Philip Oddie & Abhishek Oswal The clinical scenario The patient - PowerPoint PPT Presentation

Philip Oddie & Abhishek Oswal

The clinical scenario The patient & problem  Mrs C. Hocolate is a 57 year old known hypertensive who read in the Daily Mail that eating dark chocolate will help reduce her blood pressure The key research data needed  In adults with hypertension, does eating dark chocolate reduce blood pressure compared to a dark chocolate free diet?

The search (database & terms) & results

Primary Study Reference: Cocoareducesbloodpressureand insulinresistance and improvesendothelium- dependentvasodilation inhypertensives.Grassi et al. Hypertension 2005 Aug;46(2):398-405. STUDY Question Patients: 25-60yr old (mean age 44, n = 20) 140<SBP<160mmHg. Not previously treated Intervention: Dark Chocolate Comparison: White Chocolate Outcome: OGTT, BP, ABPM, FMD, Haematological check Quality of Study Randomised? – Yes? Accounted for: obesity, pregnancy, tobacco, alcohol, atherosclerosis, cardiac abnormalities, cholesterol Measurement: (blinded OR objective?): Objective Overall: Good 

Primary Study Results

The search (database & terms) & results

Systematic Review Reference: Does chocolate reduce blood pressure? A meta-analysis. Reid et al. BMC Med. 2010 Jun 28;8:39. STUDY Question Patients: Adults Intervention: Low dose of a flavanol containing cocoa product for >2 weeks Comparison: Low Flavanol placebo or white chocolate Outcome: Change in SBP/DBP Quality of Study Find: “chocolate OR cocoa AND blood pressure” in Medline, Cochrane and grey literature databases. Could have used more? Appraised: Scored using Cochrane guidelines Synthesised: Meta-analyis with forest plots performed Overall: Good methods, but high degree of heterogeneity

SBP (Hypertensive) SBP (All) SBP (Normotensive)

Key Results & application to patient Outcomes Difference/mmHg [95CI] I 2 SBP (all) -3.16 [-5.08, -1.23] 74 DBP (all) -2.02 [-3.35, -0.69] 62 SBP -5.02 [-7.99, -2.05] 90 (hypertensive) DBP -2.73 [-4.89, -0.48] 79 (hypertensive) SBP -1.56 [-3.81, +0.69] 23 (normotensive) DBP -1.28 [-2.88, +0.33] 24 (normotensive) The Benefits and risks to patient Unclear whether the benefits seen in hypertensive patients are valid  Your Recommendation Have it in moderation, but important to consider other factors too 