Medically Tailored Groceries for Blood Pressure Control

The concept of "food is medicine" has gained momentum as a strategy to integrate foodbased nutritional interventions into healthcare as a therapy to manage and treat chronic diseases.1,2 Yet despite its intuitive appeal and growing healthcare, public, and policy interest, the field remains limited by a paucity of randomized controlled trials that evaluate real-world implementation and clinical outcomes.1,2 In this issue of JAMA, the GoFresh trial by Juraschek et al. represents an important contribution to the evidence base, testing whether home-delivered groceries patterned after the Dietary Approaches to Stop Hypertension (DASH) diet can improve blood pressure among Black adults living in "food desert" neighborhoods.3 In this randomized, parallel-arm trial, 180 Black adults with elevated systolic blood pressure (SBP, 120-150 mmHg) and not receiving anti-hypertensive medications were assigned to either three months of home-delivered DASH-patterned groceries with dietitian counseling or a $500 monthly stipend for self-directed grocery shopping.The DASH groceries were designed to provide the full dietary needs of each household and achieve calorie and nutrient targets including a potassium/sodium ratio above 2.0 and saturated fat intake less than 7% of energy.The primary outcome was change in office SBP at 3 months, with secondary outcomes including diastolic blood pressure (DBP), LDL cholesterol, body mass index (BMI), and dietary adherence.At three months, the DASH group achieved greater reduction in SBP (-5.7 mmHg) compared to the self-directed group (-2.2 mmHg), with a between-group difference of -3.4 mmHg (P=0.009).DBP and LDL cholesterol also declined more in the DASH group.These effects were not sustained at six months, three months after the grocery deliveries ended.Notably, the SBP reduction was larger among adults age 65+ years (between-group difference: -12.7 mmHg), consistent with the known age-related sensitivity of BP effects of dietary sodium, 4 but was not significantly different among those with higher or lower baseline SBP, perhaps owing to the relatively narrow range of SBP eligibility criteria.While the GoFresh trial demonstrates that medically tailored groceries (MTG) can reduce SBP, several design limitations raise questions about internal validity, costs, and external relevance.