Cocoa flavanols and blood pressure
What 2 graded rows on cocoa flavanols agree on for blood pressure, and where they differ. Counted side by side, never averaged.
Consensus finder Rows from the Cocoa flavanols page, reviewed Oct 21, 2026 How it decides
What the rows agree on
Each block and row is one graded row from the Cocoa flavanols page, with its PubMed record.
Your question
Cocoa flavanols and blood pressure
2 rows · 10,709 peopleSplit. 1 row found an improvement and 1 found no difference.
- BGrade B× 1
- ∅No effect× 1
- Rows
- 2
- Trials
- 36
- People
- 10,709
- Pooled reviews may count some twice
Where they differ
From the rowsThe best-graded row, grade B, is a systematic review of 1,804 people (2017) and found an improvement. 1 row is graded No effect, our grade for adequately powered trials that found no effect.
The row that found no difference was larger: 8,905 people, against 1,804 people for the row that found an improvement.
The row that found an improvement is a pooled review of several trials; the row that found no difference is a single study.
The row that found no difference ran longer (3.4 years) than the row that found an improvement (2 weeks).
The row that found no difference is newer (2025) than the row that found an improvement (2017).
The rows
1 improved · 1 no difference- BGrade BBlood pressure · Improved
Systematic review, 35 studies · n 1,804 · 2017 · Mainly healthy adults in 35 trials (40 comparisons)
30–1,218 mg flavanols/day (mean 670 mg) · 2–18 weeks
Systolic and diastolic pressure each fell about 1.8 mm Hg versus control; about 4 mm Hg systolic in people with hypertension and no significant change in normotensive people. Excluding trials with industry-employed authors shrank the effect slightly.
Row on the Cocoa flavanols page · PubMed 28439881 (opens PubMed)
- ∅No effectNew high blood pressure over 3 years · No difference
RCT · n 8,905 · 2025 · COSMOS participants without hypertension at baseline (mean age 71)
500 mg flavanols/day (including 80 mg epicatechin) · Median 3.4 years
Incident hypertension did not differ (7.1 vs 7.4 per 100 person-years; HR 0.96, 95% CI 0.88–1.05). In a subgroup analysis, people with baseline systolic pressure under 120 mm Hg had 24% lower risk (HR 0.76, 95% CI 0.64–0.90), seen from year 2, while those at 120–139 mm Hg had no benefit (HR 1.05).
Row on the Cocoa flavanols page · PubMed 40832703 (opens PubMed)