title: Cocoa reduces blood pressure and insulin resistance and improves endothelium-dependent vasodilation in hypertensives.
abstract: 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.
authors: Dipartimento Internal Medicine and Public Health, University of L'Aquila, Piazzale Salvatore Tommasi 1, 67100 Coppito, L'Aquila, Italy.
authors: Davide
authors: D
authors: Grassi
authors: Stefano
authors: S
authors: Necozione
authors: Cristina
authors: C
authors: Lippi
authors: Giuseppe
authors: G
authors: Croce
authors: Letizia
authors: L
authors: Valeri
authors: Paolo
authors: P
authors: Pasqualetti
authors: Giovambattista
authors: G
authors: Desideri
authors: Jeffrey B
authors: JB
authors: Blumberg
authors: Claudio
authors: C
authors: Ferri
mesh_terms: D000328:Adult; D001794:Blood Pressure; D018660:Blood Pressure Monitoring, Ambulatory; D001916:Brachial Artery / Q000503:physiopathology; D002099:Cacao; D008078:Cholesterol, LDL / Q000097:blood; D018592:Cross-Over Studies; D004730:Endothelium, Vascular / Q000503:physiopathology*; D005260:Female; D005951:Glucose Tolerance Test; D006801:Humans; D006973:Hypertension / Q000097:blood / Q000178:diet therapy* / Q000503:physiopathology*; D007333:Insulin Resistance; D008297:Male; D008875:Middle Aged; D014664:Vasodilation
chemical_list: D008078:Cholesterol, LDL