Cardiovascular Diseases (CVDs) are the number one cause of death globally, as many people still their lives to deaths from CVDs than from any other cause. An estimated 17.9 million people died from CVDs in 2016, representing 31% of all global deaths. Out of these deaths, 85% are due to heart attack and stroke. Hypertension, also known as high or raised blood pressure is a global public health issue. It attributes to the burden of heart disease, stroke and kidney failure, premature mortality, and disability. It disproportionately affects the population in low and middle-income countries and is arising as a significant general wellbeing worry in developing countries like India . One of the worldwide focuses for noncommunicable diseases venture is to diminish the predominance of hypertension by 25% by 2025 (benchmark 2010) as hypertension has credited 19% of worldwide deaths.
Treating hypertension only reduces cardiovascular risk by 25% but treating increased cholesterol in hypertension clients reduces the residual cardiovascular risk for more than 35% as 61% to 65% of hypertensives are hypercholesterolemic. The relationship between serum cholesterol and high blood pressure will not only increase the risk of cardiovascular diseases but also indulges in the elevation of other critical significant modulation of blood glucose, electrolytes, and renal parameters. Hence it is mandatory to treat the hypertensive clients not only for the increased blood pressure but also the increased cholesterol, alterations in serum electrolytes, glucose levels, and renal parameters thereby decreasing the complications of heart attack, heart failure, stroke, aneurysm, and renal failure.
Chocolate is best known as an indulgent confection with its blessed ingredient of cocoa extracted from cocoa beans had varied beneficial effects on human life. Cocoa lowers the risk of cardiovascular diseases, rich in anti-oxidants improves endothelial function, thereby reducing the formation of atherosclerotic plaque in the coronary arteries, increases nitric oxide bioavailability and protects vascular endothelium, alleviates stress considerably, decreases body weight by reducing mesenteric white adipose tissue weight and serum triglycerides, increases the cerebral blood flow, reduces dementia, reduces blood glucose level and decreases the risk of stroke, inhibits lipoxygenase pathways, by directly binding to the active sites of the enzymes lipoxygenase and exhibits anti-inflammatory actions. Every 10 mmHg reduction in SBP significantly reduces the risk of major cardiovascular events, CHD, stroke, and heart failure, which leads to a significant 13% reduction in all-cause mortality. A recent meta-analysis of intervention studies looking at the BP-lowering effect of flavanol-rich cocoa found a significant reduction of 4.5 mm Hg for systolic BP (SBP) and 2.5 mm Hg for diastolic BP (DBP).
The diagnosis of hypertension and its co-morbidities continues to generate fear and turmoil in the lives of the families. It is widely advisable to take easily available, feasible measures to reduce the cardiovascular risk whereby the people voluntarily adopt them for their healthy life other than medications. As hypertension and other comorbidities go hand in hand, it is advisable to check the selected biochemical parameters of hypertension among the hypertensive clients to warn them of the hidden risk factors related to high blood pressure which eventually protect them from the hilarious evident cardiovascular struggles in their lifetime. Instead of taking treatment separately for all the possible cardiovascular risk factors of hypertension with high-cost medications, the researcher planned to render a single remedy for all these multiple risk factors. Cocoa products will play the role of this single remedy which by its consumption reduces all the notable risk factors and increases the health compliance of hypertensive clients.
Framingham risk scores of various studies had suggested that cocoa flavanols reduced the age-related risk of cardiovascular diseases. The bioavailability of the cocoa seemed to enlighten the endothelial function which encompassed the total hypertensive picture into a healthy cardiac outfit outranged by many meta-analysis studies. The objectives of the study were to compare the pretest and posttest levels of selected biochemical parameters of hypertension among clients with hypertension within and between the control and experimental category of clients to evaluate the effectiveness of cocoa powder.
The research work was performed between the months of July and December 2020 in a rural area, Vallam, Thanjavur District, Tamil Nadu. The cocoa powder was obtained by freshly compressed cocoa beans manufactured by The Lotus Chocolate Company Limited, Telangana, Hyderabad. The study protocol was approved by the Institutional Ethical Committee of Saveetha Medical College Hospital, Chennai. The target population of the selected rural area was screened by the investigator and the pilot study was carried out to substantiate the reliability, validity, and feasibility of the study.
Inclusion requirements for the research study included hypertensive clients with stage I hypertension (systolic 130-139 mm Hg and diastolic 80-89 mm Hg), stage II hypertension (systolic 140-179 mm Hg and diastolic 90-119 mm Hg), aged between 30 and 70 years, of both sexes, under regular hypertensive treatment, increased cholesterol levels and able to understand Tamil and English. Hypertensive clients who were pregnant, had other significant cardiovascular problems during the lactation period, were not willing to intervene, and were not available at the time of data collection were exempted from the research sample selection.
The data collection tool consisted of demographic variables and the observational schedule of selected biochemical hypertension parameters. Demographic variables comprised of age in years, gender, education, occupation, monthly income, religion, marital status, type of family, dietary habits, intake of fruits and vegetables daily, duration of hypertension, regular treatment, family background of hypertension, the habit of tobacco chewing, the habit of smoking, the habit of alcohol intake, abdominal obesity, amount of salt intake per day, history of daily physical activity and history of a stressful lifestyle. The observation schedule encompassed blood pressure and biochemical parameters (random blood sugar, total cholesterol, high-density lipoprotein, low-density lipoprotein, triglycerides, serum sodium, serum potassium, serum chloride, serum urea, serum creatinine, and serum uric acid).
After getting informed consent from the research participants, 2 ml of blood was taken for the biochemical investigations. The cocoa powder was given as 5 grams in 125 ml of water for each day in the first part of the prior day nourishment for ninety days along with their antihypertensive drugs after the pretest for the experimental group. Blinding was not done for cocoa administration. However, the person estimating the biochemical parameters was blinded from the study. The control group received the standard hypertensive pharmacologic treatment. The experimental clients were monitored for any side effects. On the 91st day, a posttest was done for the samples of both groups and the findings were recorded. The primary outcome of the study was a significant reduction in blood pressure, lipid profile, and blood glucose levels. The minimal significant reduction in serum sodium and renal parameters were recorded as a secondary outcome.
Finally, it is concluded that hypertension has multi-risk co-morbidities which when left unnoticed will ultimately end up with end-stage complications and cocoa powder has multi-beneficial cardio effects which will embrace all these risk factors to lead the hypertensive clients in a healthy platform of their lives. This research study can be replicated by applying the findings with large samples and with other underlined morbidities of cardiovascular diseases.