Community-Based Dietary Approach for Hypertensive African Americans with Chronic Kidney Disease

 描述(由申请人提供)：与白人相比，非裔美国人(AA)受高血压和慢性肾脏疾病(CKD)的影响不成比例。种族差异在社会经济地位较低的人群中最为严重，饮食因素可能是造成这种差异的主要原因。与白人相比，SES低的美国人更有可能经历食物不安全和生活在“食物沙漠”中，并且不太可能遵循饮食方法来阻止高血压(DASH)一致的饮食。尽管有证据表明，坚持DASH饮食可能比白人对AAS的血压有更大的好处，而且有证据表明DASH饮食可能减缓CKD的进展(包括减少尿白蛋白排泄)。我们建议以我们的试点研究“五加坚果和豆类试验”令人鼓舞的结果为基础，该试验是约翰·霍普金斯大学的调查人员、一个社区超市、巴尔的摩市卫生局的“虚拟超市”计划、一个社区诊所和一个高度参与的社区咨询委员会之间的合作伙伴关系进行的。这项随机试验测试了一种饮食方法的效果，以增加DASH饮食的一个核心特征--高钾食物的摄入量。共有123名患有控制性高血压的AA患者从社区诊所招募，他们得到了个性化的饮食建议，杂货订购和送货方面的帮助，以及为期8周的每周30美元的高钾食物。通过这种方法，我们证明了水果、蔬菜、钾、镁和纤维的消费量在统计上显著增加，而钠的摄入量减少。此外，总体上尿白蛋白排泄量减少了14%，在登记时有显著白蛋白尿的患者减少了30%。在本申请中，我们建议对AAS进行更大规模(n=150)和更长时间(1年)的饮食干预试验。 高血压(控制或未控制)加上轻度/中度慢性肾脏病--这是一个饮食不佳的不良影响风险非常高的人群。在随机试验的背景下，主要目的是测试这样一种假设，即提供采用DASH饮食和30美元的营养建议 根据个人选择和社区诊所招募的患者在社区商店的供应情况，每周摄入相当于价值的富钾食物，将降低高血压和CKD患者的血压和尿白蛋白排泄量。我们建议的优势包括整合一支经验丰富、高度合作的调查团队，他们拥有临床试验、肾病、健康差距、社区参与性研究、将试验整合到初级保健实践和统计分析方面的专业知识。调查团队包括高度参与的社区咨询委员会，并与约翰霍普金斯社区医生、巴尔的摩市卫生局和当地超市建立了密切的合作伙伴关系。如果我们的假设是正确的，那么我们的试验将建立一种立即可翻译、廉价和安全的辅助治疗方法，用于治疗低SES AA中的高血压和肾脏损害(蛋白尿)。

 DESCRIPTION (provided by applicant): African Americans (AAs) are disproportionately affected by hypertension and chronic kidney disease (CKD) when compared to whites. Racial disparities are most profound among persons of low socioeconomic status (SES) and dietary factors likely underlie much of this disparity. Low SES AAs are more likely to experience food insecurity and live in "food deserts" and are less likely to follow a Dietary Approaches to Stop Hypertension (DASH) accordant diet than are whites. This is despite evidence that adherence to the DASH diet may have greater blood pressure benefit for AAs than whites, and evidence that the DASH diet may slow CKD progression (including reductions in urine albumin excretion). We propose to build upon encouraging results of our pilot study, "The Five-Plus Nuts and Beans Trial", which was conducted as a partnership between Johns Hopkins investigators, a community supermarket, the Baltimore City Health Department's "Virtual Supermarket" program, a community-based clinic and a highly engaged Community Advisory Board. This randomized trial tested the effects of a dietary approach to increase consumption of a central feature of the DASH diet--high potassium foods. A total of 123 AA patients with controlled hypertension, and recruited from a community-based clinic, were provided personalized dietary advice, assistance with grocery ordering and delivery, and $30 per week worth of high potassium foods for an 8-week period. With this approach, we demonstrated statistically significant increases in consumption of fruits, vegetables, potassium, magnesium and fiber, and decreases in sodium intake. Also, there was a 14% reduction in urinary albumin excretion overall, and a 30% reduction among patients with significant albuminuria at enrollment. In this application, we propose a larger (n=150) and longer (1 year) trial of a dietary intervention in AAs with hypertension (controlled or uncontrolled) plus mild/moderate CKD-a population at very high risk of the adverse effects of poor diets. The primary aim, in the setting of a randomized trial, is to test the hypothesis that delivery of nutritional advice to adopt the DASH diet and $30 per week worth of potassium-rich foods, tailored to personal choices and availability in neighborhood stores of patients recruited from community-based clinics, will reduce blood pressure and reduce urinary albumin excretion in low SES AAs with hypertension and CKD. Strengths of our proposal include the integration of an experienced, highly collaborative team of investigators with expertise in clinical trials, nephrology, health disparities, community-based participatory research, integration of trials into primary care practices, and statistical analyses The investigation team includes a highly involved Community Advisory Board, and has an established close partnership with Johns Hopkins Community Physicians, the Baltimore City Health Department and local supermarkets. If our hypothesis is correct, then our trial will establish an immediately translatable, inexpensive, and safe approach for adjuvant therapy in the treatment of hypertension and kidney damage (albuminuria) among low SES AAs.