Cocoa:Uses in complimentary and alternative medicine to reduce blood pressure

Icame across a paper title“Complimentary and alternative medicine approaches to blood pressure reduction” by one Richard Nahas published in the Canadian Family Physician 2008.

It readily caught my attention when I saw references to cocoa. High Blood pressure (BP) is one of the most important cardiovascular risk factors worldwide (Lancet 2004)1.

Only about a third of patients achieve optimal BP control using drug therapy (Hypertension 2003). Because a reduction of 5mm Hg in systolic BP has been associated with a 7% reduction in all-cause mortality (JAMA 2002), it is important to consider other interventions that reduce BP.

The Joint National Committee on Prevention, Detection, Evaluation and Treatment of High Blood Pressure recommends five lifestyle changes for all patients with hypertension; reducing sodium intake, increasing exercise, moderating alcohol consumption, losing weight and following the Dietary Approaches to Stop Hypertension (DASH) eating plan.

It goes on to state that less widely prescribed but increasingly popular among patients are Complimentary and Alternative medicine (CAM) antihypertensive therapies.

As the name suggests these alternatives are not generally taught in training institutions for health professionals and therefore not widely available in regular health facilities.

It went on to say that dark chocolate and other foods derived from the cacao bean (Theobroma cacao) are rich in flavonoid polyphenols such as procyanidins (Cardiol 2004).

The Olmec and Aztec Mesoamericans used cacao to treat pain and inflammation.

It mentioned that a direct relationship between cacao intake, blood pressure, benefits to the heart and mortality was first demonstrated in the Dutch Zutphen Elderly Study. In that study 470 elderly men were followed prospectively for 15 years.

Those with the highest cocoa consumption had lower blood pressure and an adjusted 50% relative reduction in risk of heart related and all-cause mortality. (Arch Intern Med 2006). This has been confirmed by several small trials.

One involved 173 persons whose blood pressures were measured before and after daily consumption of chocolate. Patients consumed an average of 100g daily (500mg of polyphenols) for about 2weeks.

Other trials have shown blood pressure reduction in both persons with high blood pressure and normal blood pressure. Others have found long term blood pressure reduction from regular consumption of smaller amounts of chocolate.

It also found an increased level of nitric oxide, a key agent in the prevention and resolution of several heart related disorders.

A growing list of conditions including those commonly associated as risk factors for atherosclerosis such as high blood pressure and high cholesterol are associated with diminished release of nitric oxide into the arterial wall.

This was seen as further evidence that flavonoids in cacao increase nitric oxide in endothelial cells and that chocolate improves endothelial function.

It concluded that it was reasonable to recommend that people with high blood pressure eat 10 to 30g of dark chocolate daily. I would add that this should be extended to persons at high risk of high blood pressure.

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