Black Men With High Blood Pressure, See Your Barber?

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Mid adult man getting his haircut in a barber shop and reading a newspaper

Black men have the highest rate of hypertension-related death of any group in the U.S. (three times the rate of white men), partly because high blood pressure goes untreated in so many African Americans. To help remedy the problem — especially in patients who haven’t sought a doctor’s care — public health officials have long offered regular blood pressure screening at common places of congregation: churches, community centers and barbershops. Question is, do such interventions work?

Some of these initiatives have been ongoing since the 1980s, but until now no one has done a systematic study of their effects. Now, a new study of 17 Dallas-area barbershops with primarily black clientele finds that when barbers offer free blood pressure screening and encourage patrons with high blood pressure to see their doctor, it helps people control their hypertension. (More on Want Good Health? There Are 10 Apps for That)

In the study, barbershops were assigned to be either an “intervention” shop or a control shop. In the intervention shops, barbers began with a 10-week baseline BP screening. Over the next 10 months, barbers offered clients BP checks with every haircut, and urged those with high blood pressure to see a doctor. They also gave clients referral cards to give their doctors with their latest BP readings. As extra motivation, the barbers were trained to tell clients “model” stories about other patrons who benefited from getting their hypertension under control.

If a hypertensive client had not seen a doctor by his next haircut, the barber would schedule an appointment for him. If the client then saw the doctor, he received a free haircut. (More on Why Are Black Bikers More Likely to Die in Crashes than Whites?)

In the control group, patrons were simply given a baseline screening and then were given a standard American Heart Association pamphlet about high blood pressure in African Americans.

At the end of the 10-month period, both groups successfully got clients to treat their blood pressure, but the rate of success in the intervention group was higher. Among the 695 clients with hypertension in the intervention group, the percentage who had brought their BP down to a safe level increased from 34% at baseline to nearly 54% 10 months later. Among the 602 men with high BP in the control group, that rate went from 40% to 51%. In the intervention group, 20% of hypertensive clients were on BP medication, compared with 10% of the control group.

The authors of the study note that widespread barbershop outreach could reduce heart attacks, strokes and death in the vulnerable black population, and save the health-care system millions. They write:

If the intervention could be implemented in the approximately 18,000 black-owned barbershops in the United States to reduce systolic BP…in the approximately 50% of hypertensive U.S. black men who patronize these barbershops [an estimated 2.2 million people], we project that about 800 fewer myocardial infarctions, 550 fewer strokes and 900 fewer deaths would occur in the first year alone, saving about $98 million in [coronary heart disease] care and $13 million in stroke care.

“What we learned from this trial is that the benefits of intensive blood pressure screening are enhanced when barbers are empowered to become health care extenders to help combat this epidemic of the silent killer in their community,” said the study’s author Dr. Ronald G. Victor of the Cedars-Sinai Heart Institute in Los Angeles in a statement. “Barbers, whose historical predecessors were barber-surgeons, are a unique work force of potential community health advocates because of their loyal clientele.” (More on Why Do Black Patients Get Unwanted End-of-Life Care?)

The study, titled BARBER-1 (for Barber-Assisted Reduction in Blood Pressure in Ethnic Residents), was published online Monday by the Archives of Internal Medicine.

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