used mostly for their methodological approaches.

  25. 25.

    Flammer AJ, Sudano I, Wolfrum M, Thomas R, Enseleit F, Périat D, et al. Cardiovascular effects of flavanol-rich chocolate in patients with heart failure. Eur Heart J. 2011;33(17):2172–80.

  26. 26.

    Ibero-Baraibar I, Romo-Hualde A, Gonzalez-Navarro CJ, Zulet MA, Martinez JA. The urinary metabolomic profile following the intake of meals supplemented with a cocoa extract in middle-aged obese subjects. Food Funct. 2016;7(4):1924–31.

  27. 27.

    Neufingerl N, Zebregs YE, Schuring EA, Trautwein EA. Effect of cocoa and theobromine consumption on serum HDL-cholesterol concentrations: a randomized controlled trial. Am J Clin Nutr. 2013;97(6):1201–9.

  28. 28.

    Rassaf T, et al. Vasculoprotective effects of dietary cocoa flavanols in patients on hemodialysis: a double-blind, randomized, placebo-controlled trial. Clin J Am Soc Nephrol. 2016;11(1):108–18.

  29. 29.

    Sorond FA, Hurwitz S, Salat DH, Greve DN, Fisher ND. Neurovascular coupling, cerebral white matter integrity, and response to cocoa in older people. Neurology. 2013;81(10):904–9.

  30. 30.

    Crews WD Jr, Harrison DW, Wright JW. 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 Clin Nutr. 2008;87(4):872–80.

  31. 31.

    Davison K, et al. Dose-related effects of flavanol-rich cocoa on blood pressure. J Hum Hypertens. 2010;24(9):568.

  32. 32.

    Davison K, Coates AM, Buckley JD, Howe PR. Effect of cocoa flavanols and exercise on cardiometabolic risk factors in overweight and obese subjects. Int J Obes. 2008;32(8):1289–96.

  33. 33.

    Desideri G, et al. Benefits in cognitive function, blood pressure, and insulin resistance through cocoa flavanol consumption in elderly subjects with mild cognitive impairment: the cocoa, cognition, and aging (CoCoA) study. Hypertension. 2012;60(3):794–801.

  34. 34.

    Haghighat N, et al. The effects of dark chocolate on glycemic control and blood pressure in hypertensive diabetic patients: a randomized clinical trial. Razi J Med Sci. 2013;20(113):78–86.

  35. 35.

    Mastroiacovo D, Kwik-Uribe C, Grassi D, Necozione S, Raffaele A, Pistacchio L, et al. Cocoa flavanol consumption improves cognitive function, blood pressure control, and metabolic profile in elderly subjects: the Cocoa, Cognition, and Aging (CoCoA) Study—a randomized controlled trial. Am J Clin Nutr. 2014;101(3):538–48.

  36. 36.

    Mellor DD, Sathyapalan T, Kilpatrick ES, Beckett S, Atkin SL. High-cocoa polyphenol-rich chocolate improves HDL cholesterol in type 2 diabetes patients. Diabet Med. 2010;27(11):1318–21.

  37. 37.

    Taubert D, Roesen R, Lehmann C, Jung N, Schömig E. Effects of low habitual cocoa intake on blood pressure and bioactive nitric oxide: a randomized controlled trial. JAMA. 2007;298(1):49–60.

  38. 38.

    • Gopalakrishnan S, Ganeshkumar P. Systematic reviews and meta-analysis: understanding the best evidence in primary healthcare. J Fam Med Prim Care. 2013;2(1):9–14. References which were used mostly for their methodological approaches.

  39. 39.

    Kapil V, Milsom AB, Okorie M, Maleki-Toyserkani S, Akram F, Rehman F, et al. Inorganic nitrate supplementation lowers blood pressure in humans: role for nitrite-derived NO. Hypertension. 2010;56(2):274–81.

  40. 40.

    Ried K, Frank OR, Stocks NP. Aged garlic extract lowers blood pressure in patients with treated but uncontrolled hypertension: a randomised controlled trial. Maturitas. 2010;67(2):144–50.

  41. 41.

    Kanegae H, Oikawa T, Okawara Y, Hoshide S, Kario K. Which blood pressure measurement, systolic or diastolic, better predicts future hypertension in normotensive young adults? J Clin Hypertens. 2017;19(6):603–10.

  42. 42.

    Franklin SS. Hypertension in older people: part 1. J Clin Hypertens. 2006;8(6):444–9.

  43. 43.

    Kario K. Prognosis in relation to blood pressure variability: pro side of the argument. Hypertension. 2015;65(6):1163–9.

  44. 44.

    Kario K. Evidence and perspectives on the 24-hour management of hypertension: hemodynamic biomarker-initiated ‘anticipation medicine’ for zero cardiovascular event. Prog Cardiovasc Dis. 2016;59(3):262–81.

  45. 45.

    Chowdhury EK, Owen A, Krum H, Wing LM, Nelson MR, Reid CM, et al. Systolic blood pressure variability is an important predictor of cardiovascular outcomes in elderly hypertensive patients. J Hypertens. 2014;32(3):525–33.

  46. 46.

    Leoncini G, Viazzi F, Storace G, Deferrari G, Pontremoli R. Blood pressure variability and multiple organ damage in primary hypertension. J Hum Hypertens. 2013;27(11):663–70.

  47. 47.

    Potter JF. CHAPTER 43 - Hypertension, in Brocklehurst's Textbook of geriatric medicine and gerontology. In: Fillit HM, Rockwood K, Woodhouse K, editors. . 7th ed. Philadelphia: W.B. Saunders; 2010. p. 300–11.

  48. 48.

    Franklin SS. Ageing and hypertension: the assessment of blood pressure indices in predicting coronary heart disease. J Hypertens Suppl. 1999;17(5):S29–36.

  49. 49.

    Einhorn PT, Davis BR, Massie BM, Cushman WC, Piller LB, Simpson LM, et al. The antihypertensive and lipid lowering treatment to prevent heart attack trial (ALLHAT) heart failure validation study: diagnosis and prognosis. Am Heart J. 2007;153(1):42–53.

  50. 50.

    Black HR, Elliott WJ, Grandits G, Grambsch P, Lucente T, White WB, et al. Principal results of the controlled onset verapamil investigation of cardiovascular end points (CONVINCE) trial. JAMA. 2003;289(16):2073–82.

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Acknowledgments

We are grateful to our colleagues for their patience and their advice on searching the papers.

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Correspondence to Sadegh Jafarnejad.

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Jafarnejad, S., Salek, M. & Clark, C.C.T. Cocoa Consumption and Blood Pressure in Middle-Aged and Elderly Subjects: a Meta-Analysis. Curr Hypertens Rep 22, 1 (2020). https://doi.org/10.1007/s11906-019-1005-0

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Keywords

  • Cocoa
  • Blood pressure
  • Middle-aged
  • Elderly
  • Meta-analysis