Article Impact Level: HIGH Data Quality: STRONG Summary of European Journal of Preventive Cardiology, zwaf173. https://doi.org/10.1093/eurjpc/zwaf173 Dr. Vasiliki Lagou et al.
Points
- This meta-analysis of 145 randomized controlled trials found that chronic intake of flavan-3-ol-rich foods significantly lowered office and 24-hour ambulatory blood pressure in over 5,000 participants.
- The greatest blood pressure reductions were seen in individuals with elevated or hypertensive baseline values, with office BP reductions reaching up to −2.8 mmHg and ambulatory BP reductions up to −3.7 mmHg.
- Meta-regression revealed that baseline BP, but not comorbidities or study length, predicted the extent of BP reduction, and epicatechin in cocoa-based interventions had a dose-dependent effect.
- Flavan-3-ols also improved endothelial function, increasing flow-mediated dilation by 2.0 percent acutely and 1.7 percent chronically, independent of blood pressure changes.
- Although results were highly heterogeneous, the study supports moderate-strength evidence that flavan-3-ol-rich foods can benefit cardiovascular health, especially in those with high blood pressure.
Summary
This meta-analysis aimed to evaluate the effects of flavan-3-ol-rich interventions, such as those found in cocoa, tea, apples, and grapes, on blood pressure (BP) and endothelial function. Data from 145 randomized controlled trials (RCTs) involving 5,205 participants were analyzed, with flavan-3-ol interventions delivering an average of 586 mg (95% CI, 510–662) of flavan-3-ols. The results showed that chronic consumption of flavan-3-ols significantly reduced both office and 24-hour ambulatory BP. The reduction in office BP was −2.8 mmHg (95% CI, −3.9 to −1.7) and −2.0 mmHg (95% CI, −2.6 to −1.3), while 24-hour ambulatory BP decreased by −3.7 mmHg (95% CI, −5.8 to −1.6) and −2.6 mmHg (95% CI, −4.5 to −0.8), respectively. These effects were more pronounced in individuals with elevated or hypertensive baseline BP.
Further meta-regression analysis indicated that the magnitude of BP reduction was inversely related to baseline BP but not to the proportion of participants with cardiovascular disease, diabetes, or study duration. A dose-dependent relationship was observed with epicatechin, specifically in cocoa-based studies. Additionally, flavan-3-ols were found to improve endothelial function, as indicated by a +2.0% (95% CI, 1.6–2.3) increase in flow-mediated dilation after acute consumption and a +1.7% (95% CI, 1.3–2.2) increase after chronic consumption, independent of BP.
The study suggests that flavan-3-ol-rich foods can substantially lower elevated BP and enhance endothelial function, supporting their potential role in cardiovascular prevention. While the adverse events were minimal (0.4%), the substantial heterogeneity in effect sizes (I2 > 50%) limits the strength of the evidence to ‘moderate.’ These findings highlight the promise of incorporating flavan-3-ol-rich foods into a healthy lifestyle, particularly for individuals with elevated BP.
Link to the article: https://academic.oup.com/eurjpc/advance-article-abstract/doi/10.1093/eurjpc/zwaf173/8092214
References Lagou, V., Greyling, A., Ferruzzi, M. G., Skene, S. S., Dubost, J., Demirkan, A., Prokopenko, I., Shlisky, J., Rodriguez-Mateos, A., & Heiss, C. (2025). Impact of flavan-3-ols on blood pressure and endothelial function in diverse populations: A systematic review and meta-analysis of randomized controlled trials. European Journal of Preventive Cardiology, zwaf173. https://doi.org/10.1093/eurjpc/zwaf173
