1. Non-Hispanic black male barber patrons prescribed antihypertensive therapy with barber encouragement along with lifestyle modification experienced greater reductions in blood pressures compared to those who received lifestyle modification advice alone.
2. A greater percentage of participants in the intervention group achieved a 130/80 mm Hg blood pressure goal compared to participants in the control group.
Evidence Rating Level: 1 (Excellent)
Study Rundown: Hypertension remains a pervasive health problem for non-Hispanic black males, who tend to have greater incidence and prevalence of this condition compared to other racial/ethnic groups. Previous literature has supported the role of barbershop-affiliated outreach programs as a well-established means to disseminate health information and measure health outcomes. The current study utilized a cluster-randomized trial design to implement a blood pressure control program that studied the efficacy of pharmacist-led antihypertensive prescription plans compared to lifestyle modification plans in Los Angeles barbershops, both utilizing barber encouragement of patrons. Overall, it was noted that participants who were assigned to the antihypertensive prescription plan group experienced greater reductions in blood pressure, and had greater percentages of participants meet the specified blood pressure goals established for the cohort compared to those in the control group receiving lifestyle modification encouragement.
The strengths of this analysis include the use of a community-based design that was integrated into the daily lives of the participants it chose to include for analysis. Limitations include the non-blinded nature of the study, which may have confounded individual results.
Relevant Reading: Cardiovascular Disease Control Through Barbershops: Design of a Nationwide Outreach Program
In-Depth [randomized controlled trial]: This non-blinded, clustered-randomized controlled trial enrolled 319 participants between 2015 to 2017 from 52 black-owned barbershops. Eligible patients had mean systolic blood pressures of 140 mm Hg or higher. Individual barbershops served as cluster units. After randomization, 132 participants in 28 barbershops were assigned to the intervention group and 171 participants in 24 barbershops were assigned to the control group. Both arms underwent blood pressure measurements at two time-points: at baseline, and at 6 months’ post-randomization. The primary endpoint of this study was any measured changes in systolic blood pressure from baseline to 6 months. Secondary endpoints included changes in diastolic blood pressure, rates of participants whose blood pressures met a 130/80 mm Hg goal, average number of hypertensive drugs used during the trial, presence of any adverse drug reactions, as well as qualitative patient measures including self-rated health and patient engagement.
The intervention group had a mean systolic blood pressure of 152.8 mm Hg at baseline, and a 125.8 mm Hg systolic blood pressure after 6 months (27.0 mm Hg decrease). The control group had a 154.6 mm Hg average systolic blood pressure at baseline, and a 145.4 mm Hg systolic blood pressure after 6 months (9.3 mm Hg decrease). Together, this equated to a 21.6 mm Hg greater decrease in blood pressure in the intervention group compared to control (95% confidence interval [CI], 14.7 to 28.4 mm Hg; P<0.001). There were also greater decreases in diastolic blood pressure in the intervention group compared to the control group, measured at a 14.9 mm Hg difference between the two groups (95% CI, 10.3 to 19.6 mm Hg; P<0.001). A total of 84 participants (63.6%) in the intervention group maintained blood pressures under 130/80 mm Hg compared to 20 participants (11.7%) in the control group (Effect size: 5.7; 95% CI: 2.5 to 12.8; P<0.001).
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