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Barbershop intervention sustains BP reductions in black men at 1 year
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An intervention to reduce BP through health promotion at barbershops continued to be effective in black men with hypertension, according to 1-year results of the Los Angeles Barbershop Blood Pressure study published in Circulation.
“Our results indicate that our new model of [hypertension] care can succeed in reaching high-risk hypertensive populations and markedly improve control rates with simple treatment algorithms, frequent follow-up and persistence in adjusting therapy when blood pressure remains above goal,” Ciantel A. Blyler, PharmD, clinical pharmacist at Smidt Heart Institute at Cedars-Sinai Medical Center, and colleagues wrote.
Extension phase of study
As Cardiology Today previously reported, black men assigned the intervention had a mean systolic BP decrease of 27 mm Hg compared with 9.3 mm Hg assigned the control at 6 months. The mean reduction in systolic BP was 21.6 mm Hg greater with the barbershop intervention (95% CI, 14.7-28.4). Mean baseline systolic BP was 153 mm Hg to 154 mm Hg at baseline.
Researchers analyzed 1-year data from 319 black men who had systolic BP greater than 140 mm Hg at baseline and regularly frequented 52 barbershops in the study. Patients were assigned a pharmacist-led intervention or a control group.
The intervention consisted of barbers suggesting follow-up visits with pharmacists for BP medications. Those in the control group received information about BP and lifestyle modifications from their barber, in addition to instructions on following up with their primary care providers.
Follow-up was conducted by phone to collect information on interval health changes. Patients were also given monthly haircut vouchers and culturally specific health lessons during the phone call. The intervention group received $25 per visit to the pharmacist for the cost of transportation and medication costs. Questionnaires were also completed by patients at 6 and 12 months to obtain information on patient-reported outcomes, BP measurements, demographic characteristics and prescription information from pill bottles.
The primary outcome was systolic BP changes at 12 months. Secondary outcomes of interest were defined as BP goal attainment rates, diastolic BP changes, adverse drug reactions, number of antihypertensive drugs prescribed and patient engagement.
At 12 months, cohort retention was 90% in the intervention and control groups.
BP reductions
The mean systolic BP at baseline was similar between the intervention (152.4 mm Hg) and control groups (154.6 mm Hg). At 12 months, mean systolic BP decreased by 28.6 mm Hg in the intervention group and 7.2 mm Hg in the control group, with a 20.8 mm Hg greater mean systolic BP reduction in patients assigned the intervention vs. the control (95% CI, –13.9 to –27.7).
More patients assigned the intervention achieved a BP less than 130/80 mm Hg compared with controls (68% vs. 11%; P = .0177).
There were no treatment-related serious adverse events or deaths in either group.
“The results presented herein successfully demonstrate both efficacy and sustainability, and now warrant broad-scale implementation research,” Blyler and colleagues wrote. “Toward that end, cost-effectiveness is being assessed to determine fiscally viable business models and to assess potential savings to public and private payors. An initial pilot study is also underway to assess whether these results can be replicated in a different city and with a different pharmacist-led team.” – by Darlene Dobkowski
Disclosures: The study was funded by a grant from NHLBI. Blyler reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.
Perspective
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Keith C. Ferdinand, MD
These innovative community-based interventions are informative on how we can address and potentially eliminate the unacceptable disparities in hypertension and CV care in the U.S.
Our private practices, community health centers and even in-patient facilities must be places where patients are treated with respect, and we apply appropriate evidence-based medicine to all individuals, regardless of race, ethnicity, gender, socioeconomic status or geography.
The Los Angeles Barbershop Blood Pressure study is a sterling example of merging sensitive patient-centered care and best medical practices. Unfortunately, the widespread application of this technique remains a difficult hurdle to overcome.
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