"Barbershop Interventions for Blood Pressure Reduction in Black Men". The New England Journal of Medicine. 2018.

Clinical Question

Does a pharmacist-led intervention program in black-owned barbershops improve blood pressure control in non-Hispanic black men with uncontrolled hypertension?

Bottom Line

Among black male barbershop patrons with uncontrolled hypertension, a pharmacist-led intervention program within barbershops resulted in a significantly larger decrease in blood pressure compared to an active control group promoting lifestyle modification and doctor appointments.

Major Points

Non-Hispanic black men have disproportionately higher rates of hypertension-related mortality and lower rates of hypertension treatment and control. Interventions to manage hypertension outside of traditional health care settings may be necessary. This study found that a pharmacist-led intervention in barbershops effectively reduced blood pressure in black men with uncontrolled hypertension.

Guidelines

As of August 2017, no specific guidelines reflect the results of this trial for hypertension management in similar community settings.

Design

Multicenter, cluster-randomized, open-label trial
N=319 black male patrons of 52 black-owned barbershops
Pharmacist-led intervention (n=132 in 28 barbershops)
Active control: encouraged lifestyle changes and doctor appointments (n=171 in 24 barbershops)
Setting: Black-owned barbershops in Los Angeles County
Enrollment: February 2015 to July 2017
Mean follow-up: 6 months
Analysis: Modified intention-to-treat
Primary outcome: Change in systolic blood pressure at 6 months

Population

Inclusion Criteria
Self-identified black male regular patrons aged 35 to 79
Systolic blood pressure of 140 mm Hg or more
Exclusion Criteria
Women and individuals receiving dialysis or chemotherapy
Baseline Characteristics
Mean systolic blood pressure: 152.8 mm Hg (intervention) and 154.6 mm Hg (control)

Interventions

In the intervention group, barbers encouraged follow-up with pharmacists who prescribed antihypertensive medication, monitored blood pressure, and adjusted therapy under a collaborative practice agreement with participants’ doctors.
In the control group, barbers encouraged lifestyle changes and doctor visits.

Outcomes

Primary Outcomes
Mean systolic blood pressure decreased by 27.0 mm Hg in the intervention group and by 9.3 mm Hg in the control group.
The mean reduction was 21.6 mm Hg greater in the intervention group (P<0.001).
Secondary Outcomes
The intervention group showed a 14.9 mm Hg greater reduction in diastolic blood pressure compared to the control group (P<0.001).
63.6% of participants in the intervention group achieved a blood pressure <130/80 mm Hg compared to 11.7% in the control group (P<0.001).

Criticisms

The results may not be generalizable to nonurban areas or different community settings.
Pharmacist availability and collaboration with physicians may limit the feasibility of implementing this intervention widely.

Funding

Funded by the National Heart, Lung, and Blood Institute, the National Center for Advancing Translational Sciences UCLA Clinical and Translational Science Institute, California Endowment, Lincy Foundation, Harriet and Steven Nichols Foundation, Burns and Allen Chair in Cardiology Research, and Cedars–Sinai Medical Center's Division of Community Relations and Development.

Further Reading

Supplementary material for the study can be found at NEJM.org.
ClinicalTrials.gov number, NCT02321618.