Food-as-Medicine Intervention Signals BP Benefit in High-Risk Adults

A more intensive “food-is-medicine” intervention didn’t improve diet quality overall but did signal blood pressure reductions in adherent, high-risk adults with uncontrolled hypertension, a randomized pilot trial showed.

In the trial’s population of Black and Hispanic adults living in food deserts, the intervention providing produce and tailored dietary coaching didn’t significantly improve DASH (Dietary Approaches to Stop Hypertension) score compared with a group only getting free fruits and vegetables, with a 0.5-point difference between groups on the 0-9 point scale (P=0.452) by week 24, reported Elohor Oborevwori, MD, MPH, of the Johns Hopkins School of Nursing in Baltimore.

However, the secondary endpoint of systolic blood pressure change over 24 weeks fell significantly more with the intervention in the subset of individuals with high DASH adherence (-13.3 mm Hg, P=0.010, vs +2.0 mm Hg with enhanced usual care), she said at the National Kidney Foundation’s Spring Clinical Meeting.

The THRIVE program utilized a multi-faceted approach:

• Weekly $35 produce prescriptions with optional home delivery
• Tailored DASH coaching from dietitians with curated recipes
• Adaptive bidirectional text messages and links to social resources

The “enhanced usual care” group received bags of produce and the same social resource links, but without the tailored coaching or prescriptions.

“Hypertension is the number one modifiable risk factor for cardiovascular disease and CKD [chronic kidney disease], which affects 1 in 2 adults in the U.S.,” said Oborevwori. She emphasized that the condition disproportionately impacts Black adults, who have a prevalence of 59% and face compounding risks like food insecurity and gaps in culturally concordant care.

The data bolster the argument for integrating nutritional support into cardiovascular prevention, she added.

These findings align with a broader food-as-medicine movement to expand the role of nutrition in clinical practice. “Poor nutrition is the top cause of death and disability in the United States … causing more harm than tobacco use, alcohol, physical inactivity, and air pollution,” said Dariush Mozaffarian, MD, DrPH, director of the Food is Medicine Institute at Tufts University in Boston, at a Senate subcommittee hearing on the matter in 2024.

Meanwhile, the DASH diet consistently ranks as one a top diet, focusing on heart-health by emphasizing whole foods like vegetables, fruits, whole grains, and lean protein and restricting sodium, sugar, and saturated fats. Beyond hypertension reduction, the DASH diet has been tied to lower risks for death and cognitive decline.

However, adherence remains a hurdle, especially for lower-resourced individuals. A similar trial last year reported systolic blood pressure reductions when DASH-style groceries were delivered to Black adults residing in “food deserts,” though blood pressure rebounded after the intervention ended.

The THRIVE trial recruited 80 participants from churches, food distribution centers, and clinics who were living in food deserts around Maryland.

The cohort comprised 62% Black participants, with an average age of 54, and 57% were female. Most (76%) had stage 1 (130/80-139/89 mm Hg) or stage 2 hypertension (>140/90 mm Hg), about 90% had overweight or obesity, and average HbA1c was 5.8%.

The population faced significant socioeconomic barriers: 36% were food-insecure, one-third lacked health insurance, and 70% earned less than $50,000 annually.

“Almost 90% were foreign-born,” Oborevwori pointed out. This is very important in understanding how to tailor culturally-appropriate food to their specific backgrounds, she said.

Evidence of dietary change tended to be reflected in biomarkers, as the urine sodium-to-potassium ratio was numerically but not significantly lower with the intervention at 24 weeks. Prior data have shown a higher sodium-to-potassium excretion ratio is associated with increased risk of subsequent cardiovascular disease.

At baseline, half of participants had a DASH score — assessed by 24-hour dietary recall — below 4.5. The average score was 3.8 out of 9. By the end of 24 weeks, the average rose to 4.1 in the THRIVE group.

A key finding emerged when researchers looked at “DASH readiness,” or how likely a participant was to adhere to the diet based on their baseline habits. Those with higher baseline DASH scores (>4.5) reaped greater blood pressure improvements from the intervention (-13.3 vs +2.0 mm Hg with usual care), while those with low baseline adherence had only modest reductions (-2.4 vs -1.1 mm Hg with usual care).

This suggests that while produce prescriptions help, existing access to healthy food and a baseline “readiness” to change are major predictors of success. Oborevwori noted that these results support a future, fully-powered randomized controlled trial that accounts for these baseline readiness factors.

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