Barbershops Used to Control Blood Pressure

In a unique randomized trial], African American men who were patrons of black-owned barbershops in Dallas County, where they had their BP regularly measured and were encouraged to contact a physician when it was elevated, showed a mean 7.8-mm-Hg drop in systolic pressure over 10 months.

That was only 2.5-mm-Hg more of a drop (p=0.08) than seen in a comparator group of men who had received standard educational pamphlets on high BP in African Americans, but no BP checks or other encouragement to assess blood pressure at the barbershops.

"That doesn't sound like much of a blood-pressure fall for any one person, but at the population level it's a very large effect," lead author Dr. Ronald G Victor (Cedars-Sinai Heart Institute, Los Angeles, CA) observed.  

A barber chair is a great setting for measuring blood pressure -- much better than, say, a table in a cold examination room, where the patients are holding on with tight knuckles, legs and arms dangling. Moreover, it wasn't the study's primary outcome. The primary outcome was change in rate of BP control among hypertensives, with BP control defined conventionally as achievement of <135/85 mm Hg for nondiabetics and <130/80 for diabetics.  

By that measure, men in the intervention group did significantly better, with a BP-control rate that was 8.8 absolute percentage points higher than achieved in the comparator group (p<0.04).

The findings show that the barbershop is an effective venue for delivering health messages to a population, African-American men, that is at especially high risk for hypertension and its complications.

"Black-owned barbershops hold special appeal for community-based intervention trials," the researchers write, "because they are a cultural institution that draws a large and loyal male clientele and provides an open forum for discussion of numerous topics, including health, with influential peers." 

Part of what made the intervention strategy work, he said, was the amount of responsibility given to the barbers themselves, who took their customers' blood pressures and encouraged them to see a doctor when appropriate.  

"The barbers can be looked at as sort of an indigenous work force of community health workers," Victor said. Their established relationship with the customer was central to the study's design. "Having them be the centerpiece and own the intervention -- I think that was the unique aspect of the trial."  

In his editorial accompanying the report, Dr. Clyde W. Yancy (Baylor University Medical Center, Dallas, TX) agrees that the barber-patron relationship was key. "In the current study," he writes, "African American men frequenting community barbershops were exposed to health messaging and specifically hypertension screening by a trusted partner. This issue cannot be overemphasized, because the barrier of cultural competency that permeates the traditional healthcare-provider-patient interface in at-risk communities is a nonissue when a community partner assumes the task of elevating awareness, screening for risk factors, and becoming a change agent." 

The present study therefore outlines two potentially effective community-based strategies to improve hypertension detection and control: providing culturally sensitive health-education materials …  in a trusted venue (barbershops); and incorporating community partners (barbers) in the care of those with known risk factors for heart disease." 

Archives of Internal Medicine, Oct 25, 2010