Miller Edgar R, Cooper Lisa A, Carson Kathryn A, Wang Nae-Yuh, Appel Lawrence J, Gayles Debra, Charleston Jeanne, White Karen, You Na, Weng Yingjie, Martin-Daniels Michelle, Bates-Hopkins Barbara, Robb Inez, Franz Whitney K, Brown Emily L, Halbert Jennifer P, Albert Michael C, Dalcin Arlene T, Yeh Hsin-Chieh
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 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.
Am J Prev Med. 2016 Jan;50(1):87-95. doi: 10.1016/j.amepre.2015.06.010. Epub 2015 Aug 29.
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.
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.
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.
The primary outcome was blood pressure change. Analyses were conducted in January to October 2014.
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.
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.
不健康饮食（通常钾含量低）可能导致血压方面的种族差异。我们测试了为患有高血压的非裔美国成年人提供每周饮食建议、协助选择含钾量更高的食品杂货以及每周30美元食物津贴对血压和其他结果的有效性。
2012年5月至2013年11月期间，我们进行了一项为期8周的随机对照试验，设有两个平行组。
地点/参与者：我们从马里兰州巴尔的摩市的一家城市初级保健诊所随机选取了123名血压得到控制的非裔美国人，并与一家社区超市和巴尔的摩市卫生部门合作开展该试验。平均（标准差）年龄为58.6（9.5）岁；71%为女性；血压为131.3（14.7）/77.2（10.5）毫米汞柱；体重指数为34.5（8.2）；28%患有糖尿病。
随机分配到积极干预组（终止高血压膳食疗法[DASH]增强版）的参与者接受教练指导的饮食建议，并获得每周在线订购和购买高钾食物的协助（每周30美元），这些食物由一家社区超市送到附近图书馆。对照组的参与者收到一份印刷版的DASH饮食手册以及与DASH增强版组等值的借记卡账户。
主要结局是血压变化。分析于2014年1月至10月进行。
与对照组相比，DASH增强版组自我报告的水果和蔬菜摄入量增加（平均=1.4，95%置信区间=0.7，2.1份/天）；估计钾摄入量增加（平均=0.4，95%置信区间=0.1，0.7克/天）；尿钾排泄增加（平均=19%，95%置信区间=1%，38%）。对血压没有显著影响。
在社区诊所为血压得到控制的非裔美国高血压患者提供饮食建议、食品杂货订购协助以及每周30美元的高钾食物的项目，并未降低血压。然而，该干预措施增加了水果、蔬菜的摄入量以及尿钾排泄量。
