GoFreshRx, THRIVE Trials Show BP Benefits of ‘Food Is Medicine’

NEW ORLEANS, LA—Removing barriers to Dietary Approaches to Stop Hypertension (DASH)-patterned meals for patients and their families is associated with gains in BP control in Black adults with hypertension, two newly released studies suggest.

In GoFreshRx, patients who received a combination of fresh DASH-aligned grocery deliveries plus dietician counseling (intervention group) had a mean 7-mm Hg decrease in systolic BP at 3 months compared with a 2-mm Hg reduction in patients who received a comparable stipend to encourage purchasing DASH-friendly groceries (P = 0.002). They also saw greater reductions in diastolic blood pressure and LDL cholesterol.

In THRIVE, a pilot study that involved dietician coaching plus a produce prescription tailored to patients food preferences but in keeping with a DASH eating plan, the intervention was associated with a 3.3-mm Hg reduction in systolic BP at 12 weeks compared with a 2.2-mm Hg reduction in patients with who received a delivery of produce each week. Greater decreases were seen in patients in the intervention group who had high rates of DASH adherence.

Both studies were presented here at the American College of Cardiology 2026 Scientific Session. GoFreshRx was simultaneously published in Nature Medicine.

Stephen Juraschek, MD, PhD (Harvard T.H. Chan School of Public Health, Boston, MA), who led the GoFreshRx study, said patients were encouraged to cook at home, maintain a potassium/sodium ratio of 2:1 using the micronutrients of the groceries, reduce saturated fat to < 7% of all calories, and build their meals around fruits and vegetables, whole grains, lean meat, low-fat dairy, nuts, seeds, and legumes.

“Following these four principles with our dietician support, individuals were able to select grocery lists that they were able to share with up to five adults at dinnertime,” he said during a media briefing, adding that the BP changes seen in the study were partially sustained once the intervention ended.

“These findings highlight the potential of food delivery interventions to improve cardiometabolic health in urban Black communities actively treated for hypertension with limited grocery access, and we believe the maintenance is encouraging for potential cost-effectiveness over time,” Juraschek added.

Following the GoFreshRx presentation in a late-breaking trial session, Karen Aspry, MD (Brown University Health, Providence, RI), said that the durability of the effect on BP and the low attrition rate in the study are both impressive given how difficult “food as medicine” trials can be both to conduct and to show demonstrable effects of the intervention.

GoFreshRx Results

Juraschek and colleagues conducted the study in parallel with a sister study, GoFresh, which showed that while home-delivered, DASH-patterned groceries combined with dietitian counseling resulted in declines in BP in Black adults, those effects were not maintained once the intervention ended.

GoFreshRx included 176 hypertensive patients (mean age 60 years; 80% women) residing in Boston-area communities characterized by lower income and few grocery stores. At baseline, mean systolic BP on medication was 130 mm Hg, mean diastolic BP was 78 mm Hg. One-third of those randomized to the intervention group and 52% of those randomized to the grocery stipend group were taking two or more antihypertensives.

The intervention group ordered their groceries weekly with a dietician’s help and had them delivered to their home. The comparator group received $500 at weeks 4, 8, and 12, with no restriction on how it was spent. Both groups had follow-up visits at week 12 to assess primary and secondary outcomes and then entered maintenance phase with no delivered groceries, no stipend, and minimal contact with the study team. In-person follow-up was conducted again at 6 months.

Between 12 weeks and 6 months, the intervention group maintained a lower systolic BP than the comparator group, with a median difference of 4.4 mm Hg, as well as lower diastolic BP, with a median difference of 2.1 mm Hg.

Juraschek emphasized that the intervention was not intended to encourage weight loss. Overall adherence to the DASH diet was high, as measured by both urine and 24-hour dietary recall. More than 98% of those in the intervention group reported enjoying the groceries they received and 95.2% said they felt DASH was easy to understand.

As for why this intervention helped patients maintain the BP benefits after it ended, while GoFresh did not, Juraschek noted that the GoFreshRx population were all actively on antihypertensives, which may have meant they were more motivated to make changes than patients not on medication. He said it’s also likely that the GoFreshRx patients had more feedback than those in GoFresh, either through high rates of home BP monitoring or BP management surveillance by their healthcare teams.

THRIVE

The THRIVE study, conducted in Maryland and led by Oluwabunmi Ogungbe, PhD (Johns Hopkins School of Nursing, Baltimore), included 80 participants (mean age 54 years; 57% women) with hypertension who lived in areas where it can be difficult to find fresh produce.

More than 60% of patients identified as Black/African American and 34% were Hispanic. About 70% had a household income under $50,000 per year, 31% had no health insurance, and 36% were food insecure. Approximately 75% of participants had stage 1 or 2 hypertension, 90% were overweight or obese, and the mean HbA1c was 5.8%. On the DASH diet score of 0 to 10, with higher scores indicating good concordance, half of participants had a DASH score of < 4.5 at baseline.

Study participants randomized to the intervention group met with the dietician and received coaching about the DASH diet, often with their family members. They were then given a produce prescription and could discuss food options and recipes with the dietician. The prescription was “redeemed” at mobile farm stands in their community that could also help them by ordering produce or spices that were integral to their meal preparation.

The weekly produce bag received by control participants was worth about $30 and was accompanied by basic nutrition messages, but no coaching or help with DASH diet adherence.

At 24 weeks, the intervention group had a 6.8-mm Hg reduction from baseline in systolic BP compared with 0.3 mm Hg in controls. The intervention group also had a greater mean change in DASH scores, and among those with high adherence to the DASH diet at 24 weeks, the average reduction in systolic BP was 13.3 mm Hg.

Adapting to DASH

To TCTMD, Ogungbe said food is cultural and personal, which THRIVE tried to honor by making sure participants could obtain ingredients that fell within their preferences, often with the help of a dietitian from their own cultural background.

Still, this type of research remains challenging, she added. While the study was a pilot that the researchers hope to expand upon, Ogungbe said that in considering how to help participants maintain the advantages gained from the intervention, one possibility is a step-down approach where they have access to some support, but not as much as was provided in the study.

“Another thing we’re thinking about is using AI,” she said. This could entail automated nudges, for example, if BP starts to increase.

Juraschek too, said maintenance of the gains from these interventions is crucial, especially the educational takeaways about food shopping, preparation, and attention to key principles of healthy eating.

“Some portions of the counseling could be automated,” he told TCTMD. “Not all, but maybe the complex cases still would benefit from access to a dietician.” Juraschek added that his group is also considering ways to automate the ordering process for DASH groceries with improved digital tools.

“Nutrient data is now available in a lot of virtual grocery stores. We could simply plug in the principles that are proven to work and connect with a local grocery store that could help people select the groceries that would implement the GoFresh or DASH model,” he said. “We think this is very scalable, and would be scalable to [patients with] other health conditions as well. We’ve been talking with local grocery chains about the potential of incorporating this into what they have right now.”