Hailey Miller, postdoctoral associate, is the leading author of "The Nourish Protocol: A digital health randomized controlled trial to promote the DASH eating pattern among adults with hypertension" in "Contemporary Clinical Trials" with Megan Freed, research program leader, Cherie N. Barnes, dietician clinician, Qing Yang, associate professor, and Dori Steinberg, consulting associate. Other Duke co-authors include Miriam B. Berger, Sandy Askew, Melissa C. Kay, Meghana Sai Iragavarapu and Mia de Leon, of Global Digital Health Science Center, Christina M. Hopkins and Gary G. Bennett, of Global Digital Health Science Center and Department of Psychology and Neuroscience, and Crystal C. Tyson and Laura P. Svetkey with Duke School of Medicine. 

Abstract

Introduction

Over 100 million adults in the United States have hypertension. The DASH (Dietary Approaches to Stop Hypertension) eating pattern is an evidence-based first-line treatment option for hypertension; however, adherence to the DASH eating pattern at a population level remains low. To address this gap, we will implement Nourish, a randomized controlled efficacy trial that will leverage a commercially-available smartphone application and evidence-based behavior change principles to improve adherence to the DASH eating pattern among adults with hypertension.

Methods

The Nourish trial is a two-arm, 12-month randomized control trial that will enroll adults (N = 300) with hypertension, defined as a systolic blood pressure of 120–159 mmHg; a diastolic blood pressure of 80–99 mmHg; and/or adults on blood pressure-lowering medication. Nourish will test the efficacy of a digital health intervention, as compared to the attention control arm, on DASH eating pattern adherence and blood pressure. Intervention components will include skills training, self-monitoring, personalized feedback, and responsive coaching. The primary outcome of the trial is 6-month changes in adherence to the DASH eating pattern, as measured by 24-h dietary recalls.

Discussion

Millions of Americans remain in need of effective behavioral interventions to manage and improve their hypertension and its adverse consequences. The ubiquity of smartphones offers a promising approach to disseminate the DASH eating pattern. By leveraging these widely used smartphone applications, combined with evidence-based behavior change principles and the DASH eating plan, Nourish will demonstrate the effectiveness of a digital health intervention to improve DASH adherence and ultimately, to reduce blood pressure.