World Hypertension Day: Reminder to increase consumption of flavanol-rich cocoa

Friday, May 17, 2024, is World Hypertension Day. I will use materials from the World Hypertension League (WHL) and the European Society of Cardiology (ESC). 

This year’s theme is “Measure your blood pressure accurately, control it, live longer”. Raised blood pressure (BP) is the biggest single contributing risk factor to altered global health (WHO 2023), and one of the world’s leading risk factors for death and disability.

The number of people living with hypertension doubled between 1990 and 2019, from 650 million to 1.3 billion. Hypertension is an important public health problem that leads to stroke, heart attack, heart failure, kidney damage and many other health problems.

In particular, high systolic blood pressure was the single most important risk factor for early death worldwide, leading to an estimated 10.8 million avoidable deaths every year, and a burden of 235 million years of life lost or lived with a disability annually. 

High BP has enormous economic costs for patients and their families, health systems and national economies. World Hypertension Day raises attention to the importance of better hypertension control.

Its purpose is to communicate to the public the importance of hypertension and its serious medical complications and to provide information on its prevention, detection and management.

World Hypertension League (WHL) 

Hypertension is the leading preventable risk factor for cardiovascular diseases and disability globally. In low- and middle-income countries, hypertension has a major social impact, increasing the disease burden and costs for national health systems.

In recent years, a significant increase in BP levels has been observed in LMICs, where only one in three are aware of their hypertensive condition, and only roughly eight per cent have their BP controlled.

The growth of this health burden has a major impact not only on mortality rates, but also on relevant social issues, contributing to widening the health equity gap, and importantly increasing the cost of health care for national health systems.

The present call to action aims to stimulate all African countries to adopt several solutions for better hypertension management. The following three goals should be achieved in Africa by 2030: (1) 80 per cent of adults with high blood pressure in Africa are diagnosed; (2) 80 per cent of diagnosed hypertensives, that is, 64 per cent of all hypertensives, are treated; and (3) 80 per cent of treated hypertensive patients are controlled.

To achieve these aims, the WHL called on individuals and organisations from government, private sector, health care and civil society in Africa and indeed on all Africans to undertake a few specific high-priority actions.

The aim is to improve the detection, diagnosis, management and control of hypertension, now considered to be the leading preventable killer in Africa. 

Hypertension

More than one in four adults in Ghana have hypertension. Hypertension is among the leading causes of admissions and deaths in Ghana. It was the third leading cause of admission and the leading cause of death, accounting for 4.7 per cent of the total admissions and 15.3 per cent of the total deaths in Ghana in 2017.

Hypertension is a common cause of medical emergencies such as heart failure and renal failure in Ghana. It is the main determinant of stroke in Ghana. Among the elderly patients aged 60 years or less involved in a prospective study in Ghana, the risk of incident stroke increased with increasing levels of blood pressure (BP) with 0 stroke events/100py for BP <120/80 mmHg (Bosu et al. (2021) Prevalence, awareness and control of hypertension in Ghana: A systematic review and meta-analysis. PLoS ONE 16(3): e0248137. https://doi.org/10.1371/journal. pone.0248137). 

According to the Ghana Demographic and Health Survey (GDHS) in 2014, hypertension has a prevalence of 13 per cent among adults with, 40.5 per cent on treatment and only 23.8 per cent of hypertension under control.

The May Measurement Month (MMM) initiative was adopted by a group of healthcare professionals in Ghana for early detection and appropriate management to prevent complications.

The MMM initiative, led by the International Society of Hypertension (ISH) and endorsed by the World Hypertension League (WHL), aims to screen one per cent of the population in each participating country for hypertension. 

A Dietary Approaches to Stop Hypertension (DASH) eating plan is designed to help one manage blood pressure. Emphasising healthy food sources, it also limits the intake of red meat, sodium (salt), sweets, added sugars and sugar-containing beverages, encouraging fruits, vegetables, whole grains, fish, poultry and low-fat dairy products. 

Flavanol-rich cocoa

Arterial hypertension is a major modifiable risk factor for cardiovascular and cerebrovascular disease. 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. Consumption of flavanol-rich cocoa is beneficial in lowering BP both in healthy subjects and patients with cardiovascular risk factors.

A reduction of 5mm Hg in systolic BP decreases the risk of cardiovascular events by about 20 per cent over five years (Martin et al. Cocoa flavanols and impact on human health. Food and Chemical Toxicology 151 (2021). 

Kuna Indians

The interest in the effect of cocoa on blood pressure (BP) started with the discovery that an island population in Central America, the Kuna Indians, had a distinctively low rate of hypertension, coupled with a consistently healthy low blood pressure unaffected by age.

The majority of the Kuna Indians live on the San Blas Island off Panama (population approximately 35,000); those Kuna Indians who migrated to the mainland had a higher prevalence of hypertension, as well as an age-dependent rise in blood pressure, implying that lifestyle factors such as diet rather than genetics play a protective role.

Island-dwelling Kuna Indians consume about three to four cups of cocoa drinks on average per day while the mainland-dwelling Kuna Indians consume up to 10 times less cocoa.

The mean blood pressure of the island-dwelling adult Kuna Indians hovers around 110 mmHg systolic and 70 mmHg diastolic while on the mainland the observed age-related rise in blood pressure and prevalence of hypertension is comparable with that of Western populations (Hollenberg et al. Flavavols, The Kuna, Cocoa Consumption, Nitric Oxide.

Am Soc Hypertens. 2009 Mar-Apr; 3(2): 10.1016/j. jash2008.11.001). Consume flavanol-rich cocoa every day and reduce your risk of hypertension. 

The writer is the Chief Pharmacist at Cocoa Clinic