Blood Pressure Reduction in Black Barbershops - Blood Pressure Reduction in Black Barbershops

Contribution To Literature:

The Blood Pressure Reduction in Black Barbershops trial showed that interventional therapy coordinated by barbers and pharmacists in the barbershop was superior at improving blood pressure control.

Description:

The goal of this cluster randomized trial was to evaluate interventional therapy compared with standard therapy among black barbershop patrons with uncontrolled hypertension.


Study Design

Black barbershop patrons with uncontrolled hypertension were randomized to interventional therapy (n = 139) versus standard therapy (n = 180). Interventional therapy consisted of barbers who promoted monthly follow-up with pharmacists who then prescribed antihypertensive medications at the barbershop. Point-of-care electrolytes were also obtained. Standard therapy consisted of barbers who promoted lifestyle modification and follow-up with primary care physicians.

  • Step 1: amlodipine plus irbesartan
  • Step 2: indapamide
  • Step 3: spironolactone

Baseline systolic blood pressure was 153 mm Hg in the interventional group vs. 155 mm Hg in the standard therapy group. Goal blood pressure was <130/80 mm Hg.

  • Total number of enrollees: 319
  • Duration of follow-up: 6 months
  • Mean patient age: 54 years
  • Percentage with diabetes: 21%

Inclusion criteria:

  • Black barbershop patrons (at least one haircut in 6 weeks for at least 6 months)
  • Ages 35-79 years
  • Systolic blood pressure  ≥140 mm Hg x 2 days

Principal Findings:

The primary outcome, change in systolic blood pressure at 6 months, was -27.0 mm Hg in the interventional group compared with -9.3 mm Hg in the standard therapy group (p < 0.001).

Secondary outcomes:

  • Blood pressure <130/80 mm Hg: 63.6% in the interventional group vs. 11.7% in the standard therapy group (p < 0.001)
  • Number of blood pressure medications: 2.6 in the interventional group vs. 1.4 in the standard therapy group (p < 0.001)
  • No serious adverse events

Interpretation:

Among black barbershop patrons with uncontrolled hypertension, interventional therapy was effective at reducing systolic blood pressure at 6 months compared with standard therapy. Interventional therapy was coordinated by barbers who promoted follow-up with pharmacists in the barbershop who prescribed antihypertensive medications. Interventional therapy was associated with a high rate of optimal blood pressure control without serious adverse events.

References:

Victor RG, Lynch K, Li N, et al. A Cluster-Randomized Trial of Blood-Pressure Reduction in Black Barbershops. N Engl J Med 2018;378:1291-1301.

Presented by Dr. Ronald G. Victor at the American College of Cardiology Annual Scientific Session (ACC 2018), Orlando, FL, March 12, 2018.

Clinical Topics: Diabetes and Cardiometabolic Disease, Prevention, Statins, Hypertension

Keywords: ACC18, ACC Annual Scientific Session, African Americans, Amlodipine, Antihypertensive Agents, Blood Pressure, Blood Pressure Determination, Electrolytes, Hypertension, Indapamide, Life Style, Metabolic Syndrome X, Pharmacists, Physicians, Primary Care, Point-of-Care Systems, Primary Prevention, Spironolactone


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