Cut Your Pressure Too: The Los Angeles Barbershop Blood Pressure Study

Uncontrolled hypertension (HTN) is one of the most important causes of premature disability
and death among non-Hispanic black men. Indeed, black men have the highest HTN death rate of
any U.S. race, ethnic, or gender group, contributing to a lower life expectancy. The
age-adjusted HTN-related death rate is 3.3-times higher among black men than white men. To
address this major health disparity, the investigators designed a novel community-partnered
team approach to improve HTN management among black men and prevent needless strokes, heart
attacks, kidney failure, and heart failure.

HTN requires physician (or middle-level provider) interaction to optimize blood pressure (BP)
medication; black men have less interaction than black women; and thus far lower rates of HTN
treatment (73% vs. 86%) and control (36% vs. 50%). Black-owned barbershops are a uniquely
personal setting to discuss health with influential male peers. Barbershop health outreach is
well-established, but untested as a vehicle for improving HTN control. Scientific evaluation
is crucial to best allocate finite healthcare dollars and avoid promoting a "community health
industry" that benefits only the promoters.

Under-treatment of HTN is common in primary care due to competing demands on physicians'
time. The best way to improve HTN control is with team-based approaches enlisting
pharmacists. They are more accessible than physicians, more knowledgeable about medication,
and receive training on patient education. The investigators' new conceptual model links the
barber-based intervention to team-based care delivery.

The purpose of this research study is to compare this new conceptual model to another
barber-based patient-centered blood pressure program to see which is more effective in
improving high blood pressure among Black patrons of African American owned barbershops in
LA. Patrons randomized to Group 1 (the new conceptual model) will provide blood pressure
readings for patrons aged 35 to 79 years of age and refer those with HTN to a Clinical
Pharmacist to work with their doctors in optimizing blood pressure medication.

Patrons of Group 1 shops will also be exposed to role model posters are not intended as
recruitment materials, but rather are educational tools that intend to highlight positive
experiences of participation. The text of the role model stories will in no way provide
statements of the effectiveness of the intervention being evaluated by the present research
study. Rather, they are the main health messaging tools needed to promote completion of the
program in order to achieve the experiences described. Essentially the document will be used
as an intervention tool for peer-based health messaging - stories from real customers in the
barbershop modeling target behaviors leading that promote continued participation in the
protocol by peers with the hopes of achieving to the detection, treatment, and control of
high blood pressure. Each role model story will encourage one of two desired health behaviors
of potential subjects with elevated BP: 1) ask the barber to check patients' BP with each
haircut, 2) schedule a follow-up visit with the study pharmacist to get patient's blood
pressure under control. Large posters in the barbershop will show the model customer, his
barber, and the study pharmacist who facilitated the desired behavior change. The model's
(participants) own words will be used on the poster.

Group 2 barbershop patrons will be exposed to up-to-date information on high blood pressure
and on lifestyle topics for blood pressure and heart health including weight management,
healthy cooking, cholesterol lowering, and exercise.

A pre-specified cross-sectional sub study utilized the trial's initial screening population
to test for an association between self-reported nocturia (>2 nightly/voids) and elevated
daytime (in-barbershop) blood pressure.

Inclusion Criteria:

- 35 to 79 years of age

- Non-Hispanic Black men

- Long-term/frequent barbershop patronage (barbershop patrons having at least one
haircut every 6 weeks in the same barbershop for the past 6 months).

- Systolic BP >140 at 2 screenings on 2 separate days

- Complete set of Baseline Data

Exclusion Criteria:

- Women

- Children

- <35 years of age

- Non-black

- Hispanic ethnicity

- New/infrequent patronage (<8 haircuts at same barbershop in last 12 months)

- Systolic BP <140 at either screening

- Currently receiving cancer chemotherapy

- On Dialysis

- Incomplete baseline data

- Serious Plan to Move in the next 1.5 years

- Plans to be out of the area for > 1 month in the next 1.5 years