Institute for Research and Education to Advance Community Health, Washington State University, Seattle, WA, United States.
Nutrition Department at University of California, Davis, Davis, CA, United States.
Front Public Health. 2023 Jun 2;11:1117824. doi: 10.3389/fpubh.2023.1117824. eCollection 2023.
INTRODUCTION: American Indian and Alaska Native (AI/AN) adults experience disproportionate cardiovascular disease (CVD) morbidity and mortality compared to other races, which may be partly attributable to higher burden of hypertension (HTN). Dietary Approaches to Stop Hypertension (DASH) is a high-impact therapeutic dietary intervention for primary and secondary prevention of CVD that can contribute to significant decreases in systolic blood pressure (BP). However, DASH-based interventions have not been tested with AI/AN adults, and unique social determinants of health warrant independent trials. This study will assess the effectiveness of a DASH-based intervention, called Native Opportunities to Stop Hypertension (NOSH), on systolic BP among AI/AN adults in three urban clinics. METHODS: NOSH is a randomized controlled trial to test the effectiveness of an adapted DASH intervention compared to a control condition. Participants will be aged ≥18 years old, self-identify as AI/AN, have physician-diagnosed HTN, and have elevated systolic BP (≥ 130 mmHg). The intervention includes eight weekly, tailored telenutrition counseling sessions with a registered dietitian on DASH eating goals. Intervention participants will be provided $30 weekly and will be encouraged to purchase DASH-aligned foods. Participants in the control group will receive printed educational materials with general information about a low-sodium diet and eight weekly $30 grocery orders. All participants will complete assessments at baseline, after the 8-week intervention, and again 12 weeks post-baseline. A sub-sample of intervention participants will complete an extended support pilot study with assessments at 6- and 9-months post-baseline. The primary outcome is systolic BP. Secondary outcomes include modifiable CVD risk factors, heart disease and stroke risk scores, and dietary intake. DISCUSSION: NOSH is among the first randomized controlled trials to test the impact of a diet-based intervention on HTN among urban AI/AN adults. If effective, NOSH has the potential to inform clinical strategies to reduce BP among AI/AN adults. CLINICAL TRIALS REGISTRATION: https://clinicaltrials.gov/ct2/show/NCT02796313, Identifier NCT02796313.
简介：与其他种族相比，美洲印第安人和阿拉斯加原住民（AI/AN）成年人的心血管疾病（CVD）发病率和死亡率不成比例，这可能部分归因于高血压（HTN）负担加重。“停止高血压的饮食方法”（DASH）是一种针对 CVD 的一级和二级预防的高影响力治疗性饮食干预措施，可显著降低收缩压（BP）。然而，尚未对 AI/AN 成年人进行基于 DASH 的干预试验，独特的健康社会决定因素需要独立的试验。本研究将评估一种基于 DASH 的干预措施，称为“停止高血压的原住民机会”（NOSH），对三所城市诊所中 AI/AN 成年人收缩压的有效性。 方法：NOSH 是一项随机对照试验，旨在测试经改编的 DASH 干预措施与对照条件相比的有效性。参与者年龄≥18 岁，自我认定为 AI/AN，经医生诊断患有 HTN，且收缩压升高（≥130mmHg）。该干预措施包括 8 次每周的电话营养咨询，由注册营养师针对 DASH 饮食目标进行咨询。干预组参与者将每周获得 30 美元，并鼓励其购买符合 DASH 标准的食物。对照组参与者将收到关于低盐饮食的一般信息的印刷教育材料和每周 8 次 30 美元的杂货订单。所有参与者将在基线、8 周干预后和基线后 12 周完成评估。干预组的一个亚样本将完成扩展支持试点研究，在基线后 6 个月和 9 个月进行评估。主要结果是收缩压。次要结果包括可改变的 CVD 风险因素、心脏病和中风风险评分以及饮食摄入量。 讨论：NOSH 是第一个测试基于饮食的干预措施对城市 AI/AN 成年人 HTN 影响的随机对照试验之一。如果有效，NOSH 有可能为减少 AI/AN 成年人的血压提供临床策略。 临床试验注册：https://clinicaltrials.gov/ct2/show/NCT02796313，标识符 NCT02796313。
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