title: Differential treatment of hypertension by primary care providers and hypertension specialists in a barber-based intervention trial to control hypertension in Black men.
abstract: Black men have less physician contact than other groups and thus lower rates of hypertension treatment and control. In the Barber-Assisted Reduction in Blood Pressure among Ethnic Residents trial, hypertension control in 8 active-intervention barbershops where barbers offered blood pressure (BP) checks with haircuts and motivated black male patrons with high BP to seek provider follow-up showed a small improvement over that in 7 comparison shops where patrons received hypertension pamphlets but not barber-BP checks. Undertreatment of hypertension, which is common in primary care, may have impacted the outcomes. Thus, in patrons with a baseline systolic BP of ≥140 mm Hg and 10-month follow-up including BP and medication data, we performed post hoc comparison of systolic BP reduction between comparison-arm patrons (n = 68) treated by primary care providers (PCPs) with (1) intervention-arm patrons (n = 37) treated by PCPs or (2) intervention-arm patrons (n = 33) who lacked access to PCPs and were treated by hypertension specialist physicians serving as safety net providers. The latter group had higher baseline systolic BP than the others (162 ± 3 vs 155 ± 2 and 154 ± 2 mm Hg, respectively, p <0.01). After adjustment for baseline systolic BP and other covariates, systolic BP reduction was 21 ± 4 mm Hg greater than in the comparison group (p <0.0001), when barbers referred patrons to hypertension specialists but was no different when they referred to PCPs (4 ± 4 mm Hg, p = 0.31). Specialist-treated patrons received more BP medication and different classes of medication than PCP-treated patrons. In conclusion, the barber-based intervention-if connected directly to specialty-level medical care-could have a large public health impact on hypertensive disease in black men.
authors: Heart Institute, Hypertension Center of Excellence, Cedars-Sinai Medical Center, Los Angeles, California.
authors: Florian
authors: F
authors: Rader
authors: Robert M
authors: RM
authors: Elashoff
authors: Sara
authors: S
authors: Niknezhad
authors: Ronald G
authors: RG
authors: Victor
mesh_terms: D001741:Black or African American; D000959:Antihypertensive Agents / Q000627:therapeutic use; D001794:Blood Pressure / Q000187:drug effects*; D001795:Blood Pressure Determination; D002140:California / Q000453:epidemiology; D006801:Humans; D006973:Hypertension / Q000188:drug therapy* / Q000208:ethnology / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D058007:Physicians, Primary Care; D011320:Primary Health Care / Q000379:methods*; D016896:Treatment Outcome
chemical_list: D000959:Antihypertensive Agents
references: J Clin Hypertens (Greenwich). 2010 Nov;12(11):869-78
references: 21054774
references: Hypertension. 2010 Nov;56(5):801-3
references: 20921426
references: Arch Intern Med. 2008 Jun 23;168(12):1285-93
references: 18574085
references: Eur Heart J. 2007 Jun;28(12):1462-536
references: 17562668
references: JAMA. 2005 Apr 6;293(13):1595-608
references: 15811979
references: Hypertension. 2010 Nov;56(5):780-800
references: 20921433
references: Med Care. 1986 Jan;24(1):67-74
references: 3945130
references: Arch Intern Med. 2011 Feb 28;171(4):342-50
references: 20975012
references: Hypertension. 2008 Nov;52(5):818-27
references: 18852389
references: Arch Intern Med. 2003 Dec 8-22;163(22):2677-8
references: 14662620
references: Epidemiology. 2007 Sep;18(5):552-60
references: 17879427
references: BMJ. 2011 Aug 25;343:d4891
references: 21868454
references: Am Heart J. 2009 Jan;157(1):30-6
references: 19081393
references: Arch Intern Med. 2012 Sep 24;172(17):1344-5
references: 22869238
references: N Engl J Med. 2001 Aug 16;345(7):479-86
references: 11519501
references: Arch Intern Med. 2002 Feb 25;162(4):413-20
references: 11863473
references: Arch Intern Med. 2011 Feb 28;171(4):350-2
references: 20975014
references: Hypertension. 2008 Jun;51(6):1403-19
references: 18391085
references: Am J Public Health. 2003 May;93(5):724-31
references: 12721133
references: Scand J Work Environ Health. 2000 Aug;26(4):363-7
references: 10994804
references: Hypertension. 2003 Dec;42(6):1206-52
references: 14656957
references: J Hum Hypertens. 2001 Mar;15(3):191-5
references: 11317204
references: J Am Coll Cardiol. 2012 Aug 14;60(7):599-606
references: 22796254
references: Hypertension. 2006 Mar;47(3):345-51
references: 16432045
references: Circulation. 2013 Jan 1;127(1):143-52
references: 23283859
references: J Clin Hypertens (Greenwich). 2009 Jul;11(7):376-82
references: 19583634
references: J Clin Periodontol. 1987 Jan;14(1):34-7
references: 3468126