Translating Dietary Trials into the Community
Hypertension (HTN) is a prevalent risk factor for cardiovascular, cerebrovascular, and renal disease, and disproportionately affects African Americans (AA). Although HTN awareness and treatment rates among AA are similar to, or exceed non-Hispanic whites, control of HTN among AAs remains inadequate. Randomized clinical trials have demonstrated the effectiveness of lifestyle measures in lowering BP, including the Dietary Approaches to Stop Hypertension (DASH) diet, which lowers systolic BP 6-14 mmHg. DASH calls for increased consumption of fruits, vegetables, and low fat dairy, and decreased saturated fat and sodium intake. There is limited evidence that DASH has been widely adopted by the public and AA from lower income communities may be less able to adopt DASH as currently disseminated due to barriers related to income, education, attitudes about foods, health beliefs, and neighborhood availability of healthier foods. We propose to utilize quantitative and qualitative research techniques (including focus groups and surveys) to assess environmental, intra-personal, interpersonal and cultural factors that could affect the translation of the DASH diet in a low-income AA community, then utilize the knowledge gathered to adapt existing intervention strategies and tools. These will provide the materials for a randomized three month pilot lifestyle intervention implementing the DASH diet. The 40 participants will be aged 21+ and have pre-HTN or HTN with blood pressure between 120-150/80-95 mmHg on 0,1 or 2 antihypertensive agents, and will be AA residents of Eastern Winston-Salem (a lower-income area whose population is 65 percent AA). We will exclude persons with a medical need for an alternative diet and/or a lower BP goal than 140/90, including persons with diabetes, heart failure, renal failure, morbid obesity (BMI>45) or those who are extremely underweight (BMI<18.5). The intervention arm (20 persons) will consist of 8 group and 2 individual sessions and emphasize the adoption of DASH diet pattern at breakfast, lunch, dinner, snacks, both at home and when dining out. The control arm (20 persons) will receive standard DASH and high blood pressure informational handouts. The primary outcomes of the pilot will be process measures, including participation and dietary change from baseline. This project will provide critical information supporting the development of a community-based intervention promoting the adoption of DASH, which has already been established to be an effective BP lowering strategy in persons with pre-HTN and HTN. Public Health Relevance: The DASH diet is rich in fruits, vegetables, and low fat dairy foods and is known to lower blood pressure in adults. This research project seeks to promote the adoption of the Dietary Approaches to Stop Hypertension (DASH) eating pattern by African American adults with hypertension or prehypertension living in a lower- income minority community.