Abstract
Although a Dietary Approaches to Stop Hypertension (DASH) eating plan has been shown to lower blood pressure (BP) in Black adults, this intervention has not been tested in individuals who were being actively treated for hypertension. In this study, we conducted a randomized clinical trial (GoFreshRx) to test whether local groceries ordered with the assistance of a dietitian to align with the DASH diet might lower BP among Black adult residents of Boston communities with few grocery stores who were being actively treated for hypertension. Individuals whose systolic blood pressure (SBP) was 120 mmHg to <150 mmHg despite active hypertension treatment were randomized either to 12 weeks of weekly home-delivered DASH groceries with dietitian counseling or to receiving three US$500 stipends every 4 weeks. The primary outcome was research clinic-measured SBP measured at 3 months. Secondary outcomes were diastolic blood pressure (DBP) and low-density lipoprotein cholesterol (LDL-c) levels. Maintenance of health effects was assessed at 3 months after the intervention. Of 176 participants (mean age 60.1 (s.d., 11.5) years; 80.7% female), 173 were available for SBP measurement at 3 months. Mean (s.d.) baseline SBP/DBP was 130.5 (7.0)/77.8 (8.9) mmHg. At 3 months, SBP changed by −7.0 mmHg in the DASH groceries group and by −2.0 mmHg in the self-directed group (intergroup difference: −5.0 mmHg; 95% confidence interval: −8.0 to −1.9; P = 0.002). Moreover, compared to the self-directed group, 3 months of DASH groceries changed DBP by −1.8 mmHg (−3.6 to −0.1) and LDL-c by −7.0 mg dl−1 (−13.6 to −0.5). In prespecified analyses, the beneficial effects of DASH grocery delivery on SBP and DBP were partially maintained 3 months after the intervention had concluded. Nutrient-targeted grocery ordering appears to be a useful strategy to improve longer-term cardiometabolic health. ClinicalTrials.gov registration: NCT05393232.
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Data availability
Requests for access to deidentified GoFreshRx data may be emailed with a research proposal to the corresponding author (sjurasch@bidmc.harvard.edu). GoFreshRx investigators will evaluate all proposals for scientific merit, and access will be granted after approval of the proposal and completion of a data transfer agreement. Data will be available approximately 1 year after the 12-month follow-up visits are completed (anticipated 1 June 2027). Review of requests may take up to 1 month.
Code availability
All analyses were performed using SAS version 9.4 software. Researchers interested in the analytical code may contact the corresponding author (sjurasch@bidmc.harvard.edu) and include the goals and rationale of their inquiry and analysis plans.
References
Pencina, M. J. et al. Quantifying importance of major risk factors for coronary heart disease. Circulation 139, 1603–1611 (2019).
Hardy, S. T. et al. Trends in blood pressure control among US adults with hypertension, 2013–2014 to 2021–2023. Am. J. Hypertens. 38, 120–128 (2024).
Sekkarie, A. Prevalence of self-reported hypertension and antihypertensive medication use among adults—United States, 2017–2021. MMWR Morb. Mortal. Wkly. Rep. 73, 191–198 (2024).
Brush, J. E. et al. Association between neighborhood-level social vulnerability and hypertension outcomes. JACC Adv. 4, 101912 (2025).
Howard, G. et al. Association of clinical and social factors with excess hypertension risk in black compared with white US adults. JAMA 320, 1338–1348 (2018).
Sacks, F. M. et al. Effects on blood pressure of reduced dietary sodium and the Dietary Approaches to Stop Hypertension (DASH) diet. DASH-Sodium Collaborative Research Group. N. Engl. J. Med. 344, 3–10 (2001).
Miller, E. R. et al. A dietary intervention in urban African Americans: results of the ‘Five Plus Nuts and Beans’ randomized trial. Am. J. Prev. Med. 50, 87–95 (2016).
Juraschek, S. P. et al. A randomized pilot study of DASH patterned groceries on serum urate in individuals with gout. Nutrients 13, 538 (2021).
Song, J. et al. Blood pressure–lowering medications, sodium reduction, and blood pressure. Hypertension 81, e149–e160 (2024).
Juraschek, S. P. et al. DASH-patterned groceries and effects on blood pressure: the GoFresh randomized clinical trial. JAMA 335, 36−48 (2026).
Vollmer, W. M. et al. Effects of diet and sodium intake on blood pressure: subgroup analysis of the DASH-sodium trial. Ann. Intern. Med. 135, 1019–1028 (2001).
Svetkey, L. P., McKeown, S. P. & Wilson, A. F. Heritability of salt sensitivity in black Americans. Hypertension 28, 854–858 (1996).
Elijovich, F., Kirabo, A. & Laffer, C. L. Salt sensitivity of blood pressure in black people: the need to sort out ancestry versus epigenetic versus social determinants of its causation. Hypertension 81, 456–467 (2024).
Kurtz, T. W., DiCarlo, S. E., Pravenec, M. & Morris, R. C. No evidence of racial disparities in blood pressure salt sensitivity when potassium intake exceeds levels recommended in the US dietary guidelines. Am. J. Physiol. Heart Circ. Physiol. 320, H1903–H1918 (2021).
Mozaffarian, D. Medically tailored groceries for blood pressure control: promise, progress, and need for optimal design. JAMA 335, 27–29 (2026).
Turkson-Ocran, R.-A. N. et al. Rationale and design of the Groceries for Black Residents of Boston to Stop Hypertension Among Adults Without Treated Hypertension (GoFresh) trial. Am. J. Hypertens. 36, 256–263 (2023).
Ferro, K. M. et al. Nutrition intervention of groceries for Black residents of Boston to stop hypertension (GoFresh) among adults with or without treated hypertension trial: rationale, design, and guiding domains. Trials 26, 560 (2025).
Neal, B. et al. Effect of salt substitution on cardiovascular events and death. N. Engl. J. Med. 385, 1067–1077 (2021).
Filippini, T. et al. Blood pressure effects of sodium reduction: dose-response meta-analysis of experimental studies. Circulation 143, 1542–1567 (2021).
Filippini, T. et al. Potassium intake and blood pressure: a dose-response meta-analysis of randomized controlled trials. J. Am. Heart Assoc. 9, e015719 (2020).
Welling, P. A. et al. Potassium-switch signaling pathway dictates acute blood pressure response to dietary potassium. Hypertension 81, 1044–1054 (2024).
Appel, L. J. et al. Effects of protein, monounsaturated fat, and carbohydrate intake on blood pressure and serum lipids: results of the OmniHeart randomized trial. JAMA 294, 2455–2464 (2005).
Estruch, R. et al. Primary prevention of cardiovascular disease with a mediterranean diet supplemented with extra-virgin olive oil or nuts. N. Engl. J. Med. 378, e34 (2018).
Massachusetts Food Trust Program. Massachusetts Public Health Alliance. https://mapublichealth.org/priorities/access-to-healthy-affordable-food/ma-food-trust-program/ (2016).
Massachusetts General Hospital. Community Health Needs Assessment Report 2022 https://www.massgeneral.org/assets/mgh/pdf/community-health/cchi/2022_chna_rreport.pdf (2022).
Malden Community Food Assessment Core Leadership Team. Malden Community Food Assessment, 2019−2021 https://www.massgeneral.org/assets/mgh/pdf/community-health/cchi/2022_chna_rreport.pdf (2021).
Harris, P. A. et al. Research electronic data capture (REDCap)—a metadata-driven methodology and workflow process for providing translational research informatics support. J. Biomed. Inform. 42, 377–381 (2009).
Harris, P. A. et al. The REDCap consortium: building an international community of software platform partners. J. Biomed. Inform. 95, 103208 (2019).
Frankenfield, D., Roth-Yousey, L. & Compher, C. Comparison of predictive equations for resting metabolic rate in healthy nonobese and obese adults: a systematic review. J. Am. Diet. Assoc. 105, 775–789 (2005).
National Heart, Lung, and Blood Institute. DASH Eating Plan https://www.nhlbi.nih.gov/health/dash-eating-plan (accessed 16 March 2026).
National Heart, Lung, and Blood Institute. Your Guide to Lowering Your Blood Pressure with DASH. https://www.nhlbi.nih.gov/files/docs/public/heart/new_dash.pdf (2006).
Pronk Technologies. SC-4 SimCube® NIBP Simulator. https://www.pronktech.com/product/sc-4-simcube-nibp-simulator/ (accessed 16 March 2026).
Subar, A. F. et al. Formative research of a quick list for an automated self-administered 24-hour dietary recall. J. Am. Diet. Assoc. 107, 1002–1007 (2007).
Subar, A. F. et al. The Automated Self-Administered 24-hour dietary recall (ASA24): a resource for researchers, clinicians, and educators from the National Cancer Institute. J. Acad. Nutr. Diet. 112, 1134–1137 (2012).
Folsom, A. R., Parker, E. D. & Harnack, L. J. Degree of concordance with DASH diet guidelines and incidence of hypertension and fatal cardiovascular disease. Am. J. Hypertens. 20, 225–232 (2007).
Block, G., Gillespie, C., Rosenbaum, E. H. & Jenson, C. A rapid food screener to assess fat and fruit and vegetable intake. Am. J. Prev. Med. 18, 284–288 (2000).
Block, G., Woods, M., Potosky, A. & Clifford, C. Validation of a self-administered diet history questionnaire using multiple diet records. J. Clin. Epidemiol. 43, 1327–1335 (1990).
Inker, L. A. et al. New creatinine- and cystatin C−Based equations to estimate GFR without race. N. Engl. J. Med. 385, 1737–1749 (2021).
Centers for Disease Control and Prevention/Agency for Toxic Substances and Disease Registry/Geospatial Research, Analysis, and Services Program. CDC/ATSDR Social Vulnerability Index https://www.atsdr.cdc.gov/place-health/php/svi/index.html (accessed 16 March 2026).
Wilson, R. & Din, A. Understanding and Enhancing the U.S. Department of Housing and Urban Development’s ZIP Code Crosswalk Files. https://doi.org/10.13016/M2VT1GT2K (2018).
Rana, B. K. et al. Imputing observed blood pressure for antihypertensive treatment: impact on population and genetic analyses. Am. J. Hypertens. 27, 828 (2014).
Muntner, P. et al. Age-specific prevalence and factors associated with normal blood pressure among US adults. Am. J. Hypertens. 35, 319–327 (2022).
Law, M. R., Morris, J. K. & Wald, N. J. Use of blood pressure lowering drugs in the prevention of cardiovascular disease: meta-analysis of 147 randomised trials in the context of expectations from prospective epidemiological studies. BMJ338, b1665 (2009).
Min, L. et al. A method to quantify mean hypertension treatment daily dose intensity using health care system data. JAMA Netw. Open 4, e2034059 (2021).
Acknowledgements
We are grateful to our community advisory board (A. Shyevitch, C. G. Sinclair, E. Avalon, E. Gaskin, J. Robinson, S. Vixama, S. Taylor and T. J. Marshall), our nutrition science advisory board (A. N. Williams, C. Msora Kasago, S. C. Couch and X. Liu), our data safety monitoring board (H.-C. Yeh (Chair), D. E. Wesson, K. Gauvreau and L. Brewer) and GoFresh chefs for their many contributions to the GoFresh trial. We thank our dedicated volunteers who participated in the trial and in its many assessments. We thank employees at the BIDMC Clinical Research Center and the Bowdoin Health Center for their contributions to the implementation of this trial.
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S.P.J., H.C. and R.B.D. had full access to all the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. S.P.J., E.R.M., K.J.M., K.M. and S.L.F. conceptualized and designed the study. S.P.J., H.C., K.F. and R.B.D. acquired, analyzed or interpreted the data. S.P.J., H.C. and R.B.D. carried out the statistical analysis. S.P.J., R.-A.N.T.-O., J.L.C. and K.J.M. provided administrative, technical or material support and supervised the study. S.P.J. drafted the manuscript. All authors critically revised the manuscript for important intellectual content.
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This trial was supported by R01MD016068. This work was conducted with support from the UM1TR004408 award. S.P.J. is supported by grants from the National Institutes of Health (NIH) and the American Heart Association. D.C.C. is supported by grants from the NIH and Somatus. R.-A.N.T.-O. is supported by National Heart, Lung, and Blood Institute 3R01HL158622-01S1.
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Juraschek, S.P., Col, H., Ferro, K. et al. DASH-patterned groceries and effects on blood pressure in adults treated for hypertension: the GoFreshRx randomized trial. Nat Med (2026). https://doi.org/10.1038/s41591-026-04319-4
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DOI: https://doi.org/10.1038/s41591-026-04319-4
