To bring down hypertension, try a barbershop intervention

John Murphy, MDLinx | March 12, 2018

A little off the top—of your systolic blood pressure?

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A visit to the barber to lower blood pressure?

Barber Eric Muhammad takes a blood pressure reading of customer Mark Sims during a clinical trial of hypertension in African American men. (Photo: Cedars-Sinai Medical Center)

Nearly 65% of African American men who received blood pressure management at the barbershop brought their blood pressure under control, thanks to their barbers and specially-trained pharmacists.

These results were presented at the American College of Cardiology’s 67th Annual Scientific Session and Expo in Orlando, FL, held March 10-12, 2018, and also published in The New England Journal of Medicine.

“When we provide convenient and rigorous medical care to African American men by coming to them—in this case having pharmacists deliver that care in barbershops—blood pressure can be controlled and lives can be saved,” said the study’s lead author Ronald G. Victor, MD, associate director, Smidt Heart Institute, Cedars-Sinai Medical Center, David Geffen School of Medicine, University of California, Los Angeles.

“High blood pressure disproportionately affects the African American community and we must find new ways to reach out so we can prevent strokes, heart attacks, heart failure, and early deaths,” added Dr. Victor, whose own hypertension was diagnosed by a barber in Dallas during his first barbershop-based study in the 1990s.

A previous study by Dr. Victor, published in 2011, showed that barbers could be effective in helping their customers lower hypertension. But this new study is the first to show that linking health promotion by barbers to advanced medical intervention in a barbershop setting can be effective in reducing blood pressure.

High fades and low pressure

In this study, Dr. Victor and colleagues enrolled 319 African American men from 52 African American-owned barbershops in the Los Angeles area. The researchers randomly assigned the men, who all had systolic blood pressure of 140 mmHg or higher, to two groups.

In the intervention group, barbers encouraged subjects to meet in the barbershop with specially-trained pharmacists who prescribed an antihypertensive drug regimen, measured blood pressure, encouraged lifestyle changes, monitored plasma electrolyte levels, and then sent progress notes to each patron’s primary care provider. Some of the barbers measured blood pressure, too.

In the control group, barbers encouraged subjects to make lifestyle changes and to follow up with a primary care provider.

Mean systolic blood pressure at baseline was 152.8 mmHg in the intervention group and 154.6 mmHg in the control group. By 6 months, mean systolic pressure dropped by 27.0 mmHg (to 125.8 mmHg) in the intervention group compared with a decrease of 9.3 mmHg (to 145.4 mmHg) in the control group. The reduction in systolic blood pressure was 21.6 mmHg greater on average in the intervention group than in the control group (95% CI: 14.7-28.4; P < 0.001).

Almost two-thirds (64%) of participants in the intervention group brought their blood pressure below 130/80 mmHg in 6 months, compared with about 12% in the control group.

“This is a very significant effect for a hypertension trial of any kind,” Dr. Victor said.

A no-brainer

“It’s a no-brainer that black men are at the highest risk of high blood pressure,” said barber Eric Muhammad, Inglewood, CA, who participated in the study. “What’s different about this study is it looks at ways to effectively bring it down with the help of your friends, family, and support group.”

Mr. Muhammad’s enthusiasm for the project was such that he helped recruit 50 other barbershops to participate.

Pharmacist C. Adair Blyler, PharmD, CHC, who treated patrons in barbershops for the study, said the location was key in reducing blood pressure. “There is a different level of trust and respect that’s earned when you meet people where they are, instead of in a hospital or clinic,” he said. “The rapport I’ve been able to establish with this group of patients has been unlike any other I’ve had in my professional career.”

Dr. Victor added, “Once you have hypertension, it requires a lifetime commitment to taking medications and making lifestyle changes. It is often challenging to get people who need blood pressure medication to take them, even as costs and side effects have gone down over the years. With this program, we have been able to overcome that barrier.”

The researchers are now in a second phase of the study to determine if the benefits can be sustained for an additional 6 months. Dr. Victor also hopes to expand the program to other parts of the country and to reach a larger population, including African American men with more moderate blood pressure levels.

The study was funded in part by the National Heart, Lung and Blood Institute of the National Institutes of Health.

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