African Americans with Uncontrolled Hypertension Often Lack Healthy Foods

Many African Americans with uncontrolled hypertension do not have recommended food choices in their homes. They also often do not have adequate discussions with their doctors about diet, especially the Dietary Approaches to Stop Hypertension (DASH) diet, according to findings from two studies presented at ASN Kidney Week 2015.

The DASH diet is recommended for the treatment of hypertension, especially among African Americans.

To assess barriers to following the DASH diet, Deidra Crews, MD, ScM, FASN, of Johns Hopkins University School of Medicine and her colleagues conducted interviews and inspected the homes of 159 African Americans with uncontrolled hypertension living in Baltimore, MD. They found that those with chronic kidney disease (CKD) were less likely to have fresh fruits than those with normal kidney function and that young African Americans were less likely to have plant proteins available. Those who were both young and with lower incomes were less likely to have whole grains in their homes.

Overall, only 14.5% of patients had all 5 of the DASH food categories in their homes (fruits, vegetables, low-fat dairy, whole grains, and plant proteins).

Beyond looking at food availability, Crews and her team also looked at the homes’ capacity for preparing adequate meals. While more than 80% had full-sized ovens and refrigerators to allow for DASH meal preparation, low health literacy was associated with a lower likelihood of having these appliances.

“The homes of urban African Americans with risk factors for chronic kidney disease were often lacking either the foods or needed appliances for preparing DASH diet–accordant meals,” said Dr. Crews. “Interventions to improve the dietary quality of this high-risk group should consider these factors.”

Dr. Crews and her colleagues also looked at how often diet discussions occurred among primary care physicians and African Americans with uncontrolled hypertension at increased risk for CKD.

For this study, the investigators audio-recorded 127 patients’ routine visits with their primary care physicians at the first visit following study enrollment. Diet was discussed in 73% of visits, but only 12% of visits included discussion of the DASH diet. Discussions about diet were more likely to occur when the visits were longer, were centered on patient priorities, and were attended by patients with higher incomes.

“DASH Diet Accordant Foods in the Homes of Urban African Americans at Risk for CKD” (Abstract SA-PO711).

“Engaging Urban African Americans at Risk for CKD in Discussions about their Diet” (Abstract SA-PO715).