Conference News Roundup—American College of Cardiology

While high blood pressure is a common problem among many American adults, African American men are more likely than other groups to have high blood pressure that is not adequately controlled and tend to have less contact with the health care system.

“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,” said Ronald G. Victor, MD, Associate Director of the Smidt Heart Institute at Cedars-Sinai in Los Angeles. “If this model were scaled up and sustained, millions of lives could be saved, and many heart attacks and strokes could be prevented.”

Previous studies have shown that equipping barbers—who remain trusted, consistent, and convenient figures for many African American men—with health information can positively affect health. The new study is unique because it combined barbershop-based health outreach with the delivery of care by medical professionals at the barbershop and evaluated subsequent efficacy with a randomized trial.

The study recruited 319 men at 52 Los Angeles County barbershops. All the men had systolic blood pressure over 140 mm Hg, based on multiple measurements taken on two different days. The men ranged in age from 35 to 71 and, on average, had patronized their barbershop for more than a decade and had their hair cut twice a month.

In total, 303 men completed the study—representing a 95% cohort retention—and all received an intervention designed to help them lower their blood pressure.

A little over half of the men (171) were randomly assigned to receive health education from their barbers, who were trained to use a National Heart, Lung, and Blood Institute–developed script to encourage the men to visit their doctors and get their blood pressure under control.

The remaining men (132) were randomly assigned to receive regular monitoring (at least once per month) and active medication management by a pharmacist who met them at the barbershop. During each pharmacist visit, the men in this group received a blood pressure evaluation and a finger-stick blood test, which the pharmacist used to evaluate each man’s response to blood pressure medications and adjust prescriptions as needed. The pharmacists worked directly with the men under a collaborative care agreement with their primary care doctors.

On average, men who interacted only with their barber and were referred to their own doctor saw their systolic blood pressure decrease from 155 mm Hg at the start of the study to 145 mm Hg after six months. Diastolic blood pressured decreased by 4 mm Hg in this group. By contrast, men who interacted with their barber and a pharmacist saw their systolic blood pressure decrease from 153 mm Hg at the start of the study to 126 mm Hg after six months, along with a decrease in diastolic blood pressure of 18 mm Hg.

Under current American College of Cardiology–American Heart Association guidelines, blood pressure below 130/80 mm Hg is considered normal. At the end of six months, 64% of participants who saw a pharmacist had blood pressure in the normal range, compared with 12% of participants who were referred to their own doctor. “This is a large effect for a hypertension trial of any kind,” said Dr. Victor. “We are excited about the results.” Researchers are studying whether the effects can be sustained for an additional six months.