Will hot chocolate raise blood pressure?

Epidemiological studies suggest that cocoa-rich products reduce the risk of cardiovascular disease. Flavanols found in cocoa have been shown to increase the formation of endothelial nitric oxide which promotes vasodilation and therefore blood pressure reduction.

cochrane.org - Effect of cocoa on blood pressure - Cochrane

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Review question

We assessed the effect of cocoa products on blood pressure in adults when consumed daily for at least two weeks. We found 35 studies, covering 40 treatment comparisons.

Background

Dark chocolate and cocoa products are rich in chemical compounds called flavanols. Flavanols have attracted interest as they might help to reduce blood pressure, a known risk factor for cardiovascular disease (disorders of the heart and blood vessels). The blood pressure-lowering properties of flavanols are thought to be related to widening of the blood vessels, caused by nitric oxide.

Study characteristics

Studies were short, mostly between two and12 weeks, with only one of 18 weeks. The studies involved 1804 mainly healthy adults. They provided participants with 30 to 1218 mg of flavanols (average of 670 mg) in 1.4 to 105 grams of cocoa products per day in the active intervention group. Seven of the studies were funded by companies with a commercial interest in their results, and the reported effect was slightly larger in these studies, indicating possible bias. The evidence is current to November 2016.

Key results

Meta-analysis of 40 treatment comparisons revealed a small but statistically significant lowering of blood pressure (systolic and diastolic) of 1.8 mmHg. This small reduction in blood pressure might complement other treatment options and might contribute to reducing the risk of cardiovascular disease. We investigated whether participants' blood pressure at the start of the study, their age, an awareness of group allocation (active or control), the flavanol content used in the control group, or how long the study lasted may explain variations between trials. While blood pressure status (high blood pressure or normal blood pressure) is a likely factor in the effect size of cocoa on blood pressure, the impact of other factors needs to be confirmed or rejected in further trials. Side effects including digestive complaints and dislike of the trial product were reported by only 1% of people in the active cocoa intervention group and 0.4% of people in the control groups. Longer-term trials are needed to establish whether regularly eating flavanol-rich cocoa products has a beneficial effect on blood pressure and cardiovascular health over time, and whether there are any side effects of long-term use of cocoa products on a daily basis.

Quality of evidence

The evidence is of moderate quality. We were unable to identify any randomised controlled trials that tested the effect of long-term daily use of cocoa products on blood pressure, and there were no trials that measured the health consequences of high blood pressure, such as heart attacks or strokes.

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