Researchers may have identified a promising setting to control hypertension among black men—a group with an inordinate burden of high blood pressure and related adverse events. By bringing specialty care to the community through black-owned barbershops, Ronald G. Victor, MD, and colleagues showed substantial blood pressure reductions can be achieved within six months.
The findings were presented March 12 at the American College of Cardiology’s annual scientific session and published simultaneously in The New England Journal of Medicine.
A total of 319 regular patrons from 52 barbershops with uncontrolled hypertension—systolic blood pressure of 140 mm Hg or more at baseline—participated in the study. Of the 309 men who completed the six-month study, 132 were randomly assigned to receive monitoring and medication from a pharmacist who visited the barbershop, while the other 171 were encouraged by barbers to engage in lifestyle modifications and schedule doctor appointments.
The men seen by the pharmacist had mean drops of 27 mm Hg in systolic blood pressure and 18 mm Hg in diastolic blood pressure. The corresponding drops in the control group were 9.3 and 4 mm Hg, respectively.
"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," Victor said in a press release. "If this model was scaled up and sustained, millions of lives could be saved, and many heart attacks and strokes could be prevented."
The researchers attributed the success of their intervention to several factors. Pharmacist visits made the therapy convenient for recipients, who were easily reached because they were loyal regulars at the barbershops. Barbers who endorsed the intervention were “trusted community members,” according to the authors, making their customers more likely to adhere to the treatment. In addition, many of the patrons in the trial lived alone, and the authors speculated “peer support at the barbershop facilitated health promotion.”
At baseline, about one-half of participants in both groups were taking blood pressure medication. Six months later, 100 percent of those seen by pharmacists and 63 percent who received only encouragement to see a doctor were taking antihypertensive drugs. Sixty-four percent of the men in the intervention group improved their blood pressure to levels in the normal range, compared to 12 percent of the control group.
Victor et al. noted one of the limitations of their study is pharmacists targeted blood pressure below 130/80 mm Hg, while primary care providers for control-group participants may have used an in-office goal of 140/90. These differential targets and measurement locations may have factored into the results, and “normotensive office readings that mask high out-of-office blood pressure are common in black patients,” they wrote.
The researchers also pointed out an additional 3.5 million black men in the U.S. are considered to have hypertension now that the ACC and American Heart Association have dropped the lower threshold to 130/80 mm Hg. But most hypertensive black men still have blood pressures above the old barrier of 140/90.
“Because black men with hypertension often have multiple cardiovascular risk factors, marked reductions in blood pressure—if sustained with the use of our approach and then initiated more widely—might reduce the high rates of hypertension-related disability and death among black men with hypertension in the United States,” Victor and colleagues wrote.