Optimizing Food-Is-Medicine Programs for High Blood Pressure—Reply

JAMA Internal Medicine published a reply on April 6, 2026, that argues food-is-medicine programs for high blood pressure will be most effective when they are designed more precisely and delivered with behavior science in mind.

The reply, by Seth A. Berkowitz, Alice S. Ammerman and Darren A. DeWalt, responds to the Healthy Food First randomized clinical trial on food insecurity interventions and blood pressure. The authors said they share enthusiasm for food-is-medicine efforts, but that improved blood-pressure outcomes will likely depend on biologically informed nutrition targets and strategies that help people stick with the program over time.

The underlying trial, published in December 2025, found that a food subsidy lowered blood pressure more than a delivered food box. Lifestyle counseling and a longer intervention period did not improve outcomes.

That result fits with the broader evidence base. A June 2025 American Heart Association summary said food-is-medicine programs can improve diet quality and food security, but effects on clinical outcomes such as blood pressure have been inconsistent.

At the same time, more targeted programs may still show benefit. An American College of Cardiology press release on March 30, 2026, described a pilot in Black and Hispanic adults with hypertension that lowered blood pressure when food support was paired with culturally tailored coaching and dietitian guidance.

Taken together, the studies suggest that food access alone may not be enough. The new reply argues that program design, nutrition quality and delivery methods will likely determine whether food-is-medicine interventions meaningfully lower blood pressure.