Cocoa effects on blood pressure, endothelial function, and inflammation: a systematic review
DOI:
https://doi.org/10.34119/bjhrv6n6-044Keywords:
cocoa, chocolate, polyphenols, hypertension, inflammationAbstract
Hypertension has affected 1,13 billion people worldwide and is one of the main risk factors for cardiovascular disease, which has a high mortality rate. The aim of the study was to review the effect of cocoa on systolic and diastolic blood pressure in hypertensive patients, and its alterations in endothelial function and inflammation. We searched PubMed, Scopus, Science Direct, Lilacs and MedLine databases in August 2018. Inclusion criteria were limited to hypertensive individuals, cardiovascular diseases, intervention and randomized clinical studies; published since 2000 and in English, Spanish and Portuguese languages. A total of 433 articles were found in the search, which 13 met the inclusion criteria. The trials had a sample of 19 to 122 participants. The cocoa was offeredas chocolate bars and cocoa beverage. Chocolate bars doses ranged from 6 g to 100 g/ day and cocoa powder doses ranged from 5 g to 31 g/ day. Intervention ranged from 2 to 18 weeks. The results observed revealed a significant blood pressure-reducing effect of cocoa, an increase in flow-mediated dilation in the evaluation of endothelial function, and no changes in antioxidant and anti-inflammatory capacity were observed after intervention. The conclusion suggests that cocoa has a blood pressure lowering effect, but new studies are still required with hypertensive individuals so that their mechanisms are better evaluates and their efficacy proven.
References
- World Health Organization (2015). Q&Asonhypertension.Disponível em: http://www.who.int/features/qa/82/en/. (acessado em 16 maio 2016)
- World Health Organization (2019).Hypertension. Disponível em: https://www.who.int/news-room/fact-sheets/detail/hypertension. (acessado em 15 maio 2019)
- World Health Organization (2017). Cardiovascular diseases (CVDs). Disponível em: https://www.who.int/news-room/fact-sheets/detail/cardiovascular-diseases-(cvds). (acessado em 15 maio 2019)
-Ludovici V, Barthelmes J, Nägele MP et al. (2017) Cocoa, Blood Pressure, and Vascular Function. Front Nutr4, 1 – 12.
- Giglio RV, Patti AM, Cicero AFG et al. (2018) Polyphenols: Potential Use in the Prevention and Treatment of Cardiovascular Diseases. Curr Pharm Des 24, 239 – 258.
- Matsumoto C (2017) Cocoa Polyphenols: Evidence from Epidemiological Studies. CurrPharm Des24,140 – 145.
- Cerqueira NF, Yoshida WB (2002) Óxido nítrico: revisão. Acta CirBras17,17 – 23.
- 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 high-polyphenol dark chocolate. J Nutr138, 1671 – 1676.
- Muniyappa R, Hall G, Kolodziej TL et al. (2008) Cocoa consumption for 2 wk enhances insulin-mediated vasodilatation without improving blood pressure or insulin resistance in essential hypertension. Am J Clin Nutr88,1685 – 1696.
- Khan N, Khymenets O, Urpí-Sardà M et al. (2014) Cocoa polyphenols and inflammatory markers of cardiovascular disease. Nutrients6, 844 – 880.
- Goya L, Martín MA, Sarriá B et al. (2016) Effect of Cocoa and Its Flavonoids on Biomarkers of Inflammation: Studies of Cell Culture, Animals and Humans. Nutrients8, 212 – 234.
- Teixeira BC, Lopes AL, Oliveira MRC et al. (2014) Marcadores inflamatórios, função endotelial e riscos cardiovasculares. J. vasc. bras. 13, 108 – 115.
- Impellizzeri D, Bruschetta G, Di Paola R et al.(2014) The anti-inflammatory and antioxidant effects of bergamot juice extract (BJe) in an experimental model of inflammatory bowel disease. Clin Nutr. 34, 1146 – 1154.
- Boots AW, Haenen GR, Bast A (2008) Health effects of quercetin: from antioxidant to nutraceutical. Eur J Pharmacol. 585, 325 – 337.
- Rubió L, Motilva MJ, Romero MP (2013) Recent advances in biologically active compounds in herbs and spices: a review of the most effective antioxidant and anti-inflammatory active principles. Crit Rev Food Sci Nutr. 53, 943 – 943.
- Davison K, Berry NM, Misan G et al. (2010) Dose-related effects of flavanol-rich cocoa on blood pressure. J Hum Hypertens24, 568 – 576.
- Ried K, Fakler P, Stocks NP (2017) Effect of cocoa on blood pressure. Cochrane Database Syst Rev 4.
- Joint National Committee on Prevention, Detection, Evaluation and Treatment of High Blood Pressure (2003) The seventh report of the joint national committee on prevention, detection, evaluation and treatment of high blood pressure. JAMA289, 2560 – 2572.
- Pereira M, Galvão T (2014) Extração, avaliação da qualidade e síntese dos dados para revisão sistemática.Epidemiol Serv Saude23, 577-78.
- Nogueira LP, Knibel MP, Torres MRSG et al. (2012) Consumption of high polyphenol dark chocolate improves endothelial function in individuals with stage 1 hypertension and excess body weight. Int J Hypertens2012.
- Koli R, Köhler K, Tonteri E et al. (2015) Dark chocolate and reduced snack consumption in mildly hypertensive adults: an intervention study. Nutr J14.
- Ried K, Frank OR, Stocks NP (2009) Dark chocolate or tomato extract for prehypertension: a randomised controlled trial. BMC Complement Altern Med9.
- Njike VY, Hamburg N, Kellogg M et al. (2016) Dose and response to cocoa (DARC): A randomized double-blind controlled trial. Clin Trials Regul Sci Cardio23, 9-15.
- 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.
- Bogaard B, Draijer R, Westerhof BE et al. (2010) Effects on peripheral and central blood pressure of cocoa with natural or high-dose theobromine: a randomized, double-blind crossover trial. Hypertension56, 839-46
- Rostami A, Khalili M, Haghighat N et al. (2015) High-cocoa polyphenol-rich chocolate improves blood pressure in patients with diabetes and hypertension. ARYA atheroscler11, 21-29.
- Desch S, Kobler D, Schmidt J et al. (2010) Low vs. higher-dose dark chocolate and blood pressure in cardiovascular high-risk patients. Am j hypertens23, 694-700.
- Alleyne T, Alleyne A, Arrindell D et al. (2014) Short term effects of cocoa consumption on blood pressure. West indian med j63, 312-317.
- Grassi D, Necozione S, Lippi C et al. (2005) Cocoa reduces blood pressure and insulin resistance and improves endothelium-dependent vasodilation in hypertensives. Hypertension46, 398-405.
- Ried K, Sullivan T, Fakler P, et al. (2010) Does chocolate reduce blood pressure? A meta-analysis. BMC med8, 39.
- Vlachojannis J, Erne P, Zimmermann B et al. (2016) The Impact of Cocoa Flavanols on Cardiovascular Health. Phytother res30, 1641- 1657.
- Cerqueira NF, Yoshida WB (2002) Óxido nítrico: revisão. Acta CirBras17, 417 – 423.
- Al‐Faris NA (2008) Short-term consumption of a dark chocolate containing flavanols is followed by a significant decrease in normotensive population. Pakistan j nutr7, 773‐781.
- American Diabetes Association (2019) Standards of Medical Care in Diabetes - 2019. Diabetes Care 42, Suppl.1, S7 – S12.
- Osakabe N, Yamagishi M, Sanbongi C et al. (1998) The antioxidative substances in cacao liquor. J nutrscivitaminol44, 313-21.
- Andrade DO, Santos SPO, Vilela-Martin JF (2014) Inflamação, disfunção endotelial e eventos agudos na hipertensão arterial. Rev bras hipertens21, 129-133.
- Schroeter H, Heiss C, Balzer J et al. (2006) (-)-Epicatechin mediates beneficial effects of flavanol-rich cocoa on vascular function in humans. Proc natlacad sci U S A103, 1024-1029.
- Tangney CC, Rasmussen HE (2013) Polyphenols, inflammation, and cardiovascular disease. Curratheroscler rep15, 324.
- Lee KW, Kim YJ, Lee HJ et al. (2003) Cocoa has more phenolic phytochemicals and a higher antioxidant capacity than teas and red wine. J Agric Food Chem51, 7292-7295.
- Ding EL, Hutfless SM, Ding X et al. (2006) Chocolate and prevention of cardiovascular disease: a systematic review. Nutrmetab3, 2.
- Hermann F, Spieker LE, Ruschitzka F et al. (2006) Dark chocolate improves endothelial and platelet function. Heart92, 119-20.
- Lôbo GB, Silva AV, Menezes GB. (2020) Polifenóis dietéticos e função endotelial em adultos sem diagnóstico de doenças: Uma revisão sistemática de ensaios randomizados. Brazilian Journal of Development. 85320-46.
- Prevedello MT, Comachio G. (2021) Antioxidantes e sua relação com os radicais livres, e Doenças Crônicas Não Transmissíveis: uma revisão de literatura Antioxidants and their relationship with free radicals, and Chronic Non communicable Diseases: a literature review. Brazilian Journal of Development. 55244-85.
