Modifying Dietary Behavior in Adolescents with Elevated Blood Pressure

描述(申请人提供)：青少年高血压不再是一种罕见的疾病，随着美国儿童肥胖症的流行，受影响的儿童和青少年的数量正在增加。高血压从青春期一直跟踪到成年，并与成人不良心血管事件的临床前指标有关。需要及早进行预防和干预努力，以解决这一日益严重的公共和个人健康问题。我们研究组的初步研究表明，强调高水果、蔬菜和低脂乳制品、低脂肪和低钠饮食(DASH饮食)的行为营养干预对降低青少年血压(BP)具有良好的短期效果。本研究的目的是通过对比常规营养护理干预对血压升高的青少年饮食质量、血压、高血压状况和血管功能的改变，来检验改进的24周临床行为营养干预(DASH-4青少年干预)对改善饮食质量、血压、高血压状态和血管功能的长期效果。这项研究的主要目标有两个：1)确定干预对饮食摄入量、血压、高血压状况和血管功能的影响，以及在治疗后和1年的随访中；2)检查干预依从性与饮食、血压和血管结果的关系。确诊为高血压前期和1期高血压的青少年将被随机分配到接受DASH-4青少年干预或常规营养护理的组。DASH-4-青少年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个人面对面咨询会议，指导方针与国家高血压教育计划第四份儿科报告一致。主要结果将在6个月(治疗后)和1年随访两种情况下进行评估。对治疗的依从性将通过与饮食相关的目标的实现、咨询会议的出勤率以及电话和食物监测的完成情况来衡量。这些发现有望改善临床环境下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。 简介：高血压可以对年轻人的心脏和血管系统产生有害影响，但缺乏被证明有效的治疗策略来管理高血压和恢复早期受损的心血管功能。迫切需要在制定有效和可推广的儿童高血压治疗方案方面取得进展。这项临床试验的积极结果可能会对未来的研究和治疗建议产生深远的影响，以便对控制原发性高血压进行早期干预。

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.