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Long-Term Effect of Cocoa Extract Supplementation on Incident Hypertension.

  • 2025-10
  • Hypertension (Dallas, Tex. : 1979) 82(10)
    • Rikuta Hamaya
    • Sidong Li
    • Jessica Lau
    • Matthew Allison
    • Bernhard Haring
    • Aladdin H Shadyab
    • Nudy Matthew
    • Lisa Warsinger Martin
    • Pamela M Rist
    • JoAnn E Manson
    • Howard D Sesso

Study Design

Type
Randomized Controlled Trial (RCT)
Sample size
n = 442
Population
21,442 women aged ≥65 years and men aged ≥60 years; analyses in 8905 participants free from baseline hypertension
Methods
2×2 factorial, double-blind, placebo-controlled randomized clinical trial testing cocoa extract (including 500 mg/d cocoa flavanols, with 80 mg/d [-]-epicatechin) and a multivitamin
Blinding
Double-blind
Duration
median follow-up of 3.4 years
Funding
Unclear
  • Large Human Trial

Background

Cocoa flavanols have potential blood pressure (BP)-lowering effects in shorter-term, smaller-scale randomized clinical trials, but their effect on incident hypertension has not been examined in a large-scale and long-term randomized clinical trial.

Methods

The COSMOS (Cocoa Supplement and Multivitamin Outcomes Study) is a 2×2 factorial, double-blind, placebo-controlled randomized clinical trial testing cocoa extract (including 500 mg/d cocoa flavanols, with 80 mg/d [-]-epicatechin) and a multivitamin among 21 442 women aged ≥65 years and men aged ≥60 years. Placebos did not include any bioactive compounds. In 8905 COSMOS participants free from baseline hypertension, we investigated the effect of cocoa extract on incident hypertension using Cox proportional hazards models. Incident hypertension was defined as self-reported first-time physician diagnosis, initiation of antihypertensive medications, or elevated BP.

Results

Mean age at baseline was 71.1 years (SD, 6.2), and 59% were women. Over a median follow-up of 3.4 years, cocoa extract supplementation had no significant effect on incident hypertension in an intention-to-treat analysis, with incidence rates of 7.1 and 7.4 per 100 person-years in cocoa and placebo groups, respectively (hazard ratio, 0.96 [95% CI, 0.88-1.05]). In subgroup analyses, cocoa extract supplementation reduced the incidence of hypertension among participants with baseline systolic BP <120 mm Hg (hazard ratio, 0.76 [0.64-0.90]), but not among those with systolic BP of 120 to 139 mm Hg (hazard ratio, 1.05 [0.93-1.18]; P-interaction=0.002). The effect among baseline systolic BP <120 mm Hg became evident at year 2 after randomization.

Conclusions

In older adults, long-term cocoa extract supplementation did not reduce the overall risk of self-reported incident hypertension. However, among those with normal systolic BP at baseline, cocoa extract reduced hypertension risk by 24%.

Research Insights

  • Cocoa→Reduced Incident Hypertension

    cocoa extract supplementation reduced the incidence of hypertension among participants with baseline systolic BP <120 mm Hg (hazard ratio, 0.76 [0.64-0.90])

    Effect
    Beneficial
    Effect size
    Moderate
    Dose
    500 mg/d cocoa flavanols, with 80 mg/d (-)-epicatechin
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