Cocoa, chocolate and hypertension

Abstract

Cardiovascular disease is the main cause of mortality both in developed and developing countries, killing an estimated 17 million people each year [1, 2]. In particular, hypertension is one of the most important cardiovascular disease risk factors, accounting for nearly two-thirds of all strokes and half of all ischemic heart disease [1-3]. It is also a major risk factor for dementia, chronic kidney disease and heart failure [2, 3]. Hypertension affects approximately 67 million US adults, and another 85 million have pre-hypertension [4, 5]. The most recent estimates suggest that 7.6 million premature deaths globally (13.5% of total global mortality) and 92 million disability-adjusted life years (6.0% of the global total) are attributable to hypertension [6]. Moreover, in developed countries, 90% of adults aged 55-65 years and with normal blood pressure will present with hypertension during their lifetime [7]. Conversely, lowering of an abnormally high blood pressure is associated with significant reductions in cardiovascular morbidity and mortality. However, blood pressure control requires extensive healthcare resources and, in clinical practice, most hypertensive patients are either undiagnosed, untreated or sub-optimally treated [8, 9]. Thus, considering the graded and continuous nature of the relation between blood pressure and vascular risk, international guidelines for the diagnosis and treatment of arterial hypertension [8, 9] introduced the concepts of high-normal blood pressure and pre-hypertension. The respective committees recommended the identification of these individuals as they are at increased risk for progression to hypertension and subsequently other cardiovascular diseases [8, 9]. Indeed, both conditions are very prevalent (especially in obese young people), are often associated with other cardiovascular risk factors and result in a 3.0-fold greater likelihood of progression to hypertension and a 1.4- to 2.0-fold greater risk of cardiovascular events [10].