Abstract Body: Background: Despite the efficacy of the Dietary Approaches to Stop Hypertension (DASH) diet, adherence remains low due to barriers, including food access, affordability, lack of tailored support. We hypothesized that a Food is Medicine intervention combining produce prescriptions with personalized dietitian coaching would improve dietary quality in high-risk populations.

Methods: THRIVE was a 24-week, 2-arm randomized pilot feasibility trial conducted among Black and Hispanic adults with hypertension living in Healthy Food Priority Areas in Maryland (NCT06257550). Participants were randomized 1:1 to: (1) THRIVE intervention: $30/week produce prescription via “FARMacy” market + individualized DASH-aligned dietitian coaching + adaptive bi-directional text messaging + social resource navigation, or (2) Enhanced usual care (EUC): produce bags without coaching + social resource navigation. Outcome was a change in DASH adherence score (0-9 scale) via interviewer-administered 24-hour dietary recalls. Secondary outcomes included Healthy Eating Index (HEI 2015) total score, total fruit and vegetable intake assessed at 12 and 24 weeks. Intention-to-treat analyses were conducted using paired t-tests for within-group changes and difference-in-differences (DiD) for between-group tests.

Results: Among 80 randomized participants (40 per group): mean age 54.5±11.4 years, 57% female, 62% Black, 34% Hispanic. At 12 weeks, both groups had improvements in DASH adherence scores (THRIVE: +0.33, 95% CI: -0.77, 1.43; EUC: +0.68, 95% CI: 0.06, 1.30, p=0.033, Table 1). By 24 weeks, improvements persisted in both groups (THRIVE: +0.78; Control: +0.25), DiD of +0.53 (95% CI: -0.88 to 1.94, p=0.452). There were clinically meaningful gains in total HEI scores in the THRIVE group at 12 weeks (+10.63, 95% CI: 2.85 to 18.40, p=0.010, Table 2) compared with EUC (+3.61, 95% CI: -1.83 to 9.06, p=0.186). At 24 weeks, HEI improvements were sustained in THRIVE (+6.44) vs. minimal change in EUC (+0.11), with a DiD of +6.32 (95% CI: -3.73 to 16.37, p=0.212). Vegetable intake increased at 12 weeks in the EUC group (+0.63 cups, 95% CI: 0.15 to 1.11, p=0.012)

Conclusion: This pilot trial demonstrates the feasibility and promise of a multi-component Food is Medicine intervention to improve DASH diet adherence and overall diet quality among Black and Hispanic adults with hypertension. Preliminary results support the potential value of combining produce prescriptions with personalized nutrition support