Effects of DASH Groceries on Blood Pressure in Black Residents of Urban Food Deserts

血压升高（BP）和高血压在美国猖獗，不成比例地影响了超过一半的美国人。 黑人成年人降低血压的干预措施可降低心血管疾病（CVD）、中风和早产儿的风险。 死亡DASH饮食是一种平衡的饮食计划，强调水果，蔬菜，低脂奶制品和瘦肉， 在黑人高血压患者中有效降低血压。然而，黑人成年人的吸收率很低。 事实上，不健康的饮食是黑人高血压管理差异的最重要决定因素。 成年人了尽管有许多教育倡议鼓励成年人每天吃7-9份水果， 社会经济地位较低的成年人对水果和蔬菜的平均消费量停滞不前 每天1.3份。城市“食物沙漠”的获取、成本和文化不和谐被认为是重要的 健康饮食的障碍。因此，迫切需要进行创新研究，以制定战略， 健康食品的消费，减少生活在城市食物沙漠中的黑人成年人的健康差距。 食品杂货配送方面的创新有可能克服大规模健康饮食的障碍。 规模随着大型技术型公司的出现，这些公司拥有前所未有的采购和交付能力， 能力，有可能克服传统的障碍，促进选择可口的健康食品 在城市黑人社区。然而，虚拟超市与送货上门是否可以 在城市食物沙漠中有效改善饮食和血压的杠杆从未被测试过。 我们将进行一项为期12周的个人水平的随机试验，以确定完全饮食对健康的影响。 用营养师虚拟订购的送货上门、低钠、DASH模式的杂货替代 援助.我们的提案代表了与服务于城市社区的社区诊所的伙伴关系， 在文化敏感的膳食准备和基于社区的参与性研究方面与领导人协商， 招募生活在当地城市食物沙漠中的黑人成年人，他们患有高血压或高血压。参加者将有 每周通过AmazonFresh自主选择自己的食品杂货，遵循食物分配模式， 根据DASH喂养计划，以超过其卡路里需求的量喂养各组。12周后，我们 将评估食品杂货对收缩压（主要结局）的影响，其次是对CVD风险因素的影响 （胆固醇）。我们的建议还包括8周的专门观察，以确定调解人的特点， 通过混合方法实现持续DASH依从性的障碍。 这项试验将建立一个可扩展的、以患者为导向的解决方案，克服健康食品的难获得性， 解决健康差距问题。从这项提案中获得的知识与美国食品的发展直接相关 邮票（SNAP）政策，以电子商务杂货，并将告知迭代创新的干预措施， 减少黑人成年人的饮食差异。最终，我们的建议实现了一个主要的战略优先事项， NIMHD的科学研究，以“开发和测试干预措施，以减少健康差距。”

Elevated blood pressure (BP) and hypertension are rampant in the US, disproportionately affecting over half of black adults. Interventions that lower BP reduce risk of cardiovascular disease (CVD), stroke, and premature death. The DASH diet, a balanced eating plan that emphasizes fruits, vegetables, low fat dairy, and lean meats, is efficacious in lowering BP among black adults with hypertension. However, uptake among black adults is poor. In fact, unhealthy diet is the most significant determinant of disparities in hypertension management among black adults. Despite numerous educational initiatives encouraging adults to eat 7-9 daily servings of fruits and vegetables, average consumption of fruits and vegetables by adults of lower socioeconomic status has stagnated at 1.3 servings daily. Access, cost, and cultural dissonance in urban "food deserts" have been cited as significant barriers to healthier eating. Thus, innovative research is urgently needed to devise strategies that improve consumption of healthy foods and reduce health disparities among black adults living in urban food deserts. Novel innovations in grocery delivery have the potential to overcome barriers to healthy eating on a massive scale. With the advent of large technology-based companies, which have unprecedented sourcing and delivery capabilities, it is possible to overcome traditional barriers and facilitate choice of palatable healthy foods throughout urban black communities. However, whether virtual supermarkets with home delivery can be leveraged to meaningfully improve diet and BP in an urban food desert has never been tested. We will perform a 12-week individual-level, randomized trial to determine the health effects of complete dietary replacement with home-delivered, low-sodium, DASH-pattern groceries ordered virtually with dietitian assistance. Our proposal represents a partnership with community clinics serving urban communities in consultation with leaders in culturally sensitive meal preparation and community-based participatory research to enroll black adults living in local urban food deserts with elevated BP or hypertension. Participants will have autonomy to choose their own groceries weekly through AmazonFresh, following a pattern that portions food groups according to the DASH feeding plan at an amount that exceeds their Calorie needs. After 12 weeks, we will assess the effects of the groceries on systolic BP (primary outcome) and secondarily on CVD risk factors (cholesterol). Our proposal also includes 8 weeks of dedicated observation to characterize facilitators and barriers of sustained DASH adherence via mixed methods. This trial will establish a scalable, patient-oriented solution that overcomes poor access to healthful foods and addresses health disparities. Knowledge to be gained from this proposal is directly relevant to evolving U.S. food stamp (SNAP) policy toward e-commence groceries and will inform iterative innovation on interventions that reduce dietary disparities among black adults. Ultimately, our proposal accomplishes a major strategic priority of the NIMHD for scientific research to “develop and test interventions to reduce health disparities.”