Modifying Dietary Behavior in Adolescents with Elevated Blood Pressure

描述（由申请人提供）：青少年高血压不再是一种罕见的疾病，随着美国儿童肥胖的流行，受影响的儿童和青少年的数量正在增长。高血压从青春期一直持续到成年，并且与成人不良心血管事件的临床前指标有关。需要作出早期预防和干预努力，以解决这一日益严重的公共和个人健康问题。我们研究小组的初步研究表明，行为营养干预强调高水果、蔬菜和低脂肪乳制品（低脂肪和低钠饮食）对降低青少年血压（BP）有很好的短期效果。本应用程序的目的是通过检查以DASH饮食（DASH-4- teens干预）为重点的改进的24周临床行为营养干预的长期效果，将其与常规营养护理干预相比较，以改变血压升高的青少年的饮食质量、血压、高血压状态和血管功能。本研究的主要目的有两个：1)确定干预对饮食摄入、血压、高血压状态和血管功能在治疗后立即和1年随访中的影响；2)检查干预依从性与饮食、血压和血管结局之间的关系。被诊断为高血压前期和1期高血压的青少年将被随机分配接受DASH-4-Teens干预或常规营养护理。DASH-4-Teens干预将包括个人面对面的营养咨询会议、行为咨询电话和邮件。常规营养护理将包括与国家高血压教育计划第四次儿科报告一致的指导方针的个人面对面咨询会议。在6个月（治疗后）和1年随访时测量两种情况的主要结果。治疗的依从性将通过饮食相关目标的实现、咨询会议的出席、电话和食物监测的完成来衡量。研究结果有望在临床环境中改善青少年高血压的治疗，并有助于提高这一人群的心血管健康。

DESCRIPTION (provided by applicant): Hypertension in youth is no longer a rare disease and the number of affected children and adolescents is growing with the evolving pediatric obesity epidemic in the US. Hypertension tracks from adolescence into adulthood and has been linked with preclinical indicators of adverse cardiovascular events in adults. Early prevention and intervention efforts are needed to address this increasing public and individual health problem. Preliminary studies from our research group demonstrate promising short-term effects of a behavioral nutrition intervention emphasizing a diet high in fruits, vegetables, and low fat dairy that is also low in fat and sodium (the DASH diet) on lowering blood pressure (BP) in adolescents. The purpose of this application is to extend these findings by examining the long term effects of an improved 24-week clinically-based behavioral nutrition intervention emphasizing the DASH diet (the DASH-4-Teens intervention) compared to routine nutrition care intervention on changing diet quality, BP, hypertension status, and vascular function in adolescents with elevated BP. The primary objectives of this study are two-fold: 1) to determine the impact of the intervention on dietary intake, BP, hypertension status, and vascular function immediately post-treatment and at 1 year follow-up, and 2) to examine the relationship between intervention adherence and diet, BP and vascular outcomes. Adolescents with diagnosed pre-hypertension and stage 1 hypertension will be randomly assigned to receive either the DASH-4-Teens intervention or routine nutrition care. The DASH-4-Teens intervention will include individual in-person nutrition counseling sessions, behavioral counseling telephone calls, and mailings. Routine nutrition care will include individual in-person counseling sessions on guidelines consistent with the Fourth Pediatric Report of the National High Blood Pressure Education Program. Primary outcomes will be measured in both conditions at 6 months (post-treatment) and at 1 year follow-up. Adherence to treatment will be measured as diet-related goals met, counseling session attendance, and telephone call and food monitoring completion. Findings are expected to improve the treatment of hypertensive adolescents in the clinical setting and contribute to the enhancement of the cardiovascular health of this population. Narrative: Hypertension can have deleterious effects on the cardiac and vascular systems in youth, yet there is a lack of proven effective treatment strategies for managing high blood pressure and restoring impaired cardiovascular function in early life. Strides in developing effective and generalizable treatment protocols for pediatric hypertension are urgently needed. A positive outcome from this clinical trial could have profound implications for future research and treatment recommendations for early intervention in managing primary hypertension.