Researchers tested different ways to help people with high blood pressure who struggle to afford healthy food. They studied 458 adults across North Carolina and found that giving people money to buy groceries at stores worked better than delivering pre-made food boxes to their homes. Interestingly, adding counseling sessions or extending the program longer didn’t make much difference. The study shows that the type of food help matters more than how long you receive it or whether you get coaching along the way.

The Quick Take

  • What they studied: Whether different types of food assistance programs could help lower blood pressure in people who can’t always afford healthy food
  • Who participated: 458 adults (average age 50, mostly women) with high blood pressure and food insecurity from North Carolina. About half identified as Black, one-third as White, and small numbers from other racial groups.
  • Key finding: People who received grocery store vouchers had blood pressure that was about 2-3 points lower than those who got delivered food boxes. This difference stayed consistent even 18 months later.
  • What it means for you: If you struggle to afford healthy food and have high blood pressure, programs that let you choose what to buy at stores may work better than pre-selected food deliveries. However, this is one study, and results may vary for different people.

The Research Details

This was a randomized controlled trial, which is considered one of the strongest types of research. Researchers randomly assigned 458 people to different groups to test three separate questions: (1) Is a grocery store voucher better than a delivered food box? (2) Does adding phone counseling help? (3) Is 12 months better than 6 months? By testing these three things at once, researchers could see which parts of the program actually worked.

Participants had to have high blood pressure (130 mm Hg or higher) and report that they sometimes couldn’t afford enough food. Researchers measured their blood pressure at the start, after 6 months, 12 months, and 18 months. This allowed them to see both short-term and long-term effects.

The study took place across 364 clinical sites in North Carolina, which means the results come from many different communities and healthcare settings, making the findings more reliable.

Testing different program elements separately helps policymakers and healthcare providers spend money wisely. Instead of assuming that more counseling or longer programs are always better, this study shows what actually works. This approach is important because food assistance programs cost money, and knowing which parts are most effective helps serve more people.

This study is high quality because it randomly assigned people to groups (reducing bias), included a large number of participants, and followed people for 18 months. It was published in JAMA Internal Medicine, a respected medical journal. The study included diverse participants from different racial and ethnic backgrounds. However, most participants were women, and all were from North Carolina, so results might be different in other regions or for men.

What the Results Show

The grocery store voucher approach worked better than delivered food boxes. At 6 months, people using vouchers had blood pressure readings that were about 2.5 points lower for the top number (systolic) and 1.5 points lower for the bottom number (diastolic). While these numbers might sound small, even small reductions in blood pressure can reduce the risk of heart attack and stroke.

This benefit continued at 18 months, with similar improvements. At 12 months, the voucher group still did better, but the difference wasn’t quite large enough to be certain it wasn’t due to chance.

Interestingly, adding phone counseling about healthy eating and lifestyle didn’t make blood pressure go down any more than not having counseling. People who received counseling had similar results to those who didn’t. This was surprising to researchers and suggests that the food itself matters more than coaching.

Extending the program from 6 months to 12 months didn’t produce better blood pressure results either. Both groups improved, but the longer program didn’t add extra benefit.

Food security (having enough food to eat) improved in all groups from the beginning of the study to the end. However, all three types of programs—vouchers, food boxes, and different lengths—worked about equally well at improving food security. This suggests that any type of food assistance helps people have more reliable access to food, even if one type works better for blood pressure specifically.

Previous research showed that food insecurity is linked to worse blood pressure control, but this is one of the first studies to test which type of food help works best. The finding that choice (vouchers) works better than pre-selected items (food boxes) aligns with some research in other health areas showing that giving people options can improve outcomes. The finding that counseling didn’t add extra benefit is somewhat surprising and suggests future programs might focus resources on the food assistance itself rather than adding coaching.

The study included mostly women (75%), so results might be different for men. All participants were from North Carolina, so the findings might not apply to other regions with different food systems or climates. The study lasted 18 months, so we don’t know if benefits continue longer. Some people dropped out during the study, which could have affected results. The blood pressure reductions, while real, were modest, so individual results will vary.

The Bottom Line

If you have high blood pressure and struggle to afford healthy food, a grocery store voucher program appears to be more effective than a pre-made food box delivery program (moderate confidence). Adding counseling sessions doesn’t seem necessary to see blood pressure improvements (moderate confidence). A 6-month program appears to work as well as a 12-month program for blood pressure control (moderate confidence). Talk to your doctor about whether a food assistance program might help you.

This research is most relevant for people with high blood pressure who have difficulty affording healthy food. Healthcare providers and policymakers designing food assistance programs should pay attention to these findings. People without food insecurity or those with well-controlled blood pressure may not see the same benefits. This study focused on adults, so results may not apply to children.

Blood pressure improvements appeared within 6 months and were maintained at 18 months. Most people won’t see changes overnight—expect to give a program at least 6 months to work. Individual results vary, and some people may see benefits sooner while others take longer.

Want to Apply This Research?

  • Track your systolic blood pressure (top number) weekly at the same time of day. Set a goal to see a 2-3 point reduction over 6 months. Log which foods you purchased with your voucher or received in your box to identify patterns in what helps your blood pressure most.
  • If using a grocery voucher, create a simple shopping list of 5-7 healthy foods you enjoy before each shopping trip. This helps you use your voucher strategically and builds consistent healthy eating habits. Take a photo of your receipt to track what you’re buying and identify your favorite healthy choices.
  • Check blood pressure at the same time each week (morning is best) and record it in the app. After 6 weeks, look for trends rather than focusing on single readings. Share your blood pressure log with your doctor at appointments to see if the food assistance program is working for you specifically.

This research suggests that food assistance programs may help lower blood pressure in people with food insecurity, but individual results vary. Blood pressure is a medical condition that requires ongoing care from a healthcare provider. Do not start, stop, or change any blood pressure medications based on this information. Always consult with your doctor before making changes to your diet, medication, or health routine. This study was conducted in North Carolina and may not apply equally to all populations or regions. If you have high blood pressure, work with your healthcare team to develop a treatment plan tailored to your specific needs.