Effects of Almond and Cocoa/Dark Chocolate Consumption, Alone and in Combination, on 24‐hr Ambulatory Blood Pressure in Normotensive Overweight and Obese Individuals
Authors: Berryman Claire E. , Lee Yujin , West Sheila G. , Lapsley Karen G. , Preston Amy G. , Fleming Jennifer A. , Kris‐Etherton Penny M. 
Published: November 2023

Dietary guidelines favor whole food and dietary pattern approaches to improve health and prevent disease. Almond consumption has been shown to decrease several CVD risk factors, including LDL‐C, and cocoa and dark chocolate have been shown to improve vascular measures related to CVD risk. Whether these foods, when combined, exert further CVD risk reduction due to the additive effects of their distinct mechanisms has not been evaluated in a well‐controlled feeding study. The objective was to determine the effects of dark chocolate/cocoa and almonds, alone and in combination, on 24‐hr ambulatory blood pressure (ABP). A randomized, controlled 4‐period (4 wk/period), crossover, feeding trial was conducted in overweight and obese individuals (n=31, 58% males; mean ± SD, 46 ± 10 y and 30 ± 3 kg/m2). Participants consumed each of four weight maintenance diets: 1) average American diet (AAD) alone, or with isocaloric substitution of 2) 43 g of almonds/d(ALD), 3) 11 g of cocoa and 43 g of dark chocolate/d (CHOC), or 4) both foods(CHOC+ALD). Volunteers were fitted with an ABP device (model 90207, Space labs Healthcare) to collect BP measurements every 20 min during wake time (0600 to 2200)and every 30 min during sleep time (2200 to 0600) for 24 hr at baseline and at the end of each diet period. Conservative estimates of sleep (0100 to 0530) and wake (1000 to 2100) times were used to determine differences in nighttime and day time BP. Seated systolic BP (SBP) and diastolic BP (DBP), measured on the same days and according to JNC 7 guidelines were (geometric mean, 95% CI)120 (115, 125) and 82 ± 9 mm Hg, respectively. Baseline ambulatory SBP and DBP were 123 ± 9 and 75 ± 7 mm Hg, respectively. No treatment effects were observed for ambulatory SBP (AAD: 120 ± 7, ALD: 119 ± 8, CHOC: 121 ± 8, CHOC + ALD: 121 ±8 mm Hg, main effect of treat P=0.22) or DBP (AAD: 73 ± 6, ALD: 73 ± 7, CHOC: 74 ± 7, CHOC+ALD: 74 ± 7 mm Hg, main effect of treat P=0.37). When daytime and night time ABP were examined separately, there were no treatment differences for night time SBP or DBP or daytime DBP (P>0.05). However, daytime SBP was lower(main effect of treat, P=0.02) with ALD (123 ± 7 mm Hg) compared to CHOC (127 ±7 mm Hg), and AAD (124 ± 8 mm Hg) compared to CHOC, with no differences observed for CHOC+ALD (125 ± 8 mm Hg). Greater nighttime BP dipping, the ratio of nighttime to daytime SBP, is associated with lower CVD risk. In this population, there were no significant differences in BP dipping between groups(AAD: 12 ± 7, ALD: 13 ± 6, CHOC: 15 ± 7, CHOC+ALD: 11 ± 6 %, main effect oft reat P=0.057). These data suggest incorporating almonds in an average American diet decreases daytime SBP compared to a similar diet with cocoa/dark chocolate. However, when almonds were included in the diet with cocoa/dark chocolate(CHOC+ALD), daytime SBP was no longer elevated.Support or Funding InformationThis study was funded by The Almond Board of California and The Hershey Company.