Barbershop Intervention Reduced Blood Pressure in Hypertensive Black Men
MARCH 12, 2018
Ronald G. Victor, MDA good haircut can make you feel like a new man, and in this case, also help you manage your blood pressure.
Black men have the highest rate of death related to hypertension in the US—coupled with a lower rate of physician interaction and control of hypertension compared to their female counterparts. But scaling up medical intervention in the barbershop, with barbers promoting follow-up for their patrons and monthly check-ins from a pharmacist resulted in high rates of retention and a mean of 27.0 mmHg decrease in systolic blood pressure.
“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,” Ronald G. Victor, MD, the associate director of the Smidt Heart Institute at Cedars-Sinai Hospital and the study’s lead author, said. “If this model was scaled up and sustained, millions of lives could be saved, and many heart attacks and strokes could be prevented.”
Presented at the 67th American College of Cardiology Scientific Sessions in Orlando, Florida, the study sought to develop an effective intervention to link health promotion by barbers to drug intervention by pharmacists. The primary outcome was the change in systolic blood pressure at 6 months.
The target blood pressure mark was <130/80 mmHg, in compliance with the new AHA/ACC guidelines of 2017.
“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.”
The trial randomized 319 patrons in 52 barbershops: 139 with uncontrolled hypertension in 28 shops in the intervention group, for which the barbers promoted follow-up with pharmacists that visited monthly to check blood pressure, prescribe medication, monitor electrolytes, and send notes of progress to primary care providers (PCPs); and 180 in with uncontrolled hypertension in 24 shops in the control group, for which barbers promoted follow-up with PCPs and lifestyle modification.
At baseline, cardiovascular risk factors—body mass index, smoking, and diabetes—were not statistically significantly different, save for high cholesterol, which impacted 35% of the intervention group and 24% of the control group (P = .04). Baseline systolic blood pressure was 152.8 mmHg in the intervention group and 154.6 mmHg in the control.
At 6 months, mean blood pressure in the intervention group dropping to 125.8 mmHg (–27.0 mmHg) and 145.4 mmHg in the control group (–9.3 mmHg). The mean difference in blood pressure reduction was –21.6 mmHg systolic and –14.9 mmHg diastolic (95% CI, –10.3 to –19.6; P <.001).
The blood pressure goal of <130/80 mmHg was attained by 63.6% of the intervention group (n = 84) compared with 11.7% in the control group (n = 20; RR, 5.7; 95% CI, 2.5 to 12.8; P <.001).
Victor ascribed the success of the program to many factors, including the barbers’ involvement, the medical thoroughness, and the ability of the pharmacists to bring medical care directly to the comfortable environment of the barbershop, rather than requiring the men to visit a medical center for monitoring and medication management.
Impressively, the cohort retention rate was 95%, with 132 participants in the intervention group completing the follow-up to 6 months (7 lost to follow-up, 6 withdrew, 1 deceased), and 171 completing in the control group (9 lost to follow-up, 8 withdrew, 1 deceased).
“The 2 major strengths of the study are the large reduction in blood pressure itself and the high cohort retention,” Victor said. Medication adherence was also high—at month 6, 100% of those in the intervention and 63% of those in the control group taking their medication.
A second phase of the study is planned to observe if the effects are sustained through 1 year. Additionally, the authors noted their hope for the program to expand to other parts of the country.
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