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Impact of cocoa flavanol consumption on blood pressure responsiveness to exercise

  • Narelle M. Berry (a1), Kade Davison (a1) (a2), Alison M. Coates (a1), Jonathan D. Buckley (a1) and Peter R. C. Howe (a1)...

Impaired endothelial vasodilatation may contribute to the exaggerated blood pressure (BP) responses to exercise in individuals who are overweight/obese. The present study investigated whether consumption of cocoa flavanols, which improve endothelium-dependent flow-mediated dilatation (FMD), can modify BP responsiveness to exercise. Twenty-one volunteers (eight females and thirteen males, 54·9 (se 2·2) years, BMI 31·6 (se 0·8) kg/m2, systolic BP 134 (se 2) mmHg, diastolic BP (DBP) 87 (se 2) mmHg) were randomised to consume single servings of either a high-flavanol (HF, 701 mg) or a low-flavanol (LF, 22 mg) cocoa beverage in a double-blind, cross-over design with 3–7-d washout between treatments. Two hours after cocoa consumption, FMD was measured, followed by continuous beat-to-beat assessment (Finapres™) of BP before and during 10 min of cycling at 75 % of age-predicted maximum heart rate. Averaged data from two assessments on each type of beverage were compared by analysis of covariance using pre-exercise BP as the covariate. Pre-exercise BP was similar after taking LF and HF (153 (se 3)/88 (se 3) v. 153 (se 4)/87 (se 2) mmHg, respectively, P>0·05). However, the BP response to exercise (area under BP curve) was attenuated by HF compared with LF. BP increases were 68 % lower for DBP (P = 0·03) and 14 % lower for mean BP (P = 0·05). FMD measurements were higher after taking HF than after taking LF (6·1 (se 0·6) % v. 3·4 (se 0·5) %, P < 0·001). By facilitating vasodilation and attenuating exercise-induced increases in BP, cocoa flavanols may decrease cardiovascular risk and enhance the cardiovascular benefits of moderate intensity exercise in at-risk individuals.

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Corresponding author
*Corresponding author: Dr Narelle M. Berry, fax +61 8 8302 2178, email
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1 Brown AA & Hu FB (2001) Dietary modulation of endothelial function: implications for cardiovascular disease. Am J Clin Nutr 73, 673686.
2 Park JB, Charbonneau F & Schiffrin EL (2001) Correlation of endothelial function in large and small arteries in human essential hypertension. J Hypertens 19, 415420.
3 Van Gaal LF, Mertens IL & De Block CE (2006) Mechanisms linking obesity with cardiovascular disease. Nature 444, 875880.
4 Tzemos N, Lim PO & MacDonald TM (2002) Is exercise blood pressure a marker of vascular endothelial function? QJM 95, 423429.
5 Stewart KJ, Sung J, Silber HA, et al. (2004) Exaggerated exercise blood pressure is related to impaired endothelial vasodilator function. Am J Hypertens 17, 314320.
6 Miyai N, Arita M, Miyashita K, et al. (2002) Blood pressure response to heart rate during exercise test and risk of future hypertension. Hypertension 39, 761766.
7 Jae SY, Fernhall B, Heffernan KS, et al. (2006) Exaggerated blood pressure response to exercise is associated with carotid atherosclerosis in apparently healthy men. J Hypertens 24, 881887.
8 Wilson MF, Sung BH, Pincombe GA, et al. (1990) Exaggerated pressure response to exercise in men at risk for systemic hypertension. Am J Cardiol 66, 731736.
9 Albert CM, Mittleman MA, Chae CU, et al. (2000) Triggering of sudden death from cardiac causes by vigorous exertion. N Engl J Med 343, 13551361.
10 Grassi D, Necozione S, Lippi C, et al. (2005) Cocoa reduces blood pressure and insulin resistance and improves endothelium-dependent vasodilation in hypertensives. Hypertension 46, 398405.
11 Davison K, Coates AM, Buckley JD, et al. (2008) Effect of cocoa flavanols and exercise on cardiometabolic risk factors in overweight and obese subjects. Int J Obes 32, 12891296.
12 Grassi D, Lippi C, Necozione S, et al. (2005) 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 81, 611614.
13 Taubert D, Roesen R, Lehmann C, et al. (2007) Effects of low habitual cocoa intake on blood pressure and bioactive nitric oxide. JAMA 298, 4960.
14 Keen CL, Holt RR, Oteiza PI, et al. (2005) Cocoa antioxidants and cardiovascular health. Am J Clin Nutr 81, 298303.
15 Balzer J, Heiss C, Schroeter H, et al. (2006) Flavanols and cardiovascular health: effects on the circulating NO pool in humans. J Cardiovasc Pharmacol 47, Suppl. 2, S122S127.
16 Heiss C, Dejam A, Kleinbongard P, et al. (2003) Vascular effects of cocoa rich in flavan-3-ols. JAMA 290, 10301031.
17 Heiss C, Kleinbongard P, Dejam A, et al. (2005) Acute consumption of flavanol-rich cocoa and the reversal of endothelial dysfunction in smokers. J Am Coll Cardiol 46, 12761283.
18 Karim M, McCormick K & Kappagoda CT (2000) Effects of cocoa extracts on endothelium-dependent relaxation. J Nutr 130, 2105S2108S.
19 Tanaka H, Monahan KD & Seals DR (2001) Age-predicted maximal heart rate revisited. J Am Coll Cardiol 37, 153156.
20 Balzer J, Rassaf T, Heiss C, et al. (2008) Sustained benefits in vascular function through flavanol-containing cocoa in medicated diabetic patients a double-masked, randomized, controlled trial. J Am Coll Cardiol 51, 21412149.
21 Heiss C, Finis D, Kleinbongard P, et al. (2007) Sustained increase in flow-mediated dilation after daily intake of high-flavanol cocoa drink over 1 week. J Cardiovasc Pharmacol 49, 7480.
22 Raitakari OT & Celermajer DS (2000) Flow-mediated dilatation. Br J Clin Pharmacol 50, 397404.
23 Chang HJ, Chung J, Choi SY, et al. (2004) Endothelial dysfunction in patients with exaggerated blood pressure response during treadmill test. Clin Cardiol 27, 421425.
24 Koller-Strametz J, Matulla B, Wolzt M, et al. (1998) Role of nitric oxide in exercise-induced vasodilation in man. Life Sci 62, 10351042.
25 Green DJ, Walsh JH, Maiorana A, et al. (2004) Comparison of resistance and conduit vessel nitric oxide-mediated vascular function in vivo: effects of exercise training. J Appl Physiol 97, 749755.
26 Schnorr O, Brossette T, Momma TY, et al. (2008) Cocoa flavanols lower vascular arginase activity in human endothelial cells in vitro and in erythrocytes in vivo. Arch Biochem Biophys 476, 211215.
27 Fisher NDL, Hughes M, Gerhard-Herman M, et al. (2003) Flavanol-rich cocoa induces nitric-oxide-dependent vasodilation in healthy humans. J Hypertens 21, 22812286.
28 Schroeter H, Heiss C, Balzer J, et al. (2006) ( − )-Epicatechin mediates beneficial effects of flavanol-rich cocoa on vascular function in humans. Proc Natl Acad Sci U S A 103, 10241029.
29 Hammerstone JF, Lazarus SA & Schmitz HH (2000) Procyanidin content and variation in some commonly consumed foods. J Nutr 130, 20862092.
30 Food Standards Australia New Zealand Nutrient tables for use in Australia (database on the Internet).
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British Journal of Nutrition
  • ISSN: 0007-1145
  • EISSN: 1475-2662
  • URL: /core/journals/british-journal-of-nutrition
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