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Study Summary

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African-American men have high rates of hypertension-related deaths and low rates of physician visits and adherence. Victor et al. (1) developed a cluster-randomized trial of a blood pressure (BP) control program in black-owned barbershops to assess the effects of intensive counseling and treatment within the community. The active control group consisted of trained barbers providing instruction on lifestyle modification and encouragement to follow-up with a physician. The intervention consisted of the trained barber counseling and full-time doctoral-level pharmacists specialized as hypertension clinicians regularly visiting barbershops, measuring BP, treating hypertension, and monitoring plasma electrolytes. Among the 303 black men with a confirmed systolic BP of ≥140 mm Hg and who regularly attended barbershops, the mean systolic BP in the intervention group (N=132) was reduced by 27 mm Hg at 6 months, vs. 9.3 mm Hg in the active control group (N=171) (see accompanying Hurst’s Central Illustration). A BP level < 130/80 mm Hg was achieved in 63.6% of the intervention group vs. in 11.7% of the control group.

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Blood-Pressure Reduction in Black Male Barbershop Patrons

Commentary

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Study Strengths: In this study, the challenge of bringing rigorous screening services directly into an underserved community was cleverly solved by partnering health care professionals with trusted community leaders to deliver treatment directly to patients at locations they frequent during their daily lives. By taking counseling and healthcare out of the office setting and simplifying their delivery in such a manner, this collaboration was shown to result in a greater adherence to and an impact of hypertension treatment. This was a well-designed trial demonstrating the immediate impact of community primary prevention efforts with the as yet unexplored potential for significantly impacting future cardiovascular morbidity and mortality in high-risk groups.

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Study Limitations: Limitations included a relatively short follow-up period, possible differences in the target BP of pharmacists vs. community physicians, masked hypertension (i.e., having lower BP in the doctor’s office than at home), and the more rigorous follow-up in the intervention group which may have led to greater adherence to treatment.

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Next Steps/Clinical Perspective: It will be interesting to see whether the BP control will be sustained in the next 6 months of this ongoing study and if other similar community-based cardiometabolic risk reduction studies can also demonstrate benefits. If such efforts prove to be successful they may represent a novel, viable method of primary prevention delivery.

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