番茄社区

African American men got better hypertension control from an intervention involving specialty pharmacists visiting their barbershops than if they were just encouraged to seek medical care from their usual doctors, a cluster randomized trial showed.

Mean systolic blood pressure dropped 27.0 mm Hg after 6 months in men assigned to barbershops where barbers encouraged patrons to meet with specialty-trained pharmacists who prescribed drug therapy under an agreement with the participants' doctors, compared to a decline of 9.3 mm Hg in systolic pressure among men assigned to control barbershops, where the barbers merely promoted lifestyle modification and physician visits.

Mean declines were 21.6 mm Hg greater with the intervention (95% CI 14.7-28.4), Ronald Victor, MD, of Cedars-Sinai Medical Center in Los Angeles, and colleagues reported in the and simultaneously at an American College of Cardiology meeting late-breaking trial session in Washington, D.C.

The blood pressure goal of 130/80 mm Hg or less -- fitting with the new 2017 American blood pressure guidelines -- was achieved in 63.6% of intervention versus 11.7% of control groups (P<0.001).

"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," Victor's group concluded.

As it stands, non-Hispanic black men have the highest rate of hypertension-related death of any racial, ethnic, or sex group in the U.S., they noted, adding that black men have less physician interaction than black women and lower rates of hypertension treatment and control.

"The study builds on previous studies that demonstrate black barbershops can be effective venues for interventions to lower blood pressure in black men. Previous studies have also demonstrated that pharmacist-led interventions to improve hypertension control can be effective," commented Joseph Ravenell, MD, of NYU Langone Health.

Therefore, Ravenell told 番茄社区, it wasn't surprising that an intervention combining these two ideas was successful. "The major innovation is introducing the pharmacist into the barbershop," he said.

"Churches, beauty salons and nail salons may be alternative community-based venues where this intervention can be replicated. The key characteristic of a successful venue for this kind of intervention is that it is a trusted place for the community of interest," he suggested.

The study included 319 African-American men 35-79 years old with baseline systolic blood pressure exceeding 140 mm Hg in two screenings (it averaged 152.8 mm Hg in the intervention arm and 154.6 mm Hg in controls). All blood pressure readings were taken with the Accutorr V oscillometer.

Pharmacists monitored plasma electrolyte levels right at the barbershop. They were instructed to prescribe drugs that insurance would cover, preferably amlodipine plus a long-acting angiotensin receptor blocker or angiotensin-converting enzyme inhibitor.

Intervention and control groups differed in their baseline cholesterol level, which was higher in the intervention arm. This and the unblinded nature of the trial opened up the possibility of bias, the authors acknowledged.

Over 6 months, each participant assigned to the intervention averaged seven in-person pharmacists visits, four follow-up phone calls from pharmacists, and six participant-initiated contacts with pharmacists.

The investigators highlighted the 95% rate of retention among the intervention group. "That loyal patrons of barbershops are consistent in their visits (every 2 weeks for a decade) facilitated hypertension management in the present trial," Victor and colleagues noted.

These patients also had few adverse events, namely three cases of transient acute kidney injury when patients tried indapamide. The one death in this group was determined not be related to trial participation.

"Sustainability beyond 6 months is being examined in an ongoing extension study," according to Victor's group. "Because this was an efficacy trial, large-scale implementation would require broader inclusion criteria and cost-effective business models."

"Hopefully the study reports on the costs of implementing the intervention, and projects the number of potential complications avoided as a result. Given the significant blood pressure lowering reported in the study as a result of the pharmacist intervention, we would expect many strokes, heart attacks and deaths to be prevented. Avoiding these complications of hypertension would be highly beneficial to the overall health of the population, and would likely be cost-saving to the healthcare system," Ravenell suggested.

Whether pharmacist-led interventions in barbershops are feasible and sustainable in general "will require involvement and buy-in of key stakeholders, such as pharmacies, insurance payors, and health systems," he said.

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