Impact of cocoa flavanols on blood pressure and vascular function: an updated systematic review and meta-analysis of randomized controlled trials.
Misato Sakuda, Kyoko Ito, Yuna Adaniya et al.
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In 30 seconds
This updated systematic review and meta-analysis pooled randomized controlled trials of cocoa flavanol intake in hypertensive and normotensive participants. Across 25 studies involving 1,167 participants, flavanol intake was associated with reductions in systolic blood pressure (mean difference [MD] -2.734 mmHg, 95% CI [-3.446, -2.023]) and diastolic blood pressure (MD -1.848 mmHg, 95% CI [-2.725, -0.971]). Flow-mediated dilation and pulse wave velocity also improved, while ankle-brachial index did not change significantly. Evidence certainty was moderate for systolic pressure and limited for the other outcomes.
Key findings
- Systolic blood pressure decreased by MD -2.734 mmHg (95% CI [-3.446, -2.023]).
- Diastolic blood pressure decreased by MD -1.848 mmHg (95% CI [-2.725, -0.971]).
- Flow-mediated dilation improved (MD 1.314%, 95% CI [1.043, 1.585]) and pulse wave velocity decreased (MD -0.200 m/s, 95% CI [-0.393, -0.007]).
- Ankle-brachial index showed no significant change; evidence was limited to two studies.
Why it matters
The findings suggest cocoa flavanol intake may have modest effects on blood pressure and selected measures of vascular function across both hypertensive and normotensive participants. Considering vascular indices alongside blood pressure offers a broader view of potential cardiovascular effects. However, the limited certainty for most outcomes means these pooled estimates should be interpreted cautiously.
What to keep in mind
Certainty was limited for outcomes other than systolic blood pressure; ankle-brachial index evidence came from only two studies. The included trials used a wide range of daily flavanol doses, and analyses did not establish clear dose thresholds.