Translating Dietary Trials into the Community

描述（由申请人提供）：高血压（HTN）是心血管、脑血管和肾脏疾病的普遍危险因素，对非裔美国人（AA）的影响不成比例。虽然AA中HTN的知晓率和治疗率与非西班牙裔白人相似或超过非西班牙裔白人，但AA中HTN的控制仍然不足。随机临床试验已经证明了生活方式措施在降低血压方面的有效性，包括阻止高血压的饮食方法（DASH）饮食，可降低收缩压6-14 mmHg。DASH呼吁增加水果、蔬菜和低脂乳制品的消费，减少饱和脂肪和钠的摄入。有有限的证据表明，DASH已被公众广泛采用，来自低收入社区的AA可能不太能够采用目前传播的DASH，这是由于与收入，教育，对食物的态度，健康信念和社区健康食品的可用性有关的障碍。我们建议利用定量和定性研究技术（包括焦点小组和调查）来评估可能影响低收入AA社区DASH饮食翻译的环境，个人，人际和文化因素，然后利用收集的知识来适应现有的干预策略和工具。这些将为实施DASH饮食的随机三个月试点生活方式干预提供材料。40名受试者将年龄为21岁以上，患有前HTN或HTN，血压在120-150/80-95 mmHg之间，服用0、1或2种降压药，并且将是东温斯顿-塞勒姆（一个低收入地区，人口中65%为AA）的AA居民。我们将排除需要替代饮食和/或血压目标低于140/90的患者，包括糖尿病、心力衰竭、肾功能衰竭、病态肥胖（BMI>45）或体重极低（BMI<18.5）的患者。干预组（20人）将包括8个小组和2个单独的会议，并强调在早餐，午餐，晚餐，零食，无论是在家里还是外出就餐时，都采用DASH饮食模式。对照组（20人）将收到标准DASH和高血压信息讲义。试点的主要成果将是过程措施，包括参与和从基线开始的饮食变化。该项目将提供关键信息，支持开发以社区为基础的干预措施，促进采用DASH，DASH已被确定为HTN前和HTN患者的有效降血压策略。公共卫生相关性：DASH饮食富含水果，蔬菜和低脂乳制品，已知可降低成人血压。本研究项目旨在促进生活在低收入少数民族社区的高血压或高血压前期非裔美国成年人采用饮食方法来阻止高血压（DASH）饮食模式。

DESCRIPTION (provided by applicant): 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.