NEW findings suggest that flavan-3-ols, natural compounds in cocoa, tea, and certain fruits, could help reduce blood pressure and improve vascular function, with potential relevance for cardiovascular prevention in primary care.
Flavan-3-ols have attracted interest for their cardiovascular effects, but are not currently part of standard prevention strategies. This large meta-analysis evaluated 145 randomised controlled trials from 109 publications, including 5,205 participants, to assess the impact of flavan-3-ol-rich foods, beverages, and supplements. The interventions included cocoa products, tea, grape extract, apples, and isolated compounds like epicatechin and epigallocatechin-gallate. Studies spanning from 1946–March 2024 were identified via PubMed, and data were pooled using random-effects models.
Across the trials, flavan-3-ol interventions led to significant reductions in both office blood pressure (-2.8/-2.0 mmHg) and 24-hour ambulatory blood pressure (-3.7/-2.6 mmHg) after regular consumption. More pronounced effects were seen in participants with elevated or hypertensive baseline readings, with office reductions of up to -5.9/-2.7 mmHg and ambulatory reductions of -6.8/-5.1 mmHg. Meta-regression showed the degree of blood pressure reduction was linked to baseline blood pressure, but not to cardiovascular disease, diabetes, or study duration. A dose-dependent effect was only evident in cocoa-based interventions. Importantly, flow-mediated dilation, a measure of endothelial function, improved after both acute (+2.0%) and chronic (+1.7%) intake, suggesting benefits beyond blood pressure control. Adverse events were rare (0.4%) and mild. However, substantial heterogeneity across studies (I²>50%) limited the strength of evidence to ‘moderate’.
These results highlight the potential role of flavan-3-ol-rich foods in cardiovascular prevention strategies, especially for patients with raised blood pressure. Incorporating these dietary components into patient advice could offer a low-risk option to support heart health.
Reference
Lagou V et al. Impact of flavan-3-ols on blood pressure and endothelial function in diverse populations: a systematic review and meta-analysis of randomised controlled trials. Eur J Prev Cardiol. 2025; DOI: 10.1093/eurjpc/zwaf173.
