Identification eFigure 1. Study flow diagram showing the study selection process Records identified through database searching (n = 2452) Additional records identified through other sources (n = 16) Screening Records after duplicates removed (n = 2217) Records excluded (n = 2115) Records screened (n = 2217) Eligibility Full-text articles excluded (n = 88): Full-text articles assessed for eligibility (n = 102) Not overweight or obese adults (n=13) [1-13]; Not GT/GTE supplementation, or not GT/GTE alone (n=16) [14-29]; No data on blood pressure (n=25) [30-54]; Included Studies included in qualitative synthesis (n = 14) Not RCTs (n=5) [55-59]; Not placebo used as comparison (n=17) [60-76]; Other reasons (12): Studies included in quantitative synthesis (meta-analysis) (n = 14) — Duplicates (n=5) [77-81]; — Not oral GTE supplementation (n=1) [82]; — Intervention duration less than one week (n=6) [83-88]. 1 eFigure 2. Risk of bias summary: review authors’ judgements about each risk of bias domain for each included study. 2 eFigure 3. Risk of bias graph: review authors’ judgements about each risk of bias domain presented as percentages across all included studies. 3 eFigure 4. Funnel plot to assess publication bias for effect of GT or GTE on SBP among overweight and obese adults 4 eFigure 5. Funnel plot to assess publication bias for effect of GT or GTE on DBP among overweight and obese adults 5 eTable. Summary of findings for Green tea or green tea extract compared to placebo for Blood pressure among overweight and obese adults Patient or population: Overweight and obese adults Settings: Japan, China, Poland, Netherlands, UK, USA and Australia Intervention: Green tea (GT) or green tea extract (GTE) Comparison: Placebo Outcomes Illustrative comparative risks* (95% CI) Assumed risk Placebo Corresponding risk GT or GTE Relative effect (95% CI) No of Participants (studies) Quality of the Comments evidence (GRADE) The mean change in SBP Change in SBP1 Follow-up: 3 weeks in the placebo groups to 16 weeks ranged from 8 lower to 0.79 higher mmHg The mean change in SBP in the intervention groups was 1.42 lower (2.47 to 0.36 lower) mm Hg 971 (14 studies) ⊕⊕⊝⊝2,3 low The mean change in DBP Change in DBP4 Follow-up: 3 weeks in the placebo groups to 16 weeks ranged from 4.1 lower to 2 higher mmHg The mean change in DBP in the intervention groups was 1.25 lower (2.32 to 0.19 lower) mmHg 971 (14 studies) ⊕⊕⊝⊝2,3 low Quality of life See comment5 Follow-up: 8 weeks and 16 weeks, respectively See comment5 165 (2 study) See comment6 Adverse events See comment6 Follow-up: 3 weeks to 16 weeks See comment6 823 (11 studies) ⊕⊕⊕⊝ high The dropout rate in the placebo groups ranged from 0% to 26% 971 (14 studies) ⊕⊕⊕⊕ high The dropout rate in the placebo groups ranged from 0% to 18% Treatment discontinuation Follow-up: 3 weeks to 16 weeks See comment7 *The basis for the assumed risk (e.g. the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). CI: Confidence interval; GRADE Working Group grades of evidence High quality: Further research is very unlikely to change our confidence in the estimate of effect. Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate. Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate. Very low quality: We are very uncertain about the estimate. 1 SBP: systolic blood pressure; 2 High risk of bias of incomplete outcome data and blinding, and unclear risk of bias such as allocation concealment and the influence of funding; 6 3 Unexplained heterogeneity; 4 DBP: diastolic blood pressure; 5 Only Two studies included. No difference in the effect on quality of life in one trial, while a higher score was observed only on hedonic tone in another study; 6 No sufficient information retrieved; 7 No adverse events reported, or no significant difference found between intervention and placebo groups. 7 List of excluded studies 1. Miller RJ, Jackson KG, Dadd T, Mayes AE, Brown AL, Lovegrove JA, Minihane AM: The impact of the catechol-O-methyltransferase genotype on vascular function and blood pressure after acute green tea ingestion. Molecular nutrition & food research 2012, 56(6):966-975. 2. Widlansky ME, Hamburg NM, Anter E, Holbrook M, Kahn DF, Elliott JG, Keaney, Jr., J.F, Vita JA: Acute EGCG supplementation reverses endothelial dysfunction in patients with coronary artery disease. Journal of the American College of Nutrition 2007, 26(2):95-102. 3. Freese R, Basu S, Hietanen E, Nair J, Nakachi K, Bartsch H, Mutanen M: Green tea extract decreases plasma malondialdehyde concentration but does not affect other indicators of oxidative stress, nitric oxide production, or hemostatic factors during a high-linoleic acid diet in healthy females. European journal of nutrition 1999, 38(3):149-157. 4. Maron DJ, Lu GP, Cai NS, Wu ZG, Li YH, Chen H, Zhu JQ, Jin XJ, Wouters BC, Zhao J: Cholesterol-lowering effect of a theaflavin-enriched green tea extract: A randomized controlled trial. Archives of Internal Medicine 2003, 163(12):1448-1453. 5. McMullen MK, Whitehouse JM, Shine G, Towell A: Habitual coffee and tea drinkers experienced increases in blood pressure after consuming low to moderate doses of caffeine; these increases were larger upright than in the supine posture. Food & function 2011, 2(3-4):197-203. 6. Miyazaki R, Kotani K, Ayabe M, Tsuzaki K, Shimada J, Sakane N, Takase H, Ichikawa H, Yonei Y, Ishii K: Minor effects of green tea catechin supplementation on cardiovascular risk markers in active older people: A randomized controlled trial. Geriatrics and Gerontology International 2013, 13(3):622-629. 7. Nagaya N, Yamamoto H, Uematsu M, Itoh T, Nakagawa K, Miyazawa T, Kangawa K, Miyatake K: Green tea reverses endothelial dysfunction in healthy smokers. Heart (British Cardiac Society) 2004, 90(12):1485-1486. 8. Oyama J, Maeda T, Kouzuma K, Ochiai R, Tokimitsu I, Higuchi Y, Sugano M, Makino N: Green tea catechins improve human forearm endothelial dysfunction and have antiatherosclerotic effects in smokers. Circulation Journal 2010, 74(3):578-588. 9. Princen HM, van Duyvenvoorde W, Buytenhek R, Blonk C, Tijburg LB, Langius JA, Meinders AE, Pijl H: No effect of consumption of green and black tea on plasma lipid and antioxidant levels and on LDL oxidation in smokers. Arteriosclerosis, Thrombosis & Vascular Biology 1998, 18(5):833-841. 10. Young JF, Dragsted LO, Haraldsdottir J, Daneshvar B, Kall MA, Loft S, Nilsson L, Nielsen SE, Mayer B, Skibsted LH et al: Green tea extract only affects markers of oxidative status postprandially: Lasting antioxidant effect of flavonoid-free diet. British Journal of Nutrition 2002, 87(4):343-355. 11. van het Hof KH, de Boer HS, Wiseman SA, Lien N, Westrate JA, Tijburg LB: Consumption of green or black tea does not increase resistance of low-density lipoprotein to oxidation in humans. American Journal of Clinical Nutrition 1997, 66(5):1125-1132. 12. de Maat MP, Pijl H, Kluft C, Princen HM: Consumption of black and green tea had no effect on inflammation, haemostasis and endothelial markers in smoking healthy individuals. European journal of clinical nutrition 2000, 54(10):757-763. 13. Sugihara N, Kishimoto Y, Saita E, Toyozaki M, Taguchi C, Kobayashi M, Niino H, Sagesaka Y, Tani M, Kondo K: The effects of green tea catechin on ldl oxidation and endothelial function in healthy subjects. 20th International Congress of Nutrition Granada Spain 2013, 63:1603. 14. Kappus RM, Curry CD, McAnulty S, Welsh J, Morris D, Nieman DC, Soukup J, Collier SR: The effects of a multiflavonoid supplement on vascular and hemodynamic parameters following acute exercise. Oxidative medicine and cellular longevity 2011, 2011:210798. 8 15. Kutan Fenercioglu A, Saler T, Genc E, Sabuncu H, Altuntas Y: The effects of polyphenol-containing antioxidants on oxidative stress and lipid peroxidation in Type 2 diabetes mellitus without complications. Journal of endocrinological investigation 2010, 33(2):118-124. 16. 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Applied Physiology, Nutrition and Metabolism 2010, 35(5):607-616. 29. Arazi H, Samami N, Kheirkhah J, Taati B: The Effect of Three Weeks Green Tea Extract Consumption on Blood Pressure, Heart Rate Responses to a Single Bout Resistance Exercise in Hypertensive Women. High blood pressure & cardiovascular prevention : the official journal of the Italian Society of Hypertension 2014. 9 30. Crew KD, Ho KA, Brown P, Greenlee H, Bevers TB, Arun B, Sneige N, Hudis C, McArthur HL, Chang J et al: Effects of a green tea extract, Polyphenon E, on systemic biomarkers of growth factor signalling in women with hormone receptor-negative breast cancer. J Hum Nutr Diet 2014. 31. Garcia FA, Cornelison T, Nuno T, Greenspan DL, Byron JW, Hsu CH, Alberts DS, Chow HH: Results of a phase II randomized, double-blind, placebo-controlled trial of Polyphenon E in women with persistent high-risk HPV infection and low-grade cervical intraepithelial neoplasia. Gynecol Oncol 2014, 132(2):377-382. 32. 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Kristen AV, Lehrke S, Mereles D, Schnabel PA, Rocken C, Ehlermann P, Dengler TJ, Altland K, Katus HA: Green tea reduces left ventricular myocardial mass in patients with transthyretin amyloidosis. 10 Journal of Heart and Lung TransplantationConference: 31st Annual Meeting and Scientific Sessions of the International Society for Heart and Lung Transplantation, ISHLT San Diego, CA United StatesConference Start: 20110413 Conference End: 20110(TRUNCATED) 2011, 30(4 SUPPL. 1):S193. 43. Alexopoulos N, Vlachopoulos C, Baou K, Terentes-Printzios D, Aznaouridis K, Ioakeimidis N, Dima I, Stefanadis C: The short-term effect of tea consumption on aortic stiffness and wave reflections. American College of Cardiology 58th Annual Scientific Session and i2 Summit: Innovation in Intervention Orlando, FL United States 2009, 53(10):A442. 44. 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