Barbershop-based Health Intervention Found to Lower Blood Pressure in Afro-American Men

Healthcare given by a pharmacist in the local barbershop has been found to effectively lower high blood pressure in African American patients, according to a recent study conducted by Smidt Heart Institute. The findings of the study appeared in The New England Journal of Medicine and presented as Late-Breaking Clinical Trial at the American College of Cardiology's 67th Annual Scientific Session and Expo in Orlando.

Reason for this Novel Venture

Uncontrolled high blood pressure is one of the main causes of premature disability and death among African-American men, who do not have as much interaction with doctors compared to women, necessitating this kind of community-based intervention.

"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 Ronald G. Victor, MD, associate director of the Smidt Heart Institute and the study's lead author. "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."

Methods of the Study

• The study consisted of 319 African-American men enlisted from 52 barbershops in the Los Angeles area.
• Participants had a systolic blood pressure measurement of more than 140 mmHg, putting them at greater risk of complications such as stroke and heart attack.
• The men received intervention aimed at decreasing blood pressure. Under the latest guidelines, blood pressure below 130/80 mmHg is considered normal.

All the men were randomly assigned to one of two groups

• In the first group, barbers encouraged their clients to meet specially trained pharmacists who met the men monthly in the barbershop, prescribed blood pressure medication, checked their blood tests and then sent progress notes to the patient’s primary care physician.
• In the second group, the barbers urged their customers to follow-up with a primary care provider for medication and made necessary lifestyle changes, such as more exercise and decreased salt intake.
• In patients working with both their barbers and pharmacist, systolic blood pressure (the first, or top, number) reduced from 153 mmHg at the start of the study to 126 mmHg after six months. This was associated with a decrease in diastolic blood pressure (the bottom, number) by 18 mmHg.
  
  After six months, almost two-thirds of participants in this group were able to bring down their blood pressure into the healthy range.
• Men who met only their barber noted their systolic blood pressure drop from 155 mmHg at the start of the study to 145 mmHg at the end of six months. Diastolic blood pressure readings dropped by 4 mmHg in this group.
  
  At the six-month mark, 11.7% men in this group were found to have normal blood pressure.

Thus this new study, the first of its kind shows that advice by known persons (barbers/pharmacist) to seek to advanced medical intervention in an informal (barbershop) setting can be effective in reducing blood pressure.

What Members of the Study Team Have to Say

• "It's the silent killer, and it has cost the lives and health of a lot of good men," said Eric Muhammad, whose Inglewood shop, A New You Barbershop, participated in the study. "It's a no-brainer that black men are at the highest risk of high blood pressure. 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."

Muhammad, coauthor of the study was so passionate and committed to making a difference in the lives of other men in his community, and he was able to enroll over 50 other barbershops into this study and help Dr Victor in his study.

• C. Adair Blyler, DPharm, a pharmacist who participated in the study felt that location of healthcare was key to improved outcome. He adds that the rapport and trust built with the patients where they are is much more than in a clinical setting.
• Dr Victor says that this level of rapport and trust is necessary to treat a chronic condition such as hypertension, which needs ongoing lifestyle changes as well as being compliant with medicines.

"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 team has already begun a second phase of the study to find out if the benefits can be sustained for an additional six months. Victor also hopes to expand this study to other parts of the country and to reach a larger population, including African-American men with more moderate hypertension.

References:

1. Ronald G. Victor, Kathleen Lynch, Ning Li, Ciantel Blyler, Eric Muhammad, Joel Handler, Jeffrey Brettler, Mohamad Rashid, Brent Hsu, Davontae Foxx-Drew, Norma Moy, Anthony E. Reid, Robert M. Elashoff. “A Cluster-Randomized Trial of Blood-Pressure Reduction in Black Barbershops.” New England Journal of Medicine, (2018); DOI: 10.1056/NEJMoa1717250

Source-Medindia