title: A Dietary Intervention in Urban African Americans: Results of the "Five Plus Nuts and Beans" Randomized Trial.
abstract: BACKGROUND
  Unhealthy diets, often low in potassium, likely contribute to racial disparities in blood pressure. We tested the effectiveness of providing weekly dietary advice, assistance with selection of higher potassium grocery items, and a $30 per week food allowance on blood pressure and other outcomes in African American adults with hypertension.
  
  
  METHODS
  We conducted an 8-week RCT with two parallel arms between May 2012 and November 2013.
  
  
  METHODS
  We randomized 123 African Americans with controlled hypertension from an urban primary care clinic in Baltimore, Maryland, and implemented the trial in partnership with a community supermarket and the Baltimore City Health Department. Mean (SD) age was 58.6 (9.5) years; 71% were female; blood pressure was 131.3 (14.7)/77.2 (10.5) mmHg; BMI was 34.5 (8.2); and 28% had diabetes.
  
  
  METHODS
  Participants randomized to the active intervention group (Dietary Approaches to Stop Hypertension [DASH]-Plus) received coach-directed dietary advice and assistance with weekly online ordering and purchasing of high-potassium foods ($30/week) delivered by a community supermarket to a neighborhood library. Participants in the control group received a printed DASH diet brochure along with a debit account of equivalent value to that of the DASH-Plus group.
  
  
  METHODS
  The primary outcome was blood pressure change. Analyses were conducted in January to October 2014.
  
  
  RESULTS
  Compared with the control group, the DASH-Plus group increased self-reported consumption of fruits and vegetables (mean=1.4, 95% CI=0.7, 2.1 servings/day); estimated intake of potassium (mean=0.4, 95% CI=0.1, 0.7 grams/day); and urine potassium excretion (mean=19%, 95% CI=1%, 38%). There was no significant effect on blood pressure.
  
  
  CONCLUSIONS
  A program providing dietary advice, assistance with grocery ordering, and $30/week of high-potassium foods in African American patients with controlled hypertension in a community-based clinic did not reduce BP. However, the intervention increased consumption of fruits, vegetables, and urinary excretion of potassium.
authors: Department of Medicine, The Johns Hopkins School of Medicine, Baltimore, Maryland; Johns Hopkins Center to Eliminate Cardiovascular Health Disparities, Johns Hopkins School of Medicine, Baltimore, Maryland; The Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University, Baltimore, Maryland. Electronic address: ermiller@jhmi.edu.
authors: Edgar R
authors: ER
authors: Miller
authors: Department of Medicine, The Johns Hopkins School of Medicine, Baltimore, Maryland; Johns Hopkins Center to Eliminate Cardiovascular Health Disparities, Johns Hopkins School of Medicine, Baltimore, Maryland; The Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University, Baltimore, Maryland.
authors: Lisa A
authors: LA
authors: Cooper
authors: Department of Medicine, The Johns Hopkins School of Medicine, Baltimore, Maryland; Johns Hopkins Center to Eliminate Cardiovascular Health Disparities, Johns Hopkins School of Medicine, Baltimore, Maryland; The Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University, Baltimore, Maryland; Department of Epidemiology, The Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.
authors: Kathryn A
authors: KA
authors: Carson
authors: Department of Medicine, The Johns Hopkins School of Medicine, Baltimore, Maryland; Johns Hopkins Center to Eliminate Cardiovascular Health Disparities, Johns Hopkins School of Medicine, Baltimore, Maryland; The Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University, Baltimore, Maryland.
authors: Nae-Yuh
authors: NY
authors: Wang
authors: Department of Medicine, The Johns Hopkins School of Medicine, Baltimore, Maryland; Johns Hopkins Center to Eliminate Cardiovascular Health Disparities, Johns Hopkins School of Medicine, Baltimore, Maryland; The Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University, Baltimore, Maryland.
authors: Lawrence J
authors: LJ
authors: Appel
authors: Department of Medicine, The Johns Hopkins School of Medicine, Baltimore, Maryland; Johns Hopkins Center to Eliminate Cardiovascular Health Disparities, Johns Hopkins School of Medicine, Baltimore, Maryland.
authors: Debra
authors: D
authors: Gayles
authors: Department of Medicine, The Johns Hopkins School of Medicine, Baltimore, Maryland; Johns Hopkins Center to Eliminate Cardiovascular Health Disparities, Johns Hopkins School of Medicine, Baltimore, Maryland.
authors: Jeanne
authors: J
authors: Charleston
authors: Department of Medicine, The Johns Hopkins School of Medicine, Baltimore, Maryland.
authors: Karen
authors: K
authors: White
authors: School of Mathematics and Computational Science, Sun Yat-sen University, Guangzhou, China.
authors: Na
authors: N
authors: You
authors: Department of Epidemiology, The Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.
authors: Yingjie
authors: Y
authors: Weng
authors: Department of Medicine, The Johns Hopkins School of Medicine, Baltimore, Maryland; Johns Hopkins Center to Eliminate Cardiovascular Health Disparities, Johns Hopkins School of Medicine, Baltimore, Maryland.
authors: Michelle
authors: M
authors: Martin-Daniels
authors: Department of Medicine, The Johns Hopkins School of Medicine, Baltimore, Maryland; Johns Hopkins Center to Eliminate Cardiovascular Health Disparities, Johns Hopkins School of Medicine, Baltimore, Maryland.
authors: Barbara
authors: B
authors: Bates-Hopkins
authors: Johns Hopkins Center to Eliminate Cardiovascular Health Disparities, Johns Hopkins School of Medicine, Baltimore, Maryland.
authors: Inez
authors: I
authors: Robb
authors: Department of Medicine, The Johns Hopkins School of Medicine, Baltimore, Maryland.
authors: Whitney K
authors: WK
authors: Franz
authors: Department of Medicine, The Johns Hopkins School of Medicine, Baltimore, Maryland.
authors: Emily L
authors: EL
authors: Brown
authors: Department of Medicine, The Johns Hopkins School of Medicine, Baltimore, Maryland; Johns Hopkins Center to Eliminate Cardiovascular Health Disparities, Johns Hopkins School of Medicine, Baltimore, Maryland.
authors: Jennifer P
authors: JP
authors: Halbert
authors: Department of Medicine, The Johns Hopkins School of Medicine, Baltimore, Maryland; Johns Hopkins Community Physicians, Johns Hopkins Medical Institutions, Baltimore, Maryland.
authors: Michael C
authors: MC
authors: Albert
authors: Department of Medicine, The Johns Hopkins School of Medicine, Baltimore, Maryland; The Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University, Baltimore, Maryland.
authors: Arlene T
authors: AT
authors: Dalcin
authors: Department of Medicine, The Johns Hopkins School of Medicine, Baltimore, Maryland; Johns Hopkins Center to Eliminate Cardiovascular Health Disparities, Johns Hopkins School of Medicine, Baltimore, Maryland; The Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University, Baltimore, Maryland; Department of Epidemiology, The Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.
authors: Hsin-Chieh
authors: HC
authors: Yeh
mesh_terms: D000328:Adult; D001741:Black or African American; D015142:Baltimore; D001794:Blood Pressure / Q000502:physiology*; D055812:Community-Based Participatory Research; D004032:Diet / Q000208:ethnology* / Q000379:methods; D005260:Female; D005638:Fruit; D054624:Health Status Disparities; D006801:Humans; D006973:Hypertension / Q000178:diet therapy / Q000208:ethnology; D008297:Male; D008875:Middle Aged; D009754:Nuts; D014505:Urban Population; D014675:Vegetables