Barber and Pharmacist Coordination to Improve Blood Pressure Management

The original, "Cut Your Pressure Too: The LA Barbershop Blood Pressure Study (LABBPS)" (NCT02321618) was a highly successful cluster-randomized trial of a community centered blood pressure (BP) reduction program focused on Non-Hispanic (NH) black men who experience the highest rates of hypertension (HTN) and its complications. Patrons of 52 barbershops in Los Angeles County were randomly assigned to either an intervention arm in which barbers encouraged meetings with trained clinical pharmacists who provided HTN treatment in the barbershops or a control arm in which barbers provided educational pamphlets on HTN and encouraged physician appointments. After 6 months, the intervention group had a statistically significant reduction in systolic BP (SBP) of 21.6 mmHg compared to the control group. Results were durable at 1 year. Thereafter, a pilot study (NCT03726710) aimed at improving the efficiency of the barbershop model of HTN care by substituting in-person visits with video visits once BP was at goal was undertaken in 10 hypertensive barbershop patrons. The intervention effect was unchanged. The current study represents Aim 3 of an NIH funded renewal application entitled, "Barber and Pharmacist Coordination to Improve Blood Pressure Management in Black Men". The goal of the study is to build upon the foundational work of the original study and adapt the in-person clinical pharmacist-led LABBPS hypertension (HTN) management program into a complete telemedicine version and assess feasibility, acceptability, effectiveness, and implementation considerations of the adaptation to inform future scale-up. We will design and test the impact of barber assisted hypertension screening combined with clinical pharmacist-led hypertension management delivered via a secure video platform among 55 men from 10 barbershops. Participants will be age 35-79 years with stage 2 hypertension defined as systolic blood pressure ≥ 140 mm Hg and/or diastolic blood pressure ≥ 90 mm Hg. This diverse age group was chosen because current guidelines recommend initiation of antihypertensive medications for stage 2 hypertension regardless of baseline cardiovascular risk. In addition to using validated implementation science frameworks to measure feasibility and acceptability, the study will also quantify effectiveness by comparing changes in blood pressure at 6-months to those achieved in the original in-person intervention. Hypertension (HTN) is an exceptionally common condition that imposes a substantial public health burden and disproportionately impacts non-Hispanic (NH) Black men. The Barber and Pharmacist Coordination to Improve Blood Pressure Management Study builds upon the foundational work of the Los Angeles Barbershop BP Study (ClinicalTrials.gov ID: NCT02321618) and seeks to develop a less costly and more convenient telemedicine version of pharmacist-driven, community-based hypertension care for black men that will enable widespread adoption of this healthcare model across barbershops nationwide. While the barbershop-based approach has demonstrated success in non-Hispanic black men, the benefits may well extend to other racial and ethnic populations who frequent community- based venues. Increasing adoption of community-based interventions and enabling supportive healthcare policies requires the demonstration of a financially feasible model and durable impact on clinical outcomes.