Edgar R Miller1, Lisa A Cooper2, Kathryn A Carson3, Nae-Yuh Wang2, Lawrence J Appel2, Debra Gayles4, Jeanne Charleston4, Karen White5, Na You6, Yingjie Weng7, Michelle Martin-Daniels4, Barbara Bates-Hopkins4, Inez Robb8, Whitney K Franz5, Emily L Brown5, Jennifer P Halbert4, Michael C Albert9, Arlene T Dalcin10, Hsin-Chieh Yeh3. 1. Department of Medicine, The Johns Hopkins School of Medicine, Baltimore, Maryland; Johns Hopkins Center to Eliminate Cardiovascular Health Disparities, Johns Hopkins School of Medicine, Baltimore, Maryland; The Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University, Baltimore, Maryland. Electronic address: ermiller@jhmi.edu. 2. Department of Medicine, The Johns Hopkins School of Medicine, Baltimore, Maryland; Johns Hopkins Center to Eliminate Cardiovascular Health Disparities, Johns Hopkins School of Medicine, Baltimore, Maryland; The Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University, Baltimore, Maryland. 3. Department of Medicine, The Johns Hopkins School of Medicine, Baltimore, Maryland; Johns Hopkins Center to Eliminate Cardiovascular Health Disparities, Johns Hopkins School of Medicine, Baltimore, Maryland; The Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University, Baltimore, Maryland; Department of Epidemiology, The Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland. 4. Department of Medicine, The Johns Hopkins School of Medicine, Baltimore, Maryland; Johns Hopkins Center to Eliminate Cardiovascular Health Disparities, Johns Hopkins School of Medicine, Baltimore, Maryland. 5. Department of Medicine, The Johns Hopkins School of Medicine, Baltimore, Maryland. 6. School of Mathematics and Computational Science, Sun Yat-sen University, Guangzhou, China. 7. Department of Epidemiology, The Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland. 8. Johns Hopkins Center to Eliminate Cardiovascular Health Disparities, Johns Hopkins School of Medicine, Baltimore, Maryland. 9. Department of Medicine, The Johns Hopkins School of Medicine, Baltimore, Maryland; Johns Hopkins Community Physicians, Johns Hopkins Medical Institutions, Baltimore, Maryland. 10. Department of Medicine, The Johns Hopkins School of Medicine, Baltimore, Maryland; The Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University, Baltimore, Maryland.
Abstract
INTRODUCTION: Unhealthy diets, often low in potassium, likely contribute to racial disparities in blood pressure. We tested the effectiveness of providing weekly dietary advice, assistance with selection of higher potassium grocery items, and a $30 per week food allowance on blood pressure and other outcomes in African American adults with hypertension. DESIGN: We conducted an 8-week RCT with two parallel arms between May 2012 and November 2013. SETTING/PARTICIPANTS: We randomized 123 African Americans with controlled hypertension from an urban primary care clinic in Baltimore, Maryland, and implemented the trial in partnership with a community supermarket and the Baltimore City Health Department. Mean (SD) age was 58.6 (9.5) years; 71% were female; blood pressure was 131.3 (14.7)/77.2 (10.5) mmHg; BMI was 34.5 (8.2); and 28% had diabetes. INTERVENTION: Participants randomized to the active intervention group (Dietary Approaches to Stop Hypertension [DASH]-Plus) received coach-directed dietary advice and assistance with weekly online ordering and purchasing of high-potassium foods ($30/week) delivered by a community supermarket to a neighborhood library. Participants in the control group received a printed DASH diet brochure along with a debit account of equivalent value to that of the DASH-Plus group. MAIN OUTCOME MEASURES: The primary outcome was blood pressure change. Analyses were conducted in January to October 2014. RESULTS: Compared with the control group, the DASH-Plus group increased self-reported consumption of fruits and vegetables (mean=1.4, 95% CI=0.7, 2.1 servings/day); estimated intake of potassium (mean=0.4, 95% CI=0.1, 0.7 grams/day); and urine potassium excretion (mean=19%, 95% CI=1%, 38%). There was no significant effect on blood pressure. CONCLUSIONS: A program providing dietary advice, assistance with grocery ordering, and $30/week of high-potassium foods in African American patients with controlled hypertension in a community-based clinic did not reduce BP. However, the intervention increased consumption of fruits, vegetables, and urinary excretion of potassium.
RCT Entities:
INTRODUCTION: Unhealthy diets, often low in potassium, likely contribute to racial disparities in blood pressure. We tested the effectiveness of providing weekly dietary advice, assistance with selection of higher potassium grocery items, and a $30 per week food allowance on blood pressure and other outcomes in African American adults with hypertension. DESIGN: We conducted an 8-week RCT with two parallel arms between May 2012 and November 2013. SETTING/PARTICIPANTS: We randomized 123 African Americans with controlled hypertension from an urban primary care clinic in Baltimore, Maryland, and implemented the trial in partnership with a community supermarket and the Baltimore City Health Department. Mean (SD) age was 58.6 (9.5) years; 71% were female; blood pressure was 131.3 (14.7)/77.2 (10.5) mmHg; BMI was 34.5 (8.2); and 28% had diabetes. INTERVENTION: Participants randomized to the active intervention group (Dietary Approaches to Stop Hypertension [DASH]-Plus) received coach-directed dietary advice and assistance with weekly online ordering and purchasing of high-potassium foods ($30/week) delivered by a community supermarket to a neighborhood library. Participants in the control group received a printed DASH diet brochure along with a debit account of equivalent value to that of the DASH-Plus group. MAIN OUTCOME MEASURES: The primary outcome was blood pressure change. Analyses were conducted in January to October 2014. RESULTS: Compared with the control group, the DASH-Plus group increased self-reported consumption of fruits and vegetables (mean=1.4, 95% CI=0.7, 2.1 servings/day); estimated intake of potassium (mean=0.4, 95% CI=0.1, 0.7 grams/day); and urine potassium excretion (mean=19%, 95% CI=1%, 38%). There was no significant effect on blood pressure. CONCLUSIONS: A program providing dietary advice, assistance with grocery ordering, and $30/week of high-potassium foods in African American patients with controlled hypertension in a community-based clinic did not reduce BP. However, the intervention increased consumption of fruits, vegetables, and urinary excretion of potassium.
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