Sustainability of Blood Pressure Reduction in Black Barbershops

Abstract

Background We developed a new model of hypertension (HTN) care for non-Hispanic black men that links health promotion by barbers to medication management by specialty-trained pharmacists and demonstrated efficacy in a 6-month randomized trial (Victor et al., NEJM, 2018). The marked reduction in systolic blood pressure (BP) seen at 6 months warranted continuing the trial through 12 months to test sustainability, a necessary precondition for subsequent implementation research. Methods We enrolled a cohort of 319 black male patrons with systolic BP ≥ 140 mm Hg at baseline, in a cluster-randomized trial. Fifty-two Los Angeles County barbershops were assigned to either a pharmacist-led intervention or an active control group. In the intervention group, barbers promoted follow-up with pharmacists who prescribed BP medication under a collaborative practice agreement with patrons’ primary care providers (PCPs). In the control group, barbers promoted follow-up with PCPs and lifestyle modification. After BP assessment at 6 months, the intervention continued with fewer in-person pharmacist visits to test if the intervention effect could be sustained safely for one year while reducing pharmacist travel time to and from barbershops. Final BP and safety outcomes were assessed in both groups at 12 months. Results At baseline, mean systolic BP was 152.4 mm Hg in the intervention group and 154.6 mm Hg in the control group. At 12 months, mean systolic BP fell by −28.6 mm Hg (to 123.8 mm Hg) in the intervention group and by −7.2 mm Hg (to 147.4 mm Hg) in the control group. The mean reduction was 20.8 mm Hg greater with the intervention (95% confidence interval, 13.9 to 27.7; p < 0.0001). A goal BP < 130/80 was achieved by 68.0% of the intervention group versus 11.0% of the control group (p < 0.02). These new 12-month efficacy data are statistically indistinguishable from our previously reported 6-month data. No treatment-related serious adverse events occurred in either group over 12 months. Cohort retention at 12 months was 90% in both groups. Conclusion Among black male barbershop patrons with uncontrolled HTN, health promotion by barbers resulted in large and sustained BP reduction when coupled with medication management by specialty-trained pharmacists. Broad-scale implementation research is both justified and warranted. Clinical Trial Registration ClinicalTrials.gov,

Sustainable Development Goals relevant to kidney health: an update on progress

“…Innovation also includes implementation of policies such as sodium restriction in food, tax-based incentives encouraging healthy lifestyle choices, task-sharing within the health-care workforce and the use of information technology for education and treatment at the population level. Other novel interventions such as screening and educating men about hypertension in barber shops, using fixed-dose polypills to simplify treatment regimens, tailoring therapy to a person's genotype, or generating donor chains for kidney transplantation are encouraging 10,131,[156][157][158][159] . Rollout and scaleup of such innovations should be preceded by robust implementation research to understand the potential contextual factors that might impact the success or failure, as well as the harms or benefits, of the interventions 160 .…”

Cost-Effectiveness and Challenges of Implementing Intensive Blood Pressure Goals and Team-Based Care

“…Additionally, a pharmacist-led intervention in a community setting for non-Hispanic Black male patrons of barbershops with uncontrolled BP resulted in a mean SBP reduction of 21.6 mm Hg greater than usual care at six months [55]. The effects of pharmacist-provided hypertension care often persist beyond the initial intervention period [56,57]. Strong patient-pharmacist and community relationships in addition to individualized treatment plans have been considered as drivers for these successful interventions [57–59].…”

“…The effects of pharmacist-provided hypertension care often persist beyond the initial intervention period [56,57]. Strong patient-pharmacist and community relationships in addition to individualized treatment plans have been considered as drivers for these successful interventions [57–59].…”

The Arkansas Minority Barber and Beauty Shop Health Initiative: Meeting People Where They Are

“…Barbershops and beauty shops have historically served as places where people not only get hair services but also can openly and honestly talk about issues of importance in their community (16,17). Barbershops and beauty shops are conveniently located and are frequently visited by community patrons of all ages; these locations are important and culturally appropriate avenues for addressing health and social issues (16).…”