Abstract
BackgroundOver 100 million individuals have high blood pressure, and more than half of them are women. The Dietary Approaches to Stop Hypertension (DASH) dietary pattern is a proven lifestyle approach to lower blood pressure, yet population-level adherence is poor. Innovative strategies that promote DASH are needed.ObjectiveThis paper aims to improve adherence to the DASH diet among women with hypertension or prehypertension.MethodsWe conducted a 3-month randomized controlled feasibility trial comparing app-based diet tracking (active comparator) to app-based diet tracking plus feedback on DASH adherence via text message (intervention). The intervention platform extracted nutrient data from the app, compared it to DASH recommendations, and sent tailored feedback text messages. Outcomes included the number of days participants tracked their diet, changes in their DASH adherence score, and blood pressure.ResultsThe women (N=59) had a mean age of 49.9 (SD 11.9) years and were primarily non-Hispanic White (41/59, 69%) and college educated (49/59, 83%). The mean baseline DASH score was 2.3 (SD 1.3). At 3 months, the intervention and active comparator participants had similar mean days tracked per week (4.2, SD 2.1 days vs 4.6, SD 2.7 days; P=.54) and mean changes in their DASH score (0.8, 95% CI 0.2-1.5 vs 0.8, 95% CI 0.4-1.2; P=.75). Intervention participants had lower systolic (mean difference: –2.8 mmHg, 95% CI –1.8 to 7.4; P=.23) and diastolic (mean difference: –3.6 mmHg, 95% CI –0.2 to 7.3; P=.07) blood pressure compared with active comparator participants. Most intervention participants (23/29, 79%) said they would recommend the DASH Cloud intervention to a friend or family member. However, only 34% (10/59) indicated that the feedback text messages helped them reach their diet goals.ConclusionsA digital health intervention to improve DASH adherence is feasible and produces moderately high engagement among women with elevated blood pressure. The intervention did not enhance DASH adherence over diet tracking alone but resulted in greater reductions in blood pressure. Larger studies are needed to determine how digital health interventions can improve population-level adherence to DASH.Trial RegistrationClinicalTrials.gov NCT03215472; https://clinicaltrials.gov/ct2/show/study/NCT03215472
Highlights
More than 100 million Americans have high blood pressure [1], the primary risk factor for heart disease and stroke, which are two of the leading causes of death in the United States [2]
At 3 months, the intervention and active comparator participants had similar mean days tracked per week (4.2, SD 2.1 days vs 4.6, SD 2.7 days; P=.54) and mean changes in their Dietary Approaches to Stop Hypertension (DASH) score (0.8, 95% CI 0.2-1.5 vs 0.8, 95% CI 0.4-1.2; P=.75)
The Consolidated Standards of Reporting Trials DASH (CONSORT) (Consolidated Standards of Reporting Trials) diagram (Figure 2) shows the study flow for both recruitment and retention; 422 individuals filled out the screening on the DASH Cloud website, and 363 of those individuals were ineligible, declined participation, or did not complete baseline activities
Summary
More than 100 million Americans have high blood pressure [1], the primary risk factor for heart disease and stroke, which are two of the leading causes of death in the United States [2]. In 2017, the American Heart Association implemented new guidelines for the detection, prevention, and treatment of high blood pressure [3] These guidelines lowered the thresholds for what is considered an optimal blood pressure, which resulted in about 30 million more Americans requiring treatment for high blood pressure, including 13 million more women [1,3,4]. Many of these women, present with atypical risk factors for high blood pressure and may not receive the treatment they need [5].
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