A health promotion intervention in black-owned barbershops—incorporating medication management by pharmacists—reduces blood pressure in black men with uncontrolled hypertension, reports a study in The New England Journal of Medicine.
The cluster randomized trial included 319 non-Hispanic black men with hypertension (systolic BP 140 mm Hg or higher) who were regular customers at 52 black-owned barbershops in Los Angeles County. One group of barbershops was assigned to a pharmacist-led intervention, in which barbers encouraged men to meet with specialty-trained pharmacists. The pharmacists prescribed and monitored antihypertensive drug therapy in a collaborative practice agreement with the patients’ physicians. Barbershops assigned to an active control group promoted lifestyle modification and doctor’s office visits.
Six-month outcomes were assessed in 132 men in the intervention group and 171 in the control group. Mean baseline systolic BP was 152.8 and 154.6 mm Hg, respectively; mean age was about 54.
Systolic BP decreased by 27.0 mm Hg (to 125.8 mm Hg) among men participating in the pharmacist-led intervention, compared with 9.3 mm Hg (to 145.4 mm Hg) for those in the active control group. Nearly two-thirds (63.6%) reached a BP target of less than 130/80 mm Hg, compared to 11.7% of the control group.
The intervention cohort had a retention rate of 95%; adverse events were infrequent but included three cases of transient acute kidney injury. Men in the intervention group had greater improvements in self-rated health and patient engagement. Each intervention patient received an average of seven in-person visits and four follow-up calls with the pharmacist.
This health-promotion intervention in black-owned barbershops achieves significant reductions in BP among black men with hypertension. The trial shows a large net intervention effect in a difficult-to-reach population at high risk of hypertension-related death. An ongoing extension phase will assess the sustainability of this community-level intervention [Victor RG, et al. A cluster-randomized trial of blood-pressure reduction in black barbershops. N Engl J Med 2018; 378:1291−1301].