A Cluster-Randomized Trial of Blood-Pressure Reduction in Black Barbershops

Abstract

BACKGROUND Uncontrolled hypertension is a major problem among non-Hispanic black men, who are underrepresented in pharmacist intervention trials in traditional health care settings. METHODS We enrolled a cohort of 319 black male patrons with systolic blood pressure of 140 mm Hg or more from 52 black-owned barbershops (nontraditional health care setting) in a cluster-randomized trial in which barbershops were assigned to a pharmacist-led intervention (in which barbers encouraged meetings in barbershops with specialty-trained pharmacists who prescribed drug therapy under a collaborative practice agreement with the participants’ doctors) or to an active control approach (in which barbers encouraged lifestyle modification and doctor appointments). The primary outcome was reduction in systolic blood pressure at 6 months. RESULTS At baseline, the mean systolic blood pressure was 152.8 mm Hg in the intervention group and 154.6 mm Hg in the control group. At 6 months, the mean systolic blood pressure fell by 27.0 mm Hg (to 125.8 mm Hg) in the intervention group and by 9.3 mm Hg (to 145.4 mm Hg) in the control group; the mean reduction was 21.6 mm Hg greater with the intervention (95% confidence interval, 14.7 to 28.4; P<0.001). A blood-pressure level of less than 130/80 mm Hg was achieved among 63.6% of the participants in the intervention group versus 11.7% of the participants in the control group (P<0.001). In the intervention group, the rate of cohort retention was 95%, and there were few adverse events (three cases of acute kidney injury). CONCLUSIONS Among black male barbershop patrons with uncontrolled hypertension, health promotion by barbers resulted in larger blood-pressure reduction when coupled with medication management in barbershops by specialty-trained pharmacists. (Funded by the National Heart, Lung, and Blood Institute and others; ClinicalTrials.gov number, NCT02321618.)

Impact of a pharmacist‐physician collaborative care model on time‐in‐therapeutic blood pressure range in patients with hypertension

“…This is consistent with other evidence suggesting that improving hypertension outcomes often requires more intensive follow‐up . Of course, this can be challenging to implement in routine clinical practice, but this can be achieved in models that provide care where patients live, work, and worship . Technology and telemedicine have also been proven to be useful alternatives to traditional face‐to‐face visits for up titration of antihypertensive therapy and may be necessary to implement a more intensive approach to managing patients with hypertension .…”

“…Similar to our efforts to personalize pharmacotherapy according to individual patient characteristics, our approach to care delivery should also be personalized and implemented in a way that meets the needs of that population. This has been demonstrated by other studies that have successfully improved BP outcomes by implementing innovative models at local barbershops and churches . Further evaluations are warranted to better understand why such models are successful and how to adapt them for other populations.…”

“…Few studies, however, have enrolled a predominantly black population. Victor and colleagues enrolled 319 black male barbershop patrons in a cluster‐randomized trial of BP reduction in black barbershops . Barbershops that were assigned a pharmacist‐led intervention achieved a significantly higher reduction in systolic BP (SBP) compared with barbershops serving as active controls that primarily provided education (−27 mmHg vs −9.3 mmHg, respectively; P < 0.001).…”

Defining Hypertension by Blood Pressure 130/80 mm Hg Leads to an Impressive Burden of Hypertension in Young and Middle‐Aged Black Adults: Follow‐Up in the CARDIA Study

“…Because many blacks ≤55 years of age have 10‐year CVD risk ≥10% or higher, effective pharmacotherapy should attenuate progression to more severe hypertension and potentially reduce cardiovascular events. Novel approaches to hypertension prevention, detection, treatment, and control16 may be required to improve health equity, given large racial differences in the age of onset, prevalence, and severity of hypertension.…”

A marathon, not a sprint: Growth and evolution of community‐based pharmacy residency education and training

“…Furthermore, multiple studies have documented positive outcomes of CPPs . CPPs have had an impact in wellness, coaching, preventive services, and immunizations .…”