Black and Hispanic adults with high blood pressure (hypertension) who received a culturally tailored food-based intervention with dietitian coaching experienced a significant drop in blood pressure compared with those who received an equivalent amount of fresh produce without additional supports, according to a study presented at the American College of Cardiology's Annual Scientific Session (ACC.26).
The drop in blood pressure was double in people who had stronger overall adherence with the Dietary Approaches to Stop Hypertension (DASH) dietary pattern, which relies on fruits and vegetables, nuts, whole grains and lean proteins, while limiting salt, sugar, saturated fats and processed foods.
It's not enough to just tell people to change their dietary behaviors. We asked, what if we actually prescribe what they should eat, give it to them, coach them on how to prepare those foods in ways that reflect their culture and taste preferences, and then see whether they will be more likely to sustain the change going forward?"
Oluwabunmi Ogungbe, PhD, assistant professor in the Johns Hopkins School of Nursing and Johns Hopkins Bloomberg School of Public Health in Baltimore and the study's lead author
Nearly half of U.S. adults have hypertension, which damages blood vessels and contributes to the development of heart disease. Diet is a key modifiable factor for reducing heart disease risk, but many Americans with hypertension struggle to adopt a heart-healthy, low-sodium diet. In recent years, programs that aim to make it easier for patients to sustain healthy diets, known as "food-is-medicine" strategies, have expanded, but there is a lack of evidence regarding how best to implement them.
"We already know there is efficacy; we're not testing something completely new. But we're trying to see how we can situate this within clinics and the community," Ogungbe said. "Our study demonstrates that this is feasible; we can find ways to integrate this into the health system, and we can do it in a way that truly meets people where they are."
The researchers conducted a pilot trial involving 80 adults with hypertension living in Maryland communities where it can be difficult to obtain fresh produce. Participants were 55 years old, on average; 62% of participants were Black and 34% were Hispanic. Before starting the trial, researchers worked with members of the target communities to co-design the food-is-medicine program aligning their needs and preferences with the program components.
Half of the study participants were randomly assigned to receive the co-designed, multipronged food-is-medicine intervention. The other half (controls) received a standard weekly bag of produce of equivalent value ($30) along with basic nutrition messages. Researchers assessed participants' blood pressure at baseline and after 24 weeks.
Participants in the intervention group met with a dietitian every other week for one-on-one sessions to discuss meal planning and strategies to support a heart-healthy diet. The sessions were adapted to participants' individual needs, and when possible, participants were matched with a dietitian from their own cultural background, a strategy that emerged from the co-design process. In contrast to the control group, who received produce bags via a weekly delivery, participants in the intervention group picked up their produce bags from a mobile farm stand, where they were able to request substitutions to suit their tastes. In addition, they received messages optimized with artificial intelligence to provide encouragement and feedback on heart-healthy eating.
At the end of the 24-week trial, participants in the intervention group saw a significantly greater reduction in systolic blood pressure, which was lower by 6.8 mm Hg, on average, compared with a reduction of just 0.3 mm Hg among controls. The average drop in systolic blood pressure was even greater—an average reduction of 13.3 mm Hg—among participants in the intervention group who also had high adherence to the DASH diet. This level of change exceeds the improvements seen with some blood pressure-lowering medications, although researchers said that a larger study would help confirm the findings.
"This information is really actionable for clinicians, because they can tell patients, your blood pressure is more likely to be lowered if you have the right support in place—the ability to access and afford healthy foods, the confidence to cook with them, culturally aligned guidance from someone who understands your background, and consistent encouragement along the way," Ogungbe said. "And, at the policy level, there is a lot of interest in the states and among insurers, who want to know if there is evidence that food-is-medicine actually works and how they can implement it. So, this study is helpful for adding to that evidence."
The study results demonstrate how a multi-pronged, culturally tailored intervention can be effective and feasible for making a heart-healthy diet more attainable. However, as a pilot study, the research is limited by its relatively small sample size, limited statistical power and geographic range. Additional larger studies could help to illuminate the broader feasibility of the approach, the appropriate length of time for the intervention to continue to yield sustained benefits, applicability in different communities and countries, relevance for particular patient groups and cost effectiveness. Ogungbe also said that food-based interventions can complement pharmacologic therapies but are not a replacement for the use of blood pressure-lowering medications when appropriate.
For more information on heart healthy diets, visit www.CardioSmart.org/EatBetter.
The study was funded by the American Heart Association's Healthcare by Food initiative.
Ogungbe will present the study, "Effects of a Food-is-Medicine Intervention on Blood Pressure Among Black and Hispanic Adults with Hypertension in Healthy Food Priority Areas: The Thrive Pilot Trial," on Monday, March 30, at 8:30 a.m. CT / 13:30 UTC in the Main Tent, Great Hall.
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