Hypertension

“Barbershop Intervention” Significantly Improved BP in Black Men

A community-based intervention geared towards lowering blood pressure (BP) in African-American male barbershop patrons has now demonstrated both efficacy and sustainability through 12 months.1,2

Men who received the intervention at participating barbershops in Los Angeles county experienced a 20.8 mm Hg-greater drop in mean systolic BP over the course of the trial compared with controls. In the intervention group, mean systolic BP decreased by 28.6 mm Hg (152.4 mm Hg to 123.8 mm Hg) at 12 months vs 7.2 mm Hg among controls (154.6 mm Hg to 147.4 mm Hg).

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The intervention is particularly warranted because, compared with men of other races and ethnicities, non-Hispanic black men have an especially high risk for hypertension. According to the Centers for Disease Control and Prevention, in 2015 and 2016, the prevalence of hypertension was highest among non-Hispanic black men (40.6%) compared with non-Hispanic white men (29.7%), non-Hispanic Asian men (28.7%), and Hispanic men (27.3%).3

Despite this, non-Hispanic black men are often underrepresented in pharmacist-intervention trials for uncontrolled hypertension in traditional care settings.1

“We cannot say with certainty why we see so few black men participating in pharmacist-intervention trials, but we do know that black men have less physician contact than their female counterparts,” said clinical pharmacist and trial co-author Ciantel A. Blyler, PharmD, of the Smidt Heart Institute at Cedars-Sinai Medical Center in Los Angeles. “Some of this can be attributed to historical abuses, such as the Tuskegee experiments, that have resulted in a wariness and mistrust of the medical profession,” she told Consultant360.

With this in mind, the late Ronald G. Victor, MD, Dr Blyler, and their colleagues at the Smidt Heart Institute tested the impact of the intervention in a trial that included 319 African-American male patrons of 52 Los Angeles county barbershops.

“When concepting this trial, Dr Victor, the study’s lead, thought that we could overcome the discrepancy in hypertension treatment and control rates by meeting men on their own turf and partnering with a trusted community member, such as a barber,” Dr Blyler told Consultant360.

Each barbershop was randomly assigned to a pharmacist-led intervention or an active control group. Barbers participating in the intervention promoted follow-up with pharmacists who prescribed medication for hypertension as part of a collaborative practice agreement with patrons’ primary care providers.

In the control group, barbers simply promoted follow-up with patrons’ primary care providers, as well as lifestyle modifications.

Following a BP assessment at 6 months, the sustainability of the intervention was further tested through 12 months. After the sixth month of the study, the intervention involved fewer in-person pharmacist visits.

Ultimately, efficacy data for the barbershop intervention recorded initially at 6 months and later at 12 months were found to be statistically indistinguishable.

Findings regarding the sustainability of the intervention were also encouraging. By the end of the study, 68.0% of participants in the intervention group had achieved a BP below 130/80 mm Hg compared with 11.0% of controls.

“I think we all knew this was a special idea and that we would ultimately have a positive result, but I don’t think any of us imagined that we would see the magnitude of the effect we ultimately saw,” Dr Blyler said of the findings. “I think the results of this trial show that bringing medicine into the community works, and that novel approaches like this are necessary to close the gaps in healthcare disparities.”

Approximately 90% of participants had been retained through 12 months, and no treatment-related serious adverse events had occurred in either group, the authors of the study noted.

In light of these successful findings, the authors deemed broad-scale implementation research for the barbershop intervention to be “both justified and warranted.” The findings likely also have implications for the efficacy of community-based trials in reaching high-risk communities that are traditionally difficult to reach, they said.1

The findings also indicate that expanding collaborative practice between pharmacists and physicians would serve as a “critical first step” towards implementing the intervention in more areas around the country, the authors wrote.

“There is a large and growing evidence base that demonstrates pharmacists’ utility in chronic disease management; however, adoption of the physician/pharmacist collaborative practice model has been slow in many states,” Dr Blyler told Consultant360.

—Christina Vogt

References:

  1. Victor RG, Blyler CA, Li N, et al. Sustainability of blood pressure reduction in black barbershops [Published online December 17, 2018]. Circulation.
  2. One year later, barbershop intervention continues to lower blood pressure [press release]. Dallas, TX. American Heart Association. December 17, 2018. https://newsroom.heart.org/news/one-year-later-barbershop-intervention-continues-to-lower-blood-pressure?preview=5b7c. Accessed on December 17, 2018.
  3. Fryar CD, Ostchega Y, Hales CM, Zhang G, Kruszon-Moran D. Hypertension prevalence and control among ddults: United States, 2015–2016. Centers for Disease Control and Prevention. 2017; NCHS Data Brief No. 289. https://www.cdc.gov/nchs/products/databriefs/db289.htm.