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.”