Effect of Cocoa and Tea Intake on Blood Pressure: A Meta-analysis | Complementary and Alternative Medicine | JAMA Internal Medicine | JAMA Network
[Skip to Navigation]
Access to paid content on this site is currently suspended due to excessive activity being detected from your IP address 35.170.64.36. Please contact the publisher to request reinstatement.
1.
Chobanian  AVBakris  GLBlack  HR  et al. National Heart, Lung, and Blood Institute Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure; National High Blood Pressure Education Program Coordinating Committee, The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure: the JNC 7 report.  JAMA 2003;2892560- 2572PubMedGoogle ScholarCrossref
2.
European Society of Hypertension-European Society of Cardiology Guidelines Committee, 2003 European Society of Hypertension-European Society of Cardiology guidelines for the management of arterial hypertension.  J Hypertens 2003;211011- 1053PubMedGoogle ScholarCrossref
3.
Huxley  RRNeil  HA The relation between dietary flavonol intake and coronary heart disease mortality: a meta-analysis of prospective cohort studies.  Eur J Clin Nutr 2003;57904- 908PubMedGoogle ScholarCrossref
4.
Joshipura  KJHu  FBManson  JE  et al.  The effect of fruit and vegetable intake on risk for coronary heart disease.  Ann Intern Med 2001;1341106- 1114PubMedGoogle ScholarCrossref
5.
He  FJNowson  CAMacGregor  GA Fruit and vegetable consumption and stroke: meta-analysis of cohort studies.  Lancet 2006;367320- 326PubMedGoogle ScholarCrossref
6.
Weisburger  JH Lifestyle, health and disease prevention: the underlying mechanisms.  Eur J Cancer Prev 2002;11 ((suppl 2)) S1- S7PubMedGoogle Scholar
7.
Arts  ICHollman  PCKromhout  D Chocolate as a source of tea flavonoids [letter].  Lancet 1999;354488PubMedGoogle ScholarCrossref
8.
Lichtenstein  AHAppel  LJBrands  M  et al.  Diet and lifestyle recommendations revision 2006: a scientific statement from the American Heart Association Nutrition Committee.  Circulation 2006;11482- 96PubMedGoogle ScholarCrossref
9.
Peters  UPoole  CArab  L Does tea affect cardiovascular disease? a meta-analysis.  Am J Epidemiol 2001;154495- 503PubMedGoogle ScholarCrossref
10.
Steinberg  FMBearden  MMKeen  CL Cocoa and chocolate flavonoids: implications for cardiovascular health.  J Am Diet Assoc 2003;103215- 223PubMedGoogle ScholarCrossref
11.
Kris-Etherton  PMKeen  CL Evidence that the antioxidant flavonoids in tea and cocoa are beneficial for cardiovascular health.  Curr Opin Lipidol 2002;1341- 49PubMedGoogle ScholarCrossref
12.
Buijsse  BFeskens  EJKok  FJKromhout  D Cocoa intake, blood pressure, and cardiovascular mortality: the Zutphen Elderly Study.  Arch Intern Med 2006;166411- 417PubMedGoogle Scholar
13.
Stensvold  ITverdal  ASolvoll  KFoss  OP Tea consumption: relationship to cholesterol, blood pressure, and coronary and total mortality.  Prev Med 1992;21546- 553PubMedGoogle ScholarCrossref
14.
Hodgson  JMDevine  APuddey  IBChan  SYBeilin  LJPrince  RL Tea intake is inversely related to blood pressure in older women.  J Nutr 2003;1332883- 2886PubMedGoogle Scholar
15.
Yang  YCLu  FHWu  JSWu  CHChang  CJ The protective effect of habitual tea consumption on hypertension.  Arch Intern Med 2004;1641534- 1540PubMedGoogle ScholarCrossref
16.
Klatsky  ALFriedman  GDArmstrong  MA The relationships between alcoholic beverage use and other traits to blood pressure: a new Kaiser Permanente study.  Circulation 1986;73628- 636PubMedGoogle ScholarCrossref
17.
Klatsky  ALArmstrong  MAFriedman  GD Coffee, tea, and mortality.  Ann Epidemiol 1993;3375- 381PubMedGoogle ScholarCrossref
18.
Wakabayashi  KKono  SShinchi  K  et al.  Habitual coffee consumption and blood pressure: a study of self-defense officials in Japan.  Eur J Epidemiol 1998;14669- 673PubMedGoogle ScholarCrossref
19.
Flegal  KM Evaluating epidemiologic evidence of the effects of food and nutrient exposures.  Am J Clin Nutr 1999;691339S- 1344SPubMedGoogle Scholar
20.
Taubert  DBerkels  RRoesen  RKlaus  W Chocolate and blood pressure in elderly individuals with isolated systolic hypertension.  JAMA 2003;2901029- 1030PubMedGoogle ScholarCrossref
21.
Engler  MBEngler  MMChen  CY  et al.  Flavonoid-rich dark chocolate improves endothelial function and increases plasma epicatechin concentrations in healthy adults.  J Am Coll Nutr 2004;23197- 204PubMedGoogle ScholarCrossref
22.
Grassi  DLippi  CNecozione  SDesideri  GFerri  C Short-term administration of dark chocolate is followed by a significant increase in insulin sensitivity and a decrease in blood pressure in healthy persons.  Am J Clin Nutr 2005;81611- 614PubMedGoogle Scholar
23.
Grassi  DNecozione  SLippi  C  et al.  Cocoa reduces blood pressure and insulin resistance and improves endothelium-dependent vasodilation in hypertensives.  Hypertension 2005;46398- 405PubMedGoogle ScholarCrossref
24.
Fraga  CGActis-Goretta  LOttaviani  JI  et al.  Regular consumption of a flavanol-rich chocolate can improve oxidant stress in young soccer players.  Clin Dev Immunol 2005;1211- 17PubMedGoogle ScholarCrossref
25.
Bingham  SAVorster  HJerling  JC  et al.  Effect of black tea drinking on blood lipids, blood pressure and aspects of bowel habit.  Br J Nutr 1997;7841- 55PubMedGoogle ScholarCrossref
26.
Hodgson  JMPuddey  IBBurke  VBeilin  LJJordan  N Effects on blood pressure of drinking green and black tea.  J Hypertens 1999;17457- 463PubMedGoogle ScholarCrossref
27.
Duffy  SJKeaney  JF  JrHolbrook  M  et al.  Short- and long-term black tea consumption reverses endothelial dysfunction in patients with coronary artery disease.  Circulation 2001;104151- 156PubMedGoogle ScholarCrossref
28.
Hodgson  JMCroft  KDMori  TABurke  VBeilin  LJPuddey  IB Regular ingestion of tea does not inhibit in vivo lipid peroxidation in humans.  J Nutr 2002;13255- 58PubMedGoogle Scholar
29.
Fukino  YShimbo  MAoki  NOkubo  TIso  H Randomized controlled trial for an effect of green tea consumption on insulin resistance and inflammation markers.  J Nutr Sci Vitaminol (Tokyo) 2005;51335- 342PubMedGoogle ScholarCrossref
30.
US Food and Drug Administration, Center of Food Safety and Applied Nutrition, Office of Special Nutritionals, Guidance for Industry: Significant Scientific Agreement in the Review of Health Claims for Conventional Foods and Dietary Supplements.  Washington, DC US Food and Drug Administration1999;
31.
McGinn  TWyer  PCNewman  TBKeitz  SLeipzig  RFor  GG Tips for learners of evidence-based medicine, 3: measures of observer variability (kappa statistic).  CMAJ 2004;1711369- 1373PubMedGoogle ScholarCrossref
32.
Jadad  ARMoore  RACarroll  D  et al.  Assessing the quality of reports of randomized clinical trials: is blinding necessary?  Control Clin Trials 1996;171- 12PubMedGoogle ScholarCrossref
33.
Higgins  JPThompson  SG Quantifying heterogeneity in a meta-analysis.  Stat Med 2002;211539- 1558PubMedGoogle ScholarCrossref
34.
DerSimonian  RLaird  N Meta-analysis in clinical trials.  Control Clin Trials 1986;7177- 188PubMedGoogle ScholarCrossref
35.
Egger  MDavey Smith  GSchneider  MMinder  C Bias in meta-analysis detected by a simple, graphical test.  BMJ 1997;315629- 634PubMedGoogle ScholarCrossref
36.
Duval  STweedie  R Trim and fill: a simple funnel-plot-based method of testing and adjusting for publication bias in meta-analysis.  Biometrics 2000;56455- 463PubMedGoogle ScholarCrossref
37.
Murphy  KJChronopoulos  AKSingh  I  et al.  Dietary flavanols and procyanidin oligomers from cocoa (Theobroma cacao) inhibit platelet function.  Am J Clin Nutr 2003;771466- 1473PubMedGoogle Scholar
38.
Diepvens  KKovacs  EMVogels  NWesterterp-Plantenga  MS Metabolic effects of green tea and of phases of weight loss.  Physiol Behav 2006;87185- 191PubMedGoogle ScholarCrossref
39.
Morgan  TOAnderson  AIMacInnis  RJ ACE inhibitors, beta-blockers, calcium blockers, and diuretics for the control of systolic hypertension.  Am J Hypertens 2001;14241- 247PubMedGoogle ScholarCrossref
40.
McInnes  GT Lowering blood pressure for cardiovascular risk reduction.  J Hypertens Suppl 2005;23S3- S8PubMedGoogle ScholarCrossref
41.
Lee  KWKim  YJLee  HJLee  CY Cocoa has more phenolic phytochemicals and a higher antioxidant capacity than teas and red wine.  J Agric Food Chem 2003;517292- 7295PubMedGoogle ScholarCrossref
42.
Karim  MMcCormick  KKappagoda  CT Effects of cocoa extracts on endothelium-dependent relaxation.  J Nutr 2000;1302105S- 2108SPubMedGoogle Scholar
43.
Fisher  NDHughes  MGerhard-Herman  MHollenberg  NK Flavanol-rich cocoa induces nitric-oxide-dependent vasodilation in healthy humans.  J Hypertens 2003;212281- 2286PubMedGoogle ScholarCrossref
44.
Heiss  CDejam  AKleinbongard  PSchewe  TSies  HKelm  M Vascular effects of cocoa rich in flavan-3-ols.  JAMA 2003;2901030- 1031PubMedGoogle ScholarCrossref
45.
Holt  RRSchramm  DDKeen  CLLazarus  SASchmitz  HH Chocolate consumption and platelet function.  JAMA 2002;2872212- 2213PubMedGoogle ScholarCrossref
46.
McKay  DLBlumberg  JB The role of tea in human health: an update.  J Am Coll Nutr 2002;211- 13PubMedGoogle ScholarCrossref
47.
Nutrient Data Laboratory, Food Composition Laboratory, Beltsville Human Nutrition Research Center, Agricultural Research Service, US Department of Agriculture, USDA Database for the Flavonoid Content of Dried Teas: Release 2.  Beltsville, Md Nutrient Data Laboratory2006;
48.
Rechner  ARWagner  EVan Buren  LVan De Put  FWiseman  SRice-Evans  CA Black tea represents a major source of dietary phenolics among regular tea drinkers.  Free Radic Res 2002;361127- 1135PubMedGoogle ScholarCrossref
49.
Natsume  MOsakabe  NYamagishi  M  et al.  Analyses of polyphenols in cacao liquor, cocoa, and chocolate by normal-phase and reversed-phase HPLC.  Biosci Biotechnol Biochem 2000;642581- 2587PubMedGoogle ScholarCrossref
50.
Andriambeloson  EKleschyov  ALMuller  BBeretz  AStoclet  JCAndriantsitohaina  R Nitric oxide production and endothelium-dependent vasorelaxation induced by wine polyphenols in rat aorta.  Br J Pharmacol 1997;1201053- 1058PubMedGoogle ScholarCrossref
51.
Fitzpatrick  DFMaggi  DBing  BCoffey  RGFries  D Vasorelaxation, endothelium, and wine.  Biofactors 1997;6455- 459Google ScholarCrossref
52.
Fitzpatrick  DFFleming  RCBing  BMaggi  DAO'Malley  RM Isolation and characterization of endothelium-dependent vasorelaxing compounds from grape seeds.  J Agric Food Chem 2000;486384- 6390PubMedGoogle ScholarCrossref
53.
Taubert  DBerkels  RKlaus  WRoesen  R Nitric oxide formation and corresponding relaxation of porcine coronary arteries induced by plant phenols: essential structural features.  J Cardiovasc Pharmacol 2002;40701- 713PubMedGoogle ScholarCrossref
54.
Mendes  ADesgranges  CCheze  CVercauteren  JFreslon  JL Vasorelaxant effects of grape polyphenols in rat isolated aorta: possible involvement of a purinergic pathway.  Fundam Clin Pharmacol 2003;17673- 681PubMedGoogle ScholarCrossref
55.
Holt  RRLazarus  SASullards  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;76798- 804PubMedGoogle Scholar
56.
Arts  ICHollman  PCFeskens  EJBueno de Mesquita  HBKromhout  D Catechin intake might explain the inverse relation between tea consumption and ischemic heart disease: the Zutphen Elderly Study.  Am J Clin Nutr 2001;74227- 232PubMedGoogle Scholar
57.
Keli  SOHertog  MGFeskens  EJKromhout  D Dietary flavonoids, antioxidant vitamins, and incidence of stroke: the Zutphen study.  Arch Intern Med 1996;156637- 642PubMedGoogle ScholarCrossref
58.
Arts  ICHollman  PC Polyphenols and disease risk in epidemiologic studies.  Am J Clin Nutr 2005;81 ((1) (suppl)) 317S- 325SPubMedGoogle Scholar
59.
Pogue  JYusuf  S Overcoming the limitations of current meta-analysis of randomised controlled trials.  Lancet 1998;35147- 52PubMedGoogle ScholarCrossref
60.
MacMahon  SCutler  JBrittain  EHiggins  M Obesity and hypertension: epidemiological and clinical issues.  Eur Heart J 1987;8 ((suppl B)) 57- 70PubMedGoogle ScholarCrossref
61.
Sesso  HDPaffenbarger  RS  JrOguma  YLee  IM Lack of association between tea and cardiovascular disease in college alumni.  Int J Epidemiol 2003;32527- 533PubMedGoogle ScholarCrossref
62.
Kuriyama  SShimazu  TOhmori  K  et al.  Green tea consumption and mortality due to cardiovascular disease, cancer, and all causes in Japan: the Ohsaki study.  JAMA 2006;2961255- 1265PubMedGoogle ScholarCrossref
Review
April 9, 2007

Effect of Cocoa and Tea Intake on Blood Pressure: A Meta-analysis

Author Affiliations

Author Affiliations: Department of Pharmacology, University Hospital of Cologne, Cologne, Germany.

Arch Intern Med. 2007;167(7):626-634. doi:10.1001/archinte.167.7.626
Abstract

Background  Epidemiological evidence suggests blood pressure–lowering effects of cocoa and tea. We undertook a meta-analysis of randomized controlled trials to determine changes in systolic and diastolic blood pressure due to the intake of cocoa products or black and green tea.

Methods  MEDLINE, EMBASE, SCOPUS, Science Citation Index, and the Cochrane Controlled Trials Register were searched from 1966 until October 2006 for studies in parallel group or crossover design involving 10 or more adults in whom blood pressure was assessed before and after receiving cocoa products or black or green tea for at least 7 days.

Results  Five randomized controlled studies of cocoa administration involving a total of 173 subjects with a median duration of 2 weeks were included. After the cocoa diets, the pooled mean systolic and diastolic blood pressure were −4.7 mm Hg (95% confidence interval [CI], −7.6 to −1.8 mm Hg; P = .002) and −2.8 mm Hg (95% CI, −4.8 to −0.8 mm Hg; P = .006) lower, respectively, compared with the cocoa-free controls. Five studies of tea consumption involving a total of 343 subjects with a median duration of 4 weeks were selected. The tea intake had no significant effects on blood pressure. The estimated pooled changes were 0.4 mm Hg (95% CI, −1.3 to 2.2 mm Hg; P = .63) in systolic and −0.6 mm Hg (95% CI, −1.5 to 0.4 mm Hg; P = .38) in diastolic blood pressure compared with controls.

Conclusion  Current randomized dietary studies indicate that consumption of foods rich in cocoa may reduce blood pressure, while tea intake appears to have no effect.

×