Pharmacists bring hypertension care to the barbershop

Researchers have examined a novel way to reach out to black men with hypertension… enlisting the help of pharmacists and barbers

Researchers from Cedars-Sinai, a health organisation serving Los Angeles, wanted to look at how health outreach to barbers could help black men with uncontrolled hypertension, a group which is underrepresented in pharmacist intervention trials in traditional health care settings.

Health outreach to barbershops has been well established, they write in the New England Journal of Medicine, but is largely untested regarding influence on hypertension management in this group.

“We aimed to develop a potent — and convenient — blood-pressure control program for black men in which we linked health promotion by barbers to drug treatment by pharmacists and evaluated the resultant efficacy in a cluster-randomized trial,” the researchers write.

“Although more than 40 randomized trials have provided evidence that hypertension control can be improved by the actions of pharmacists, the traditional health care settings used in such trials included few black men.”

They screened black men who were patrons of 52 participating barbershops, and enrolled 319 men with systolic blood pressure of 140mm Hg or more in a cluster-randomised trial.

The patrons were assigned to either a pharmacist-led intervention, in which the barbers encouraged meetings in the barbershops with specially trained pharmacists who prescribed drug therapy, in a collaborative agreement with the patients’ doctors; or an active control approach where barbers encouraged lifestyle modification and doctor appointments.

“In the intervention group, pharmacists met regularly with participants at the barbershops and prescribed and monitored a drug-intensification regimen and then sent notes on progress to the participants’ providers,” the authors write.

As well as prescribing antihypertensives the pharmacists, who had received specialised training and certification as hypertension specialists, measured blood pressure, encouraged lifestyle changes and monitored plasma electrolyte levels. Some of the barbers in the intervention group also measured blood pressure.

“The protocol called for the pharmacists to prescribe two-drug therapy that insurance would approve — preferably amlodipine plus a long-acting angiotensin-receptor blocker (ARB) or angiotensin-converting–enzyme (ACE) inhibitor — and to use the long-acting thiazide-type diuretic indapamide as the preferred third drug,” the researchers write.

“The primary hypothesis was that the reduction in systolic blood pressure after six months would be greater among participants at barbershops with the pharmacist-led intervention.”

At baseline, the mean systolic blood pressure was 152.8 mm Hg in the intervention group and 154.6 mm Hg in the control group.

At six months, the mean systolic blood pressure fell by 27.0 mm Hg (to 125.8 mm Hg) in the intervention group and by 9.3 mm Hg (to 145.4 mm Hg) in the control group.

The mean reduction was 21.6 mm Hg greater with the intervention (95% confidence interval, 14.7 to 28.4; P<0.001).

A blood-pressure level of less than 130/80 mm Hg was achieved among 63.6% of the participants in the intervention group versus 11.7% of the participants in the control group (P<0.001).

In the intervention group, the rate of cohort retention was 95%, and there were few adverse events (three cases of acute kidney injury).

“The effectiveness of the intervention was probably multifaceted,” the authors write.

“Pharmacists made drug therapy convenient by bringing it to the barbershop. The intervention was tailored to black men and endorsed by the involved barbers — trusted community members.

“Medication management that was delivered in barbershops by specialty-trained pharmacists, as compared with standard management afforded by primary care practices, resulted in much larger blood-pressure reductions in black male patrons of those shops who had hypertension.”

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