Abstract Body (Do not enter title and authors here):
Background
Healthy diet is a central mediator of disparities in hypertension (HTN) and its cardiovascular sequelae among Black adults. The Dietary Approaches to Stop Hypertension (DASH) eating plan lowered blood pressure (BP) among Black adults in highly controlled settings; however, real-world interventions that address access to DASH groceries tailored to diverse family preferences are lacking.

Methods
The Groceries for Black Residents of Boston to Stop Hypertension (GoFresh) Trial was a randomized, parallel study conducted in Boston from August 2022 to September 2025. GoFresh enrolled Black adults, living in communities with few grocery stores (i.e., urban “food deserts”) with systolic BP (SBP) of 120 to <150 mmHg, diastolic BP (DBP) <100 mmHg, no active HTN treatment, and no diabetes. Participants were randomized to either (1) 12 weeks of home-delivered, DASH-patterned groceries, tailored to caloric needs and ordered weekly with dietitian counseling; or (2) 3 months of a $500 monthly stipend for self-directed grocery shopping. Participants were monitored for an additional 3 months after the end of the intervention to assess maintenance. The primary outcome was office SBP at 3-months. Adherence was assessed via 24-hr urine collection and 24-hr recall. Secondary outcomes included DBP, body mass index (BMI), hemoglobin A1c, and low density lipoprotein (LDL) cholesterol.

Results
Of 180 participants, 175 (97.2%) completed the primary outcome assessment. Mean age (SD) was 46 (13.3) years (56.7% female and 6.7% Hispanic) (Table 1). Mean (SD) baseline SBP and DBP were 130.1 (6.7) and 79.8 (8.1). At 3 months, SBP changed by -5.7 mmHg (95% CI: -7.4, -3.9) among the DASH group and -2.2 mmHg (-4.1, -0.4) among the self-directed group (difference of -3.4 mmHg; -6.0, -0.8; P=0.009; Figure 1A). Compared with the self-directed group, after 3 months DASH changed DBP by -2.4 mmHg (-4.2, -0.5) (Figure 1B), urine sodium by -530 mg/24 hr (-1030, -30), urine potassium by 164 mg/24 hr (-80, 409), and LDL-cholesterol by -8.0 mg/dL (-13.7, -2.2) (Table 2). Effects were not maintained post-intervention. No significant changes were seen in BMI or hemoglobin A1c.

Conclusions
Home-delivered, low sodium-DASH groceries and dietitian counseling, reduced SBP, DBP, and LDL-cholesterol beyond comparable monetary compensation among Black adults in communities with few grocery stores. Access to healthy groceries with nutrition services are essential for maintenance of these health benefits.