Articles

Posted Jun 19 , 2018 04:18 AM

A Cluster-Randomized Trial of Blood- Pressure Reduction in Black Barbershops

Victor RG, et al. New England Journal of Medicine 2018 – March 12.

What were the findings (excerpted from the Abstract)?

Hypertension is a major problem among non-Hispanic black men, who are underrepresented in pharmacist intervention trials in traditional healthcare settings. The authors enrolled a cohort of 319 black male patrons with systolic blood pressure of 140 mmHg or more from 52 black-owned barbershops (nontraditional health care setting) in a cluster-randomized trial in which barbershops were assigned to a pharmacist-led intervention (in which barbers encouraged meetings in barbershops with specialty-trained pharmacists who prescribed drug therapy under a collaborative practice agreement with the participants’ doctors) or to an active control approach (in which barbers encouraged lifestyle modification and doctor appointments). The primary outcome was reduction in systolic blood pressure (SBP) at 6 months. At baseline, the mean SBP was 152.8 mmHg in the intervention group and 154.6 mmHg in the control group. At 6 months, the mean systolic blood pressure fell by 27.0 mmHg (to 125.8 mmHg) in the intervention group and by 9.3 mmHg (to 145.4 mmHg) in the control group. A blood-pressure level of less than 130/80 mmHg was achieved among 63.6% of the participants in the intervention group versus 11.7% of the participants in the control group. In the intervention group, the rate of cohort retention was 95%, and there were few adverse events (three cases of acute kidney injury). Among black male barbershop patrons with hypertension, health promotion by barbers resulted in larger blood-pressure reduction when coupled with medication management in barbershops by specialty-trained pharmacists.

Why is this important?

Non-Hispanic black men have the highest rate of hypertension-related death of any racial, ethnic, or sex group in the United States. Black men have less physician interaction than black women, and lower rates of hypertension treatment and control, necessitating community outreach. This study is a fascinating application of taking the intervention to the patients where they are likely to be encountered, one of the better ways to reach patients who are less likely to see a healthcare provider in a traditional setting. In addition, the role of pharmacists working with collaborative practice agreements facilitated getting patients started on medications. A further fascinating part of this study was the magnitude of the outcomes. Systolic BP decreases of 27 mmHg is nearly unheard of in most clinical trials related to BP medications. Even in the control group, simple encouragement of patients in lifestyle, medications, and doctor appointments resulted in significant reductions in systolic blood pressure. Clearly, this study is a ‘game changer’ on several fronts; from meeting patients where they are likely to be engaged, to the use of pharmacists to initiate medications, to the fact that even simple messages delivered in a venue where a patient population, in this case black males, are likely to be encountered is very encouraging.

Read the Abstract:
http://www.nejm.org/doi/full/10.1056/NEJMoa1717250