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.
African Americans are disproportionately affected by hypertension and kidney disease in the United States, and these disparities are particularly apparent among socioeconomically disadvantaged African Americans. Limited availability of healthy foods and unhealthy diets likely contribute to these disparities. In this community-based randomized clinical trial, we will test whether delivering nutritional advice to adopt the Dietary Approaches to Stop Hypertension (DASH) diet and $30 per week worth of fruits and vegetables, tailored to personal choices and availability in neighborhood stores, will reduce blood pressure and kidney damage in socioeconomically disadvantaged African Americans with hypertension and chronic kidney disease.
