Image from presentation, "A Cluster-Randomized Trial of Blood-Pressure Reduction in Black Barbershops," Victor et al
March 20, 2018 — African-American men who received medical intervention aimed at controlling their high blood pressure while at the barber saw a marked drop in blood pressure in just six months, according to research presented at the 2018 American College of Cardiology’s 67th Annual Scientific Session. Specifically, men who received frequent monitoring and medication management from a specially-trained pharmacist who met them monthly in their barbershop lowered their systolic blood pressure by 21 mm Hg more, on average, compared with men who were encouraged by their barber to follow up with a doctor and to make healthy lifestyle choices.
High blood pressure is a key risk factor for heart disease and a leading cause of heart attack and stroke. Lowering blood pressure through lifestyle modification and medications substantially reduces this risk. While high blood pressure is a common problem among many American adults, African-American men are more likely than other groups to have high blood pressure that is not adequately controlled and tend to have less contact with the health care system.
“By bringing state-of-the-art medicine directly to the people who need it on their home turf, in this case in a barbershop, and making it both convenient and rigorous, blood pressure can be controlled just as well in African-American men as in other groups,” said Ronald G. Victor, M.D., associate director of the Smidt Heart Institute at Cedars-Sinai and the study’s lead author. “If this model was scaled up and sustained, millions of lives could be saved, and many heart attacks and strokes could be prevented.”
Previous studies have shown that equipping barbers — who remain trusted, consistent and convenient influencers for many African-American men—with health information can positively affect health. The new study is unique because it combined barbershop-based health outreach with the delivery of care by medical professionals at the barbershop and evaluated subsequent efficacy with a randomized trial.
The study recruited 319 men at 52 Los Angeles County barbershops. All the men had systolic blood pressure over 140 mm Hg based on multiple measurements taken on two different days. The men ranged in age from 35 to 71 years and, on average, had patronized their barbershop for more than a decade and had their hair cut twice a month.
In total, 309 men completed the study—representing a 95 percent cohort retention —and all received an intervention designed to help them lower their blood pressure.
“The two major strengths of the study are the large reduction in blood pressure itself and the high cohort retention,” Victor said.
A little over half of the men (171) were randomly assigned to receive health education from their barbers, who were trained to use a National Heart, Lung, and Blood Institute-developed script to encourage the men to visit their doctors and get their blood pressure under control.
The remaining men (132) were randomly assigned to receive regular monitoring (at least once per month) and active medication management by a pharmacist who met them at the barbershop. During each pharmacist visit, the men in this group received a blood pressure evaluation and a finger-stick blood test, which the pharmacist used to evaluate each man’s response to blood pressure medications and adjust prescriptions as needed. The pharmacists worked directly with the men under a collaborative care agreement with their primary care doctors.
On average, men who interacted only with their barber and were referred to their own doctor saw their systolic blood pressure drop from 155 mm Hg at the start of the study to 145 mm Hg after six months. Diastolic blood pressure dropped by 4 mm Hg in this group. By contrast, men who interacted with their barber and a pharmacist saw their systolic blood pressure drop from 153 mm Hg at the start of the study to 126 mm Hg after six months, along with a drop in diastolic blood pressure of 18 mm Hg.
Under current ACC/American Heart Association guidelines, blood pressure below 130/80 mm Hg is considered normal. At the end of six months, 64 percent of those who saw a pharmacist had blood pressure in the normal range, compared with 12 percent of those who saw only their barber and were referred to their own doctor.
“This is a very large effect for a hypertension trial of any kind,” Victor said. “We are very excited about the results.”
Most people require several blood pressure medications to adequately control high blood pressure. At the start of the study, about half of the participants were taking at least one blood pressure medication, with an overall average of one medication in both groups. At six months, 100 percent of those seeing a pharmacist and 63 percent of those seeing only a barber were taking blood pressure medications. Those in the pharmacist arm of the study were also taking two more medications by the end of the study, compared with the barber-only arm.
“High blood pressure is a chronic illness that requires a lifetime commitment to medication and lifestyle modification,” Victor said. “It is often a challenge to get people who need blood pressure medication to take them, even as the costs and side effects have gone down over the years. With this program, we have been able to overcome that barrier.”
Victor attributed the program’s success to the combination of many factors, including the backing of the barbers, the medical rigor, and the convenience of specialty-trained pharmacists bringing such medical care directly to the comfortable environment of the barbershop, instead of requiring the men to visit a medical center for monitoring and medication management.
Researchers have started a second phase of the study to determine if the effects are sustained for an additional six months. In addition, they hope to expand the program to reach other parts of the country, as well as men with more moderately elevated blood pressure.
The study was funded by a grant from the National Heart, Lung, and Blood Institute of the National Institutes of Health, among other funding sources.
For more information: www.acc.org