Diet Intervention for Hypertension: Adaptation and Dissemination to Native Communities

高血压饮食干预：适应和传播到原住民社区

• 批准号: 8849671
• 负责人: DEDRA S BUCHWALD
• 金额: $ 67.37万
• 依托单位: UNIVERSITY OF WASHINGTON
• 依托单位国家: 美国
• 财政年份: 2015
• 资助国家: 美国
• 起止时间: 2015-08-15 至 2015-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8849671
• 关键词: Address; Adult; African American; American Heart Association; American Indian and Alaska Native; American Indians; Attenuated; Awareness; Blood Pressure; Body Weight decreased; Cardiovascular Diseases; Caring; Cause of Death; Centers for Disease Control and Prevention (U.S.); Cessation of life; Cities; Clinic; Clinical; Communities; DASH diet; Data; Diabetes Mellitus; Diastolic blood pressure; Diet; Diet Habits; Dietary Intervention; Dietary Practices; Disease; Education; Educational Materials; Ethnic group; Event; Fat-Restricted Diet; Fatty acid glycerol esters; Food; Funding; Goals; Guidelines; Health Insurance; Health Services Accessibility; Healthcare; Healthy People 2020; Heart; Heart Diseases; Home environment; Household; Hypertension; Hypotension; Intake; Intervention; Intervention Studies; Lead; Life; Lipids; Maintenance; Measures; Metabolic syndrome; Minority; Morbidity - disease rate; National Heart, Lung, and Blood Institute; Neighborhoods; Non-Insulin-Dependent Diabetes Mellitus; Nuts; Observational Study; Oklahoma; Participant; Patients; Pharmaceutical Preparations; Pilot Projects; Population; Prevention; Primary Prevention; Printing; Probability; Public Health; Race; Randomized; Recruitment Activity; Reducing diet; Risk; Risk Factors; Running; Rural; Secondary Prevention; Site; Smoking; Sodium; Sodium Chloride; Solutions; Stroke; Surveys; Testing; Transportation; United States Indian Health Service; Urban Population; Washington; base; bean; blood pressure reduction; blood pressure regulation; cardiovascular disorder risk; cost effective; design; diabetic; dietary approach; disability; disorder prevention; experience; fruits and vegetables; good diet; high risk; hypertension control; improved; intima media; lifestyle intervention; meetings; mortality; novel; prevent; primary outcome; programs; public health relevance; racial disparity; randomized trial; reservation-based; salt intake; secondary outcome; success; urban Native American; urban area

 DESCRIPTION (provided by applicant): Hypertension, also called high blood pressure (BP), is a major risk factor for cardiovascular disease (CVD). Nearly one-third of all U.S. adults have hypertension, but only half of these cases are successfully controlled by medication or diet. The negative public health consequences are profound. American Indians (AIs) have disproportionate CVD morbidity and mortality, and they have higher burdens of hypertension, diabetes, and smoking than other races. Yet AIs are rarely represented in national studies on hypertension management. Most interventions targeting CVD have focused on reservation-based AIs, even though 71% of AIs live in urban areas. This urban population is an invisible minority, with high rates of disease and disability, and low rates of healthcare usage. Medication alone is suboptimal for controlling BP; a heart-healthy diet is preferable. Dietary Approaches to Stop Hypertension (DASH) is a high-impact lifestyle intervention for primary and secondary prevention of CVD that centers on a low-salt, low-fat diet emphasizing fresh fruits and vegetables. In a randomized trial, the DASH diet lowered systolic BP by 11.5 mm Hg in participants with clinical hypertension. However, the DASH diet never been tested in AIs. We therefore designed an 8-week DASH intervention to improve BP control in hypertensive urban AIs. Our American Indian Five Nuts and Beans Project (AI-5) includes culturally tailored DASH education that emphasizes low sodium intake, traditional Native foods, and maintaining healthy eating habits, plus a $30 weekly credit for home delivery of groceries that meet DASH guidelines. Home delivery is a creative solution to logistical barriers, such as limited access to fresh produce, that often deter residents of poor urban neighborhoods from maintaining a healthy diet. The control condition will receive printed educational materials and a $30 weekly credit for grocery delivery, with no purchasing restrictions. Our randomized trial will test AI-5 i a total of 400 adult AIs with inadequately controlled systolic BP (140-159 mmHg). We will recruit and randomize 200 participants from each of 2 urban clinics: one in Spokane, WA, the other in Oklahoma City, OK. Our primary outcome is systolic BP measured after the 8-week intervention and again 12 weeks later. Secondary outcomes are other modifiable CVD risk factors, risk scores for heart disease and stroke, and dietary habits. We will also conduct an embedded pilot study to inform future research on long-term sustainability and impact. Our Specific Aims are to: 1) evaluate the effect of the AI-5 intervention on BP and secondary outcomes in adult AIs with poorly controlled hypertension, and 2) conduct a pilot study among 100 intervention participants after the intervention concludes by randomizing half to receive 6 weeks of dietician support (pilot intervention) and the other half to receive no further support (pilot control). We will collect BP data at 6 and 9 months post-baseline. This approach will have important public health implications and will inform efforts to export interventions for CVD and hypertension to other urban and rural AI groups.

 描述（由申请人提供）：高血压，也称为高血压（BP），是心血管疾病（CVD）的主要危险因素。近三分之一的美国成年人患有高血压，但只有一半的病例通过药物或饮食成功控制。对公众健康的负面影响是深远的。美洲印第安人（AI）有不成比例的心血管疾病发病率和死亡率，他们有更高的高血压，糖尿病和吸烟的负担比其他种族。然而，在高血压管理的国家研究中，AI很少被代表。针对心血管疾病的大多数干预措施都集中在以保护区为基础的人工智能，尽管71%的人工智能生活在城市地区。这些城市人口是一个隐形的少数群体，患病率和残疾率高，医疗保健使用率低。单靠药物控制血压是不理想的;最好是心脏健康的饮食。DASH（Dietary Approaches to Stop Hypertension）是一种高影响力的生活方式干预措施，用于CVD的一级和二级预防，以低盐，低脂饮食为中心，强调新鲜水果和蔬菜。在一项随机试验中，DASH饮食使临床高血压患者的收缩压降低了11.5 mm Hg。然而，DASH饮食从未在AI中进行过测试。因此，我们设计了一个为期8周的DASH干预，以改善高血压城市AI的血压控制。我们的美国印第安人五种坚果和豆类项目（AI-5）包括文化定制的DASH教育，强调低钠摄入量，传统的本土食物，保持健康的饮食习惯，加上每周30美元的信用卡，用于满足DASH指南的杂货送货上门。送货上门是物流障碍的一种创造性解决方案，例如新鲜农产品的获取有限，这通常会阻止贫困城市社区的居民保持健康的饮食。控制条件将收到印刷的教育材料和每周30美元的食品杂货送货信贷，没有购买限制。我们的随机试验将在总共400例收缩压控制不佳（140-159 mmHg）的成人AI中测试AI-5。我们将从2个城市诊所招募并随机分配200名参与者：一个在华盛顿州的斯波坎，另一个在俄克拉荷马州的俄克拉荷马州。我们的主要结果是8周干预后测量的收缩压，12周后再次测量。次要结果是其他可改变的CVD风险因素，心脏病和中风的风险评分以及饮食习惯。我们还将进行一项嵌入式试点研究，为未来有关长期可持续性和影响的研究提供信息。我们的具体目标是：1）评估AI-5干预对高血压控制不佳的成人AI的BP和次要结局的影响，以及2）在干预结束后，在100名干预参与者中进行试点研究，其中一半随机接受6周的营养师支持（试点 干预），另一半不接受进一步的支持（试点控制）。我们将在基线后6个月和9个月收集BP数据。这种方法将对公共卫生产生重要影响，并将为向其他城市和农村AI群体输出心血管疾病和高血压干预措施提供信息。