黄烷-3-醇对不同人群血压和内皮功能的影响：随机对照试验的系统评价和荟萃分析

Impact of flavan-3-ols on blood pressure and endothelial function in diverse populations: a systematic review and meta-analysis of randomised controlled trials.

作者信息

Lagou Vasiliki, Greyling Arno, Ferruzzi Mario, Skene Simon S, Dubost Joy, Demirkan Ayse, Prokopenko Inga, Shlisky Julie, Rodriguez-Mateos Ana, Heiss Christian

机构信息

Department of Clinical and Experimental Medicine, Faculty of Health and Medical Sciences, University of Surrey, Guildford, GU2 7XH, UK.

Unilever Food innovation Centre, Wageningen, the Netherlands.

出版信息

Eur J Prev Cardiol. 2025 Mar 24. doi: 10.1093/eurjpc/zwaf173.

DOI:10.1093/eurjpc/zwaf173

PMID:40126033

Abstract

BACKGROUND AND AIMS

Flavan-3-ols, found in cocoa, tea, and certain fruits, show promise in improving blood pressure (BP) and vascular function, but are currently not used for cardiovascular prevention. This meta-analysis evaluated the effects of flavan-3-ol-rich interventions on BP and endothelial function.

METHODS

PubMed was searched for randomized controlled trials (RCTs) published 1946-03/2024 on BP and flow-mediated dilation (FMD) after flavan-3-ol-rich food, beverage, or supplement intake. Random-effects meta-analysis of 109 publications including 145 RCTs and 5,205 participants was performed. (PROSPERO:CRD42023454691).

RESULTS

Flavan-3-ol interventions included epicatechin, epigallocatechin-gallate, cocoa products, tea, grape extract, and apples delivering 586 mg (95%CI 510,662) total flavan-3-ols. Interventions decreased office (-2.8 [95%CI -3.9, -1.7]/-2.0 [-2.6, -1.3] mmHg) and 24h-ambulatory BP (-3.7 [-5.8, -1.6]/-2.6 [-4.5, -0.8] mmHg) after chronic repetitive consumption. Effects were larger with elevated and hypertensive baseline BP or categorical hypertension (office: -5.9 [-10.0, -1.8]/-2.7 [-4.4, -1.0] mmHg, 24h-ABP: -6.8 [-16.3,2.8]/-5.1 [-12.5,2.2] mmHg). Meta-regression analysis confirmed that the magnitude of BP lowering was inversely related to baseline BP, but not to proportion of participants with CVD, diabetes mellitus, and study duration across all studies, and was dose-dependently related to epicatechin dose only in cocoa studies. FMD increased after acute (+2.0% [1.6,2.3]) and repetitive (+1.7% [1.3,2.2]) consumption independent of BP. Reported adverse events were minor and low (0.4%). The considerable heterogeneity of effect sizes (I2>50%) between studies was not explained by the investigated factors limiting the strength of evidence to 'moderate'.

CONCLUSIONS

Flavan-3-ol-rich foods considerably reduce elevated BP and improve endothelial function independent of blood pressure supporting their use for cardiovascular prevention.

摘要

背景与目的

黄烷-3-醇存在于可可、茶和某些水果中，在改善血压（BP）和血管功能方面显示出前景，但目前尚未用于心血管疾病的预防。本荟萃分析评估了富含黄烷-3-醇的干预措施对血压和内皮功能的影响。

方法

检索PubMed中1946年3月至2024年3月发表的关于摄入富含黄烷-3-醇的食物、饮料或补充剂后血压和血流介导的血管舒张（FMD）的随机对照试验（RCT）。对109篇文献进行随机效应荟萃分析，包括145项RCT和5205名参与者。（国际前瞻性系统评价注册库：CRD42023454691）。

结果

黄烷-3-醇干预措施包括表儿茶素、表没食子儿茶素没食子酸酯、可可制品、茶、葡萄提取物和苹果，提供586毫克（95%可信区间510,662）总黄烷-3-醇。长期重复食用后，干预措施可降低诊室血压（-2.8 [95%可信区间-3.9，-1.7] / -2.0 [-2.6，-1.3] mmHg）和24小时动态血压（-3.7 [-5.8，-1.6] / -2.6 [-4.5, -0.8] mmHg）。在基线血压升高和高血压或分类高血压患者中效果更大（诊室血压：-5.9 [-10.0，-1.8] / -2.7 [-4.4，-1.0] mmHg；24小时动态血压：-6.8 [-16.3,2.8] / -5.1 [-12.5,2.2] mmHg）。荟萃回归分析证实，血压降低幅度与基线血压呈负相关，但与所有研究中患有心血管疾病、糖尿病的参与者比例和研究持续时间无关，且仅在可可研究中与表儿茶素剂量呈剂量依赖性相关。急性（+2.0% [1.6,2.3]）和重复（+1.7% [1.3,2.2]）食用后，FMD增加，与血压无关。报告的不良事件轻微且发生率低（0.4%）。研究之间效应大小的显著异质性（I2>50%）无法通过所研究的因素来解释，这限制了证据强度为“中等”。