BP Care in Black Barbershops Successfully Taken Up in Nashville

The model of the neighborhood Black barbershop providing blood pressure (BP) checks and facilitating hypertension care was adapted successfully in a Tennessee city, though investigators warned of local challenges.

With the intervention implemented at eight barbershops in Nashville, 27 African Americans with uncontrolled hypertension were able to bring BP down from an average 157.7/95.1 mm Hg at baseline to 125.7/75.6 mm Hg at 6 months, according to Jarod Parrish, PharmD, of Vanderbilt University Medical Center in Nashville.

By 6 months, 85% of the group had their BP below 140/90 mm Hg, 74% had BP under 135/85 mm Hg, and 67% had their BP below 130/80 mm Hg, Parrish told the audience during this year’s virtual Hypertension Scientific Sessions hosted by the American Heart Association (AHA).

The intervention was modeled after the Los Angeles Barbershop Blood Pressure Study (LABBPS) protocol in which clients met monthly with pharmacists for a BP check at their barbershop, got prescribed antihypertensive medication, and received follow-up care by their primary care provider.

Black adults are disproportionately affected by hypertension, with mistrust of the medical community commonly cited as a barrier to care.

“The relationship between the barber and client lends a level of credence to endeavors of health and wellness that cannot be found anywhere else,” said Parrish in a Vanderbilt press release from last year. “This model will help tear down barriers of entry for the African American community, such as the distrust in the health care system due to historical injustices, and will show that, when trusted, the health care system can deliver life-altering results.”

In Nashville, participating barbershop customers met monthly with a pharmacist for medication management, and the barbers also measured BP during haircut appointments. The latter did so using a rolling blood pressure cart, stationed at each barbershop, comprising a BP monitor hooked up to a computer that automatically sent results to UCLA and Vanderbilt.

Notably, Tennessee did not permit specialty-trained pharmacists to practice independently, requiring physician visits to establish care, according to Parrish.

This was an important lesson given that the investigators’ goal was to establish a network of barbershop research hubs in Nashville as a test case for recruiting people with uncontrolled hypertension for future studies.

COVID-19 marked another challenge for the Nashville investigators, who had to amend their study protocol and study execution when all activities were initially stopped and then resumed with public health restrictions.

“Telehealth adaptations facilitated care delivery and were feasible in the barbershop locations,” Parrish noted.

LABBPS investigators had previously found a telemedicine component to work for hypertension care in Los Angeles barbershops as well.

Parrish and colleagues conducted their single-arm study from 2019 to 2021 in collaboration with community stakeholders in Nashville (barbershops, local pharmacy owners, local department of health) and the LABBPS team.

The eight participating barbershops had been in business for an average of 20 years. Each shop trained as many as four barbers for the study.

Their clients were eligible for inclusion in the study if they were Black men ages 35 to 79 with systolic BP exceeding 140 mm Hg on two screening visits. They were also required to be regulars of the barbershop, having had four haircuts from that shop in the prior 6 months.

Out of 587 barbershop clientele, 82 completed screening and were deemed eligible, of whom 30 participated and had complete data at 6 months. This cohort averaged 50.5 years of age and individuals had a mean body mass index of 32.9. Nearly half were current smokers and half reported high school or less education. None reported any prior stroke, MI, heart failure, or kidney disease.

Parrish’s team included the 27 people who agreed to having medications in their care plan in the main analysis.

At baseline, 15% of participants reported health as excellent or very good, which grew significantly to 56% at 6 months.

Adverse reactions reported were deemed unrelated to the barbershop intervention. These included three COVID-related events and seven anticipated events such as ankle swelling and dizziness, Parrish noted.