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Nutrition and Disease

Blood Pressure Is Reduced and Insulin Sensitivity Increased in Glucose-Intolerant, Hypertensive Subjects after 15 Days of Consuming High-Polyphenol Dark Chocolate^1–3,

⁴ Department of Internal Medicine and Public Health, University of L'Aquila, 67100 L'Aquila, Italy and ⁵ Antioxidants Research Laboratory, Jean Mayer USDA Human Nutrition Research Center on Aging, Tufts University, Boston, MA 02111

Flavanols from chocolate appear to increase nitric oxide bioavailability, protect vascular endothelium, and decrease cardiovascular disease (CVD) risk factors. We sought to test the effect of flavanol-rich dark chocolate (FRDC) on endothelial function, insulin sensitivity, β-cell function, and blood pressure (BP) in hypertensive patients with impaired glucose tolerance (IGT). After a run-in phase, 19 hypertensives with IGT (11 males, 8 females; 44.8 ± 8.0 y) were randomized to receive isocalorically either FRDC or flavanol-free white chocolate (FFWC) at 100 g/d for 15 d. After a wash-out period, patients were switched to the other treatment. Clinical and 24-h ambulatory BP was determined by sphygmometry and oscillometry, respectively, flow-mediated dilation (FMD), oral glucose tolerance test, serum cholesterol and C-reactive protein, and plasma homocysteine were evaluated after each treatment phase. FRDC but not FFWC ingestion decreased insulin resistance (homeostasis model assessment of insulin resistance; P < 0.0001) and increased insulin sensitivity (quantitative insulin sensitivity check index, insulin sensitivity index (ISI), ISI₀; P < 0.05) and β-cell function (corrected insulin response CIR₁₂₀; P = 0.035). Systolic (S) and diastolic (D) BP decreased (P < 0.0001) after FRDC (SBP, –3.82 ± 2.40 mm Hg; DBP, –3.92 ± 1.98 mm Hg; 24-h SBP, –4.52 ± 3.94 mm Hg; 24-h DBP, –4.17 ± 3.29 mm Hg) but not after FFWC. Further, FRDC increased FMD (P < 0.0001) and decreased total cholesterol (–6.5%; P < 0.0001), and LDL cholesterol (–7.5%; P < 0.0001). Changes in insulin sensitivity ( ISI – FMD: r = 0.510, P = 0.001; QUICKI – FMD: r = 0.502, P = 0.001) and β-cell function ( CIR₁₂₀ – FMD: r = 0.400, P = 0.012) were directly correlated with increases in FMD and inversely correlated with decreases in BP ( ISI – 24-h SBP: r = –0.368, P = 0.022; ISI – 24-h DBP r = –0.384, P = 0.017). Thus, FRDC ameliorated insulin sensitivity and β-cell function, decreased BP, and increased FMD in IGT hypertensive patients. These findings suggest flavanol-rich, low-energy cocoa food products may have a positive impact on CVD risk factors.

^* To whom correspondence should be addressed. E-mail: davide.grassi{at}cc.univaq.it.

Manuscript received 29 January 2008. Initial review completed 3 March 2008. Revision accepted 9 June 2008.

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