The Clinical Research Forum recognized the Cedars-Sinai’s Smidt Heart Institute with a 2019 Top Ten Clinical Research Achievement Award for its study aimed at developing a blood-pressure control program for African-American men in the comfortable and convenient environments of their barbershops.
In just six short months, the study – first published in the New England Journal of Medicine and led by the late hypertension expert Ronald G. Victor, MD – improved the outcomes and control of high blood pressure in more than 60 percent of participants.
The 12-month data published recently in the peer-reviewed journal Circulation backs up the results, proving that a pharmacist-led, barbershop-based medical intervention can successfully lower blood pressure in African-American men who face a higher risk of disability and premature death due to uncontrolled high blood pressure.
Not only are black men disproportionately affected by hypertension, they’re also the least likely population to seek treatment.
Nearly 64% of the study participants who worked with their barber and a pharmacist at the barbershop were able to lower their blood pressure.
Barber Eric Muhammad says that’s one reason he was so enthusiastic about the study. He’d hosted other single-day awareness events about hypertension, but Dr. Victor’s study aimed to find a long-term solution for treating high blood pressure.
“High blood pressure has cost the lives and health of a lot of good men,” Muhammad said. “What’s different about this study is it looks at bringing down blood pressure by using the men’s community—their friends, family, and support group.”
The collaboration between physicians, pharmacists and barbers showed that medical intervention in neighborhood settings can profoundly improve the health of hard-to-reach, underserved communities. Cedars-Sinai was nominated for the award by researchers at UCLA, the University of California, Los Angeles.
When a customer opens the well-worn door to Eric Muhammad‘s barbershop in Inglewood, he’ll be looking to relax in the comfort and camaraderie of a neighborhood meeting place and maybe to take a little off the top or sides. If that visitor is among the close to 40% of African American men with high blood pressure, he might also get a little taken off the top of that vital health reading.
New research suggests that shops like Muhammad’s A New You Barber and Beauty Salon might be just the place to rescue African American men from an epidemic that has ravaged their ranks: uncontrolled hypertension.
The study found that when a group of African American men with untreated high blood pressure got a screening and a friendly nudge from their barber, as well as a visit to the shop from a pharmacist, close to two-thirds of the men brought their blood pressure into a healthy range. Their systolic blood pressure — the top-line number that measures the pressure in your vessels when the heart beats — fell by an average of 27 points. In addition, their diastolic blood pressure — the bottom number that measures pressure on the vessels’ walls between heart beats — fell by an average of nearly 15 points.
The 132 men who got a barbershop visit from a pharmacist were almost six times more likely to bring their blood pressure under control than were those who just got a barber’s advice to eat better, exercise more and see a doctor. Fewer than 12% of the 171 men in the latter group brought their blood pressure under control. (Their average reductions in systolic and diastolic blood pressure readings were too small to be considered statistically significant.)
The clinical trial was conducted from February 2015 to July 2017 in 52 black-owned barber shops across Los Angeles County. Two pharmacists specially trained to treat high blood pressure shuttled across a 450-square-mile area bringing advice and an array of medications to the study’s participants. “Bringing rigorous medicine directly to men in a barbershop, and making it so convenient for them, really made a difference,” said Dr. Ronald G. Victor, who led the new study.
“We had hoped for maybe a seven-point difference” between the two groups in their systolic blood pressure, the one that is considered a better predictor of heart attack and stroke risk, Victor said. “But this was a really big difference” — the kind that “could make an impact on a national level” if the initiative were scaled up, he said. “We were really ecstatic.”
The trial results were published in the New England Journal of Medicine and presented Monday at the American College of Cardiology‘s annual meeting. Victor said that the inclusion of two pharmacists — a white woman and a woman of color, each of whom turned in similar results — was the “secret special sauce” that appeared to bring participants’ blood pressure in check. But skilled as these pharmacists were, Victor said they might not have gained the trust and influence they eventually enjoyed if they had not been welcomed into barbershops and introduced by their trusted proprietors.
“I can’t emphasize enough how much the barbers’ buy-in made all the difference,” said Victor, the associate director of Cedars-Sinai’s Smidt Heart Institute. The African American shop owners who participated in the study had been in business an average of 17 to 18 years, and the men they enrolled had typically been coming to their shops for more than a decade, typically once every two weeks.
Muhammad was among the first to sign on to the study. The proprietor of his shop for 18 years, Muhammad helped recruit nearly half of the other barbers who participated in the trial. At the busy corner of La Brea and Florence avenues, Muhammad presides over a “refuge” whose door is open “whether you’re a doctor or a gang member.” For a lot of people, he said, “just being here is a blessing.” Muhammad said he has always considered himself a potential agent of health promotion. But “it certainly surprised me for a doctor to come up with that idea,” he said.
Victor said that his own hypertension had been diagnosed by a barber during a training session for an earlier version of this study in Texas. When Victor protested that he must have been momentarily tense while getting tested, the barber gently admonished him. “If you can’t relax in my barber chair, Doc, you’ve got a problem,” the stylist told him. “Now if you’re gonna talk the talk, you gotta walk the walk.”
Close to 40% of African American men have high blood pressure, a higher rate than any other ethnic group. And about one-third of those men — compared with 43% of white men and almost 50% of black women — have brought their hypertension under control with medication. This exacts a breathtaking toll among African American men in terms of death and disability. Their high rates of heart attack and stroke largely explain the 3.4-year difference in the life expectancy between blacks and whites in the United States.
Victor was optimistic that barbershops could help close that gap. “These are magical places,” he said. “They’re a window into some of the most positive aspects of black men’s social lives: loyalty, friendship, inclusiveness. There are dads bringing their sons in, customers who have come to the same place since they were children. These men were not in the clinic, that’s for sure.”
In African American communities, “we can map the places of black barbers right there alongside black ministers” as agents of trust and authority, said Vassar College history professor Quincy T. Mills.
Prospective patients might ordinarily view physicians and pharmacists with a suspicion borne of years of systemic abuses, Mills said. But in the familiar environment of their barbershop, “I suspect the men were comforted that these interactions were happening in a crowd of people, giving them space to ask others, to push back.”
Mills, the author of “Cutting Along the Color Line: Black Barbers and Barber Shops in America,” said that a man’s health is not a subject that routinely comes up while he is in the chair. But a barber’s position of leadership, his association with personal care and the connections he forges over time with his customers may allow him to stretch the bounds of what is permissible.
“That level of trust in the barber is the first critical piece here,” he said.
Barbershops are central to the narrative of Black manhood in the United States.
It is where jokes are cracked, friends are made, issues debated, and, soon, where blood pressure will be tested.
According to the Daily Breeze, Dr. Ronald G. Victor, the head of Cedars-Sinai’s hypertension center, will use a $8.5 million grant to help train Black barbers to check men for high blood pressure.
“Uncontrolled hypertension is one of the biggest health problems facing the African-American community today,” said Victor, the Burns and Allen Chair in Cardiology Research. “Hypertension is called the silent killer because there are no symptoms. We need to find a way to reach out to the community and prevent the serious complications caused by high blood pressure because all too often, by the time a patient finds out they have the condition, the heart and kidneys already have been damaged.”
A Cedars-Sinai Heart Institute physician has been awarded an $8.5 million grant aimed at enlisting African-American barbers in the fight against hypertension, a deadly condition that can cause strokes, heart attacks and organ failure, and which is particularly devastating to African-American men.
Now, with the grant from the National Heart, Lung, and Blood Institute, Victor is about to start a new, randomized, controlled clinical trial that will include 500 African-American male patrons of 20 Los Angeles-area barbershops. All participants will have uncontrolled hypertension and be longtime customers of the participating barbershops. The goal of the new trial is to test the effectiveness of barbershop hypertension programs and whether expanding such programs is feasible and cost-effective.
The Cedars-Sinai-led research study will be conducted in partnership with several California medical centers.
According to the Centers for Disease Control and Prevention, 67 million American adults have hypertension. Of that number, 53 million are aware of their condition, 47 million are treated, and 31 million have it under control. Among African-Americans, 43 percent of men and 45.7 percent of women have hypertension, compared to 33.9 percent of White men and 31.3 percent of White women.
Victor’s 2011 study concludes that if hypertension intervention programs were put in place in the estimated 18,000 African-American barbershops in the U.S., it would result in the first year in about 800 fewer heart attacks, 550 fewer strokes and 900 fewer deaths.
“We hope that the new trial’s outcomes will show an even greater benefit while lowering the cost of providing high-quality healthcare for hypertension in a high-risk population,” Victor said.