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Chocolate and Blood Pressure in Elderly Individuals With Isolated Systolic Hypertension

Chocolate and Blood Pressure in Elderly Individuals With Isolated Systolic Hypertension Chocolate and Blood Pressure in Elderly Individuals With Isolated Systolic Hypertension To the Editor: Chocolate may have beneficial cardiovascular effects, possibly due to cocoa polyphenols.1 Experiments in animals suggest that plant polyphenols decrease blood pressure (BP)2; however, evidence from human clinical trials is lacking. We examined whether dark chocolate (polyphenol-rich chocolate [PRC]) may lower BP in individuals with mild isolated hypertension. Methods Methods We conducted a randomized crossover trial in 13 otherwise healthy individuals (6 men and 7 women, aged 55-64 years, with body mass index of 21.9-26.2 [calculated as weight in kilograms divided by the square of height in meters]) with recently diagnosed and untreated stage 1 mild isolated systolic hypertension (mean [SD] systolic BP, 153.2 [3.9] mm Hg; mean [SD] diastolic BP, 83.8 [3.5] mm Hg). After a cocoa-free run-in phase of 7 days, participants were randomly assigned to receive 14 consecutive daily doses of either 100-g dark PRC bars containing 500 mg of polyphenols and 480 kcal of energy (Ritter Sport Halbbitter, Alfred Ritter, Waldenbuch, Germany), or 14 days of 90-g white chocolate (polyphenol-free chocolate [PFC]) bars that also contained 480 kcal and similar amounts of cocoa butter, macronutrients, fiber, electrolytes, and vitamins (Milka Weisse Schokolade, Kraft Foods, Bremen, Germany). After a cocoa-free washout phase of 7 days, participants were crossed over to the other condition. Participants were asked to substitute the chocolate bars for foods of similar energy and macronutrient composition. Overall diet during the study period was assessed by reports of daily food intake and by measurement of body weight, plasma concentrations of lipids and glucose, and urinary excretion of sodium, potassium, and nitrogen at the run-in phase and after each intervention period. Methods The BP was recorded daily, in a blinded fashion, with participants in a seated position, 12 hours post-dose, in the left upper arm with a validated oscillometer (Omron HEM 722C, Omron, Mannheim, Germany). A systolic BP of more than 170 mm Hg or a diastolic BP of more than 100 mm Hg at a single visit was necessary for referral for antihypertensive pharmacological treatment. At the end of the study participants were referred to their physician for further monitoring and management of BP. We received approval for our study from the ethics committee of the Medical Faculty of the University of Cologne; all participants gave written informed consent. Results Results Participants had significantly lower systolic and diastolic BPs within 10 days of beginning PRC, but this effect was not seen during the PFC period (Figure 1). At the end of the 14-day PRC intervention, mean (SD) systolic BP had declined by 5.1 (2.4) mm Hg (P<.001; paired 2-tailed t test) and mean (SD) diastolic BP by 1.8 (2.0) mm Hg (P = .002; paired 2-tailed t test) compared with PFC. After discontinuation of PRC consumption, BP returned to preintervention values within 2 days. Heart rate was not affected by either treatment. There were no sex differences in the effects of chocolate on BP. None of the participants reached the predefined threshold that would have required antihypertensive drug therapy. Daily energy intake and macronutrient composition remained stable throughout the study. Body mass index, 24-hour urinary excretion of sodium, potassium, and total nitrogen, as well as fasting plasma concentrations of total cholesterol, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, triglycerides, and glucose were not significantly different between the run-in phase and the postintervention periods. Figure. Time Course of Mean Blood Pressure and Heart Rate During a 14-Day Diet With PRC or PFC and a Subsequent 7-Day Washout Period View LargeDownload *P <.05; †P<.001; ‡P = .04; and §P = .03, indicating significant differences in blood pressure between diets with polyphenol-rich or polyphenol-free chocolate, adjusted to a baseline blood pressure difference of zero (paired 2-tailed t tests, individual P values are adjusted for multiple comparisons by the method of Holm). All other P values are >.05. Error bars indicate SEM. Comment Comment A calorie-balanced increase in consumption of dark chocolate may favorably affect BP in previously untreated elderly hypertensive individuals. Control meals using PFC differed from PRC meals only by the lack of cocoa solids. Plant polyphenols are major constituents of the cocoa solids,3 have significant bioavailability,4 and appear to be responsible for the reductions in BP. The long-term clinical effects, however, remain unknown. References 1. Keen CL. Chocolate: food as medicine/medicine as food. J Am Coll Nutr.2001;20(5 suppl):436S-439S, 440S-442S.http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?db=m&form=6&Dopt=r&uid=11603654Google Scholar 2. Diebolt M, Bucher B, Andriantsitohaina R. Wine polyphenols decrease blood pressure, improve NO vasodilatation, and induce gene expression. Hypertension.2001;38:159-165.http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?db=m&form=6&Dopt=r&uid=11509469Google Scholar 3. Luna F, Crouzillat D, Cirou L, Bucheli P. Chemical composition and flavor of Ecuadorian cocoa liquor. J Agric Food Chem.2002;50:3527-3532.http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?db=m&form=6&Dopt=r&uid=12033823Google Scholar 4. Holt RR, Lazarus SA, Sullards MC. et al. Procyanidin dimer B2 [epicatechin-(4beta-8)-epicatechin] in human plasma after the consumption of a flavanol-rich cocoa. Am J Clin Nutr.2002;76:798-804.http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?db=m&form=6&Dopt=r&uid=12324293Google Scholar http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png JAMA American Medical Association

Chocolate and Blood Pressure in Elderly Individuals With Isolated Systolic Hypertension

Taubert, Dirk; Berkels, Reinhard; Roesen, Renate; Klaus, Wolfgang
JAMA , Volume 290 (8) – Aug 27, 2003
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References (4)

Publisher
American Medical Association
Copyright
Copyright © 2003 American Medical Association. All Rights Reserved.
ISSN
0098-7484
eISSN
1538-3598
DOI
10.1001/jama.290.8.1029
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Abstract

Chocolate and Blood Pressure in Elderly Individuals With Isolated Systolic Hypertension To the Editor: Chocolate may have beneficial cardiovascular effects, possibly due to cocoa polyphenols.1 Experiments in animals suggest that plant polyphenols decrease blood pressure (BP)2; however, evidence from human clinical trials is lacking. We examined whether dark chocolate (polyphenol-rich chocolate [PRC]) may lower BP in individuals with mild isolated hypertension. Methods Methods We conducted a randomized crossover trial in 13 otherwise healthy individuals (6 men and 7 women, aged 55-64 years, with body mass index of 21.9-26.2 [calculated as weight in kilograms divided by the square of height in meters]) with recently diagnosed and untreated stage 1 mild isolated systolic hypertension (mean [SD] systolic BP, 153.2 [3.9] mm Hg; mean [SD] diastolic BP, 83.8 [3.5] mm Hg). After a cocoa-free run-in phase of 7 days, participants were randomly assigned to receive 14 consecutive daily doses of either 100-g dark PRC bars containing 500 mg of polyphenols and 480 kcal of energy (Ritter Sport Halbbitter, Alfred Ritter, Waldenbuch, Germany), or 14 days of 90-g white chocolate (polyphenol-free chocolate [PFC]) bars that also contained 480 kcal and similar amounts of cocoa butter, macronutrients, fiber, electrolytes, and vitamins (Milka Weisse Schokolade, Kraft Foods, Bremen, Germany). After a cocoa-free washout phase of 7 days, participants were crossed over to the other condition. Participants were asked to substitute the chocolate bars for foods of similar energy and macronutrient composition. Overall diet during the study period was assessed by reports of daily food intake and by measurement of body weight, plasma concentrations of lipids and glucose, and urinary excretion of sodium, potassium, and nitrogen at the run-in phase and after each intervention period. Methods The BP was recorded daily, in a blinded fashion, with participants in a seated position, 12 hours post-dose, in the left upper arm with a validated oscillometer (Omron HEM 722C, Omron, Mannheim, Germany). A systolic BP of more than 170 mm Hg or a diastolic BP of more than 100 mm Hg at a single visit was necessary for referral for antihypertensive pharmacological treatment. At the end of the study participants were referred to their physician for further monitoring and management of BP. We received approval for our study from the ethics committee of the Medical Faculty of the University of Cologne; all participants gave written informed consent. Results Results Participants had significantly lower systolic and diastolic BPs within 10 days of beginning PRC, but this effect was not seen during the PFC period (Figure 1). At the end of the 14-day PRC intervention, mean (SD) systolic BP had declined by 5.1 (2.4) mm Hg (P<.001; paired 2-tailed t test) and mean (SD) diastolic BP by 1.8 (2.0) mm Hg (P = .002; paired 2-tailed t test) compared with PFC. After discontinuation of PRC consumption, BP returned to preintervention values within 2 days. Heart rate was not affected by either treatment. There were no sex differences in the effects of chocolate on BP. None of the participants reached the predefined threshold that would have required antihypertensive drug therapy. Daily energy intake and macronutrient composition remained stable throughout the study. Body mass index, 24-hour urinary excretion of sodium, potassium, and total nitrogen, as well as fasting plasma concentrations of total cholesterol, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, triglycerides, and glucose were not significantly different between the run-in phase and the postintervention periods. Figure. Time Course of Mean Blood Pressure and Heart Rate During a 14-Day Diet With PRC or PFC and a Subsequent 7-Day Washout Period View LargeDownload *P <.05; †P<.001; ‡P = .04; and §P = .03, indicating significant differences in blood pressure between diets with polyphenol-rich or polyphenol-free chocolate, adjusted to a baseline blood pressure difference of zero (paired 2-tailed t tests, individual P values are adjusted for multiple comparisons by the method of Holm). All other P values are >.05. Error bars indicate SEM. Comment Comment A calorie-balanced increase in consumption of dark chocolate may favorably affect BP in previously untreated elderly hypertensive individuals. Control meals using PFC differed from PRC meals only by the lack of cocoa solids. Plant polyphenols are major constituents of the cocoa solids,3 have significant bioavailability,4 and appear to be responsible for the reductions in BP. The long-term clinical effects, however, remain unknown. References 1. Keen CL. Chocolate: food as medicine/medicine as food. J Am Coll Nutr.2001;20(5 suppl):436S-439S, 440S-442S.http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?db=m&form=6&Dopt=r&uid=11603654Google Scholar 2. Diebolt M, Bucher B, Andriantsitohaina R. Wine polyphenols decrease blood pressure, improve NO vasodilatation, and induce gene expression. Hypertension.2001;38:159-165.http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?db=m&form=6&Dopt=r&uid=11509469Google Scholar 3. Luna F, Crouzillat D, Cirou L, Bucheli P. Chemical composition and flavor of Ecuadorian cocoa liquor. J Agric Food Chem.2002;50:3527-3532.http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?db=m&form=6&Dopt=r&uid=12033823Google Scholar 4. Holt RR, Lazarus SA, Sullards MC. et al. Procyanidin dimer B2 [epicatechin-(4beta-8)-epicatechin] in human plasma after the consumption of a flavanol-rich cocoa. Am J Clin Nutr.2002;76:798-804.http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?db=m&form=6&Dopt=r&uid=12324293Google Scholar

Journal

JAMA – American Medical Association

Published: Aug 27, 2003

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