ABSTRACT Hypertension rates among middle-aged non-Hispanic black (NHB) adults are among the highest in the world, which is a significant source of racial disparities in ADRD. In September 2020, two NIH directors recommended safety-net health care providers and patients and scientists co-design novel interventions to alleviate racial and socioeconomic disparities in hypertension. Also in 2020, the Lancet Commission on dementia prevention noted that lifestyle interventions may be particularly efficacious for ADRD prevention in subpopulations with high cardiovascular disease risk. This evidence points to a significant need for behavioral intervention co-design with subpopulations at high cardiovascular risk. Thus, we worked with safety-net primary care providers and NHB patients to iteratively co-design an intervention to support hypertension self-management and Mediterranean-Dash Intervention for Neurodegenerative Delay (MIND) diet and aerobic training (MAT). Due to the co-design process, MAT addresses patient and safety-net provider preferences and thus may be an engaging and sustainable strategy in an externally valid setting for the promotion of MIND diet and aerobic activity in a very high-risk subpopulation. MAT is also likely to be potent as over 50% of CVD among NHB adults has been attributed to poor diet and fitness, which contribute greatly to ADRD disparities. MAT involves our CDC-endorsed hypertension self-management education and support classes followed by home-delivered MIND food ingredients and twice-weekly MIND cooking, nutrition, and aerobic activity via videoconference. This novel intervention has not been evaluated for its effects on cognition. In an early stage randomized controlled trial, we aim to demonstrate feasibility and investigate MAT effects on cognition. We propose to test, in a Stage IB pilot RCT, MAT versus our attention control intervention (AC). We will randomize 128 NHB safety-net primary care patients with high systolic blood pressure (≥140 mm Hg) to 28wks of AC or MAT. Provider-led MAT is 28wks followed by 24wks of self-led MAT. Measures will be at baseline, post-treatment (28 weeks), and follow-up (52 weeks). We will measure feasibility and cognition. We will also explore intervention processes and obtain and store blood samples for possible future analyses. A successful pilot would support a follow-on ADRD prevention trial across safety-net primary care sites with the objectives of ADRD prevention and reduction of ADRD disparities.

NARRATIVE We propose an early stage pilot randomized controlled trial of a non-pharmacological intervention that was co- designed with non-Hispanic black (NHB) safety-net primary care patients and their providers. The intervention is delivered by safety-net providers and involves hypertension self-management education, Mediterranean- Dash Intervention for Neurodegenerative Delay (MIND) diet, and aerobic training. We will evaluate intervention feasibility and processes and investigate intervention effects on cognition in NHB adults with hypertension.