原文发表于：Hypertension. 2005 Jul 18
食用富含黄烷醇的黑巧克力可降低健康受试者的血压和胰岛素抵抗，推测黑巧克力对原发性高血压患者可能具有相同的作用。所以，我们观察了黑巧克力对原发性高血压患者的24小时动态血压，血流介导的血管舒张（FMD）和口服葡萄糖耐量试验（OGTT）的影响。
作者选入了20例未经治疗的高血压1级患者（10例男性，年龄43.7±7.8），7天不吃巧克力后，随机给予每天等热量的100克黑巧克力（含有88mg黄烷醇）或者90克不含黄烷醇的白巧克力15天。随后7天均不吃巧克力，然后两组交换。每次治疗结束时测定非侵入性24小时动态血压，血流介导的血管舒张和口服葡萄糖耐量试验、血脂和血管炎性标志物。通过OGTT值计算稳态模型的胰岛素抵抗指数(HOMA-IR)，定量胰岛素敏感检测指数(QUICKI)和胰岛素敏感指数(ISI)。食用黑巧克力者动态血压下降（24小时收缩压下降11.9±7.7 mm Hg, P<0.0001; 舒张压下降8.5±5.0 mm Hg, P<0.0001)，HOMA-IR下降 (P<0.0001)，QUICKI、ISI和 FMD改善，低密度脂蛋白下降(从3.4±0.5 到3.0±0.6 mmol/L; P<0.05)，但是食用白巧克力者没有。
结论：黑巧克力能够降低高血压患者血压、低密度脂蛋白水平，提高FMD，改善胰岛素敏感性。这一结果显示，为了平衡总热量摄入，如果高血压患者的健康饮食中包含可可，那么可可中的黄酮类物质可能具有心血管保护作用。
Cocoa Reduces Blood Pressure and Insulin Resistance and Improves Endothelium-Dependent Vasodilation in Hypertensives
Consumption of flavanol-rich dark chocolate (DC) has been shown to decrease blood pressure (BP) and insulin resistance in healthy subjects, suggesting similar benefits in patients with essential hypertension (EH). Therefore, we tested the effect of DC on 24-hour ambulatory BP, flow-mediated dilation (FMD), and oral glucose tolerance tests (OGTTs) in patients with EH. After a 7-day chocolate-free run-in phase, 20 never-treated, grade I patients with EH (10 males; 43.7±7.8 years) were randomized to receive either 100 g per day DC (containing 88 mg flavanols) or 90 g per day flavanol-free white chocolate (WC) in an isocaloric manner for 15 days. After a second 7-day chocolate-free period, patients were crossed over to the other treatment. Noninvasive 24-hour ambulatory BP, FMD, OGTT, serum cholesterol, and markers of vascular inflammation were evaluated at the end of each treatment. The homeostasis model assessment of insulin resistance (HOMA-IR),quantitative insulin sensitivity check index (QUICKI), and insulin sensitivity index (ISI) were calculated from OGTT values. Ambulatory BP decreased after DC (24-hour systolic BP –11.9±7.7 mm Hg, P<0.0001; 24-hour diastolic BP –8.5±5.0 mm Hg, P<0.0001) but not WC. DC but not WC decreased HOMA-IR (P<0.0001), but it improved QUICKI, ISI, and FMD. DC also decreased serum LDL cholesterol (from 3.4±0.5 to 3.0±0.6 mmol/L; P<0.05). In summary, DC decreased BP and serum LDL cholesterol, improved FMD, and ameliorated insulin sensitivity in hypertensives. These results suggest that, while balancing total calorie intake, flavanols from cocoa products may provide some cardiovascular benefit if included as part of a healthy diet for patients with EH.
