THE ADAPT HYPERTENSION STUDY

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This subproject is one of many research subprojects utilizing the resources provided by a Center grant funded by NIH/NCRR. The subproject and investigator (PI) may have received primary funding from another NIH source, and thus could be represented in other CRISP entries. The institution listed is for the Center, which is not necessarily the institution for the investigator. Background and rationale: Hypertension is both more common and more severe in African-Americans compared with Whites. This racial health disparity must be addressed by interventions designed to improve hypertension control that will effectively target and engage African-American populations. The Dietary Approaches to Stop Hypertension (DASH) dietary pattern was proven to reduce hypertension in a randomized trial, and the effect was greatest for African-Americans. However, when translated into the real world, an effectiveness study of the DASH pattern revealed only modest blood pressure lowering benefit for African-Americans and no benefit for African American women, in particular. It is suspected that this failure of translation from clinical trial to routine may be partially explained by cultural issues not having been appropriately addressed; for example African-American traditional food preparation may make it more difficult to follow the DASH dietary pattern, as currently formulated. Furthermore, our scientific group believes that a culturally appropriate modification of the DASH pattern holds great promise. Using principles of formative analysis, we have developed a modified DASH dietary pattern intervention that is expected to be culturally appropriate for African-Americans. The primary aim for this study is to conduct a randomized, controlled trial to determine the effectiveness of the modified DASH dietary pattern in reducing blood pressure for a cohort of African-Americans with pre-hypertension or stage I hypertension compared to a usual care control group. The behavioral intervention based on the DASH diet will be delivered by trained interventionists in a group setting over a 6 month period. Study Question: We hypothesize that greater blood pressure reduction will be achieved using a culturally appropriate DASH diet intervention in a group of African-Americans with pre-hypertension to stage I hypertension compared to a usual care control group. This study has been designed to detect a reduction in blood pressure, net of the control group, of at least 5 mm Hg systolic and 3 mm Hg diastolic, requiring randomization of 60 persons into each study group over a 3.5 year period. Utilization of GCRC: To complete our study, we will require additional outpatient nursing resources for patient measurements and specimen collection and lab analysis. The nursing resources will be used for collection of blood for glucose, insulin, lipids, and 24-hour urine collections, and measurement of height, weight, waist circumference, and blood pressure. Measures of glucose, insulin, and lipids are used to estimate cardiovascular and metabolic disease risk. The 24-hour urine collection is used for estimating adherence to the prescribed dietary pattern. The physiology and metabolic core laboratory will be utilized for analysis of the blood specimens. Study population: 120 healthy African Americans 25 years of age or older Outcome measure: Primary outcomes are change in systolic and diastolic BP at 6 months. Secondary outcomes include changes in fruit, vegetable, dairy, and fat intake.