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.

Trial registration: ClinicalTrials.gov NCT00325533.

Figure 1. Post-hoc Analyses of BP Outcomes

A) Distribution of systolic BP change in 3 subgroups: 1) comparison group patrons treated by PCPs (red solid line); 2) intervention group patrons treated by PCPs (black dotted line); 3) intervention group patrons treated by hypertension specialists (black solid line). B) Mean change in systolic BP in the three subgroups. C) Results of the multivariate linear regression model showing adjusted estimates of the mean group differences in the change of systolic and diastolic BP. The change scores in each intervention subgroup are compared to those of the comparison group and finally within the intervention group with each other. Abbreviations: BP indicates blood pressure; HTN, hypertension; PCP, primary care provider; SE, standard error.