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

In this trial involving black male barbershop patrons with uncontrolled hypertension, health promotion by barbers resulted in larger blood-pressure reduction when coupled with medication management in barbershops by specialty-trained pharmacists.

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Bibliographic Details
Published in	The New England journal of medicine Vol. 378; no. 14; pp. 1291 - 1301
Main Authors	Victor, Ronald G, Lynch, Kathleen, Li, Ning, Blyler, Ciantel, Muhammad, Eric, Handler, Joel, Brettler, Jeffrey, Rashid, Mohamad, Hsu, Brent, Foxx-Drew, Davontae, Moy, Norma, Reid, Anthony E, Elashoff, Robert M
Format	Journal Article
Language	English
Published	United States Massachusetts Medical Society 05.04.2018
Subjects	African Americans Antihypertensive Agents - therapeutic use Barbering Blood pressure Blood Pressure - drug effects Chemotherapy Cluster analysis Cohort Studies Collaboration Drug therapy Drug Therapy, Combination Evidence-based medicine Health promotion Health Promotion - methods Health Promotion - statistics & numerical data Humans Hypertension Hypertension - drug therapy Hypertension - ethnology Hypertension - therapy Intervention Life Style Male Men Middle Aged Pharmacists Self Report Socioeconomic Factors Los Angeles California United States > US
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Abstract	In this trial involving black male barbershop patrons with uncontrolled hypertension, health promotion by barbers resulted in larger blood-pressure reduction when coupled with medication management in barbershops by specialty-trained pharmacists.
AbstractList	In this trial involving black male barbershop patrons with uncontrolled hypertension, health promotion by barbers resulted in larger blood-pressure reduction when coupled with medication management in barbershops by specialty-trained pharmacists. BACKGROUNDUncontrolled hypertension is a major problem among non-Hispanic black men, who are underrepresented in pharmacist intervention trials in traditional health care settings. METHODSWe enrolled a cohort of 319 black male patrons with systolic blood pressure of 140 mm Hg 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 at 6 months. RESULTSAt 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 6 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). CONCLUSIONSAmong black male barbershop patrons with uncontrolled hypertension, health promotion by barbers resulted in larger blood-pressure reduction when coupled with medication management in barbershops by specialty-trained pharmacists. (Funded by the National Heart, Lung, and Blood Institute and others; ClinicalTrials.gov number, NCT02321618 .). Uncontrolled hypertension is a major problem among non-Hispanic black men, who are underrepresented in pharmacist intervention trials in traditional health care settings. We enrolled a cohort of 319 black male patrons with systolic blood pressure of 140 mm Hg 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 at 6 months. 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 6 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). Among black male barbershop patrons with uncontrolled hypertension, health promotion by barbers resulted in larger blood-pressure reduction when coupled with medication management in barbershops by specialty-trained pharmacists. (Funded by the National Heart, Lung, and Blood Institute and others; ClinicalTrials.gov number, NCT02321618 .). Background Uncontrolled hypertension is a major problem among non-Hispanic black men, who are underrepresented in pharmacist intervention trials in traditional health care settings. Methods We enrolled a cohort of 319 black male patrons with systolic blood pressure of 140 mm Hg 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 at 6 months. Results 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 6 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). Conclusions Among black male barbershop patrons with uncontrolled hypertension, health promotion by barbers resulted in larger blood-pressure reduction when coupled with medication management in barbershops by specialty-trained pharmacists. (Funded by the National Heart, Lung, and Blood Institute and others; ClinicalTrials.gov number, NCT02321618.)
Author	Elashoff, Robert M Li, Ning Lynch, Kathleen Moy, Norma Victor, Ronald G Rashid, Mohamad Hsu, Brent Foxx-Drew, Davontae Muhammad, Eric Blyler, Ciantel Reid, Anthony E Handler, Joel Brettler, Jeffrey
Author_xml	– sequence: 1 givenname: Ronald G surname: Victor fullname: Victor, Ronald G organization: From the Smidt Heart Institute at Cedars–Sinai Medical Center (R.G.V., K.L., C.B., E.M., M.R., B.H., D.F.-D., N.M., A.E.R.), the Department of Biomathematics, David Geffen School of Medicine, University of California, Los Angeles (N.L., R.M.E.), and Kaiser Permanente (J.H., J.B.) — all in Los Angeles – sequence: 2 givenname: Kathleen surname: Lynch fullname: Lynch, Kathleen organization: From the Smidt Heart Institute at Cedars–Sinai Medical Center (R.G.V., K.L., C.B., E.M., M.R., B.H., D.F.-D., N.M., A.E.R.), the Department of Biomathematics, David Geffen School of Medicine, University of California, Los Angeles (N.L., R.M.E.), and Kaiser Permanente (J.H., J.B.) — all in Los Angeles – sequence: 3 givenname: Ning surname: Li fullname: Li, Ning organization: From the Smidt Heart Institute at Cedars–Sinai Medical Center (R.G.V., K.L., C.B., E.M., M.R., B.H., D.F.-D., N.M., A.E.R.), the Department of Biomathematics, David Geffen School of Medicine, University of California, Los Angeles (N.L., R.M.E.), and Kaiser Permanente (J.H., J.B.) — all in Los Angeles – sequence: 4 givenname: Ciantel surname: Blyler fullname: Blyler, Ciantel organization: From the Smidt Heart Institute at Cedars–Sinai Medical Center (R.G.V., K.L., C.B., E.M., M.R., B.H., D.F.-D., N.M., A.E.R.), the Department of Biomathematics, David Geffen School of Medicine, University of California, Los Angeles (N.L., R.M.E.), and Kaiser Permanente (J.H., J.B.) — all in Los Angeles – sequence: 5 givenname: Eric surname: Muhammad fullname: Muhammad, Eric organization: From the Smidt Heart Institute at Cedars–Sinai Medical Center (R.G.V., K.L., C.B., E.M., M.R., B.H., D.F.-D., N.M., A.E.R.), the Department of Biomathematics, David Geffen School of Medicine, University of California, Los Angeles (N.L., R.M.E.), and Kaiser Permanente (J.H., J.B.) — all in Los Angeles – sequence: 6 givenname: Joel surname: Handler fullname: Handler, Joel organization: From the Smidt Heart Institute at Cedars–Sinai Medical Center (R.G.V., K.L., C.B., E.M., M.R., B.H., D.F.-D., N.M., A.E.R.), the Department of Biomathematics, David Geffen School of Medicine, University of California, Los Angeles (N.L., R.M.E.), and Kaiser Permanente (J.H., J.B.) — all in Los Angeles – sequence: 7 givenname: Jeffrey surname: Brettler fullname: Brettler, Jeffrey organization: From the Smidt Heart Institute at Cedars–Sinai Medical Center (R.G.V., K.L., C.B., E.M., M.R., B.H., D.F.-D., N.M., A.E.R.), the Department of Biomathematics, David Geffen School of Medicine, University of California, Los Angeles (N.L., R.M.E.), and Kaiser Permanente (J.H., J.B.) — all in Los Angeles – sequence: 8 givenname: Mohamad surname: Rashid fullname: Rashid, Mohamad organization: From the Smidt Heart Institute at Cedars–Sinai Medical Center (R.G.V., K.L., C.B., E.M., M.R., B.H., D.F.-D., N.M., A.E.R.), the Department of Biomathematics, David Geffen School of Medicine, University of California, Los Angeles (N.L., R.M.E.), and Kaiser Permanente (J.H., J.B.) — all in Los Angeles – sequence: 9 givenname: Brent surname: Hsu fullname: Hsu, Brent organization: From the Smidt Heart Institute at Cedars–Sinai Medical Center (R.G.V., K.L., C.B., E.M., M.R., B.H., D.F.-D., N.M., A.E.R.), the Department of Biomathematics, David Geffen School of Medicine, University of California, Los Angeles (N.L., R.M.E.), and Kaiser Permanente (J.H., J.B.) — all in Los Angeles – sequence: 10 givenname: Davontae surname: Foxx-Drew fullname: Foxx-Drew, Davontae organization: From the Smidt Heart Institute at Cedars–Sinai Medical Center (R.G.V., K.L., C.B., E.M., M.R., B.H., D.F.-D., N.M., A.E.R.), the Department of Biomathematics, David Geffen School of Medicine, University of California, Los Angeles (N.L., R.M.E.), and Kaiser Permanente (J.H., J.B.) — all in Los Angeles – sequence: 11 givenname: Norma surname: Moy fullname: Moy, Norma organization: From the Smidt Heart Institute at Cedars–Sinai Medical Center (R.G.V., K.L., C.B., E.M., M.R., B.H., D.F.-D., N.M., A.E.R.), the Department of Biomathematics, David Geffen School of Medicine, University of California, Los Angeles (N.L., R.M.E.), and Kaiser Permanente (J.H., J.B.) — all in Los Angeles – sequence: 12 givenname: Anthony E surname: Reid fullname: Reid, Anthony E organization: From the Smidt Heart Institute at Cedars–Sinai Medical Center (R.G.V., K.L., C.B., E.M., M.R., B.H., D.F.-D., N.M., A.E.R.), the Department of Biomathematics, David Geffen School of Medicine, University of California, Los Angeles (N.L., R.M.E.), and Kaiser Permanente (J.H., J.B.) — all in Los Angeles – sequence: 13 givenname: Robert M surname: Elashoff fullname: Elashoff, Robert M organization: From the Smidt Heart Institute at Cedars–Sinai Medical Center (R.G.V., K.L., C.B., E.M., M.R., B.H., D.F.-D., N.M., A.E.R.), the Department of Biomathematics, David Geffen School of Medicine, University of California, Los Angeles (N.L., R.M.E.), and Kaiser Permanente (J.H., J.B.) — all in Los Angeles
BackLink	https://www.ncbi.nlm.nih.gov/pubmed/29527973$$D View this record in MEDLINE/PubMed
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Snippet	In this trial involving black male barbershop patrons with uncontrolled hypertension, health promotion by barbers resulted in larger blood-pressure reduction... Uncontrolled hypertension is a major problem among non-Hispanic black men, who are underrepresented in pharmacist intervention trials in traditional health... Background Uncontrolled hypertension is a major problem among non-Hispanic black men, who are underrepresented in pharmacist intervention trials in traditional... BACKGROUNDUncontrolled hypertension is a major problem among non-Hispanic black men, who are underrepresented in pharmacist intervention trials in traditional...
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StartPage	1291
SubjectTerms	African Americans Antihypertensive Agents - therapeutic use Barbering Blood pressure Blood Pressure - drug effects Chemotherapy Cluster analysis Cohort Studies Collaboration Drug therapy Drug Therapy, Combination Evidence-based medicine Health promotion Health Promotion - methods Health Promotion - statistics & numerical data Humans Hypertension Hypertension - drug therapy Hypertension - ethnology Hypertension - therapy Intervention Life Style Male Men Middle Aged Pharmacists Self Report Socioeconomic Factors
Title	A Cluster-Randomized Trial of Blood-Pressure Reduction in Black Barbershops
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