Marc Sims says he was surprised when he walked into his neighborhood barbershop one Saturday morning two years ago and spotted several strangers in gray polo shirts carrying medical gear. Soon enough the 43-year-old law-firm operations clerk, a regular at the Inglewood, California barbershop, learned that the “strangers” were engaged in a research study.
Sims overheard something about measuring blood pressure and about “a health crisis” in the black community. But rather than join in the conversation, he sat and patiently waited for his weekly turn in the barber’s chair. He gazed curiously as the technicians strapped blood pressure cuffs around the arms of several patrons and pumped the cuffs full of air. He listened as they talked to the men about their measurements and what they meant. He wasn’t impressed. “Nope. Not for me. I feel fine,” he thought, even though he hadn’t seen a doctor in years. He had a more important agenda: get his haircut, chat about sports, and leave.
Then something happened: The “strangers”—who turned out to be healthcare workers—kindly asked Sims if he’d like his own blood pressure checked. After more than a little nudging from his barber—shop owner Eric Muhammad—Sims surprised himself and relented. His reading: 175/125 millimeters of mercury (mm Hg), seriously high numbers that signaled he was at dangerous risk for a heart attack and stroke. A normal blood pressure reading is less than 120/80 mm Hg.
“I couldn’t believe how high my blood pressure was,” says Sims, who quickly began to reevaluate his health. “I have an 8-year-old son and I want to be there for him. That’s what motivated me to join the program.”
The “program” was the centerpiece of an NHLBI-funded study led by researchers at the Smidt Heart Institute at Cedars-Sinai Medical Center, and it came with an unexpected twist. It involved placing pharmacists at African-American-owned barbershops so they could monitor the blood pressure of the customers with high blood pressure and prescribe medications. The barbers were also trained to take the blood pressure measurements.
When the program started researchers hoped that the unusual intervention would lead to significant reductions in blood pressure among black men, who have the highest levels of high blood pressure than any other racial, ethnic, or sex group in the United States. This group is also among the hardest to reach, which is why the barbershops, which often serve as trusted social hubs for black men, were chosen as sites for the study.
The results were impressive.
Researchers enrolled 319 African-American men, ages 35 to 79, who had high blood pressure and who were regulars at one of 52 black-owned barbershops in the Los Angeles area. They randomly assigned the men to one of two groups: An intervention group that was encouraged by their barbers to meet with pharmacists who made “house calls” to the barbershops and prescribed blood pressure medications, or a control group that simply got encouragement from their barbers to make lifestyle changes and doctor appointments.
After six months, 63 percent of the men who worked with the pharmacists achieved a healthy blood pressure level, while only 12 percent of the men in the control group did so. The intervention group achieved an average blood-pressure level of less than 130/80 millimeters of mercury (mm Hg). In the control group, the average blood pressure fell to 145 mm Hg.
Researchers say the study was the first to show clear-cut evidence that a medical intervention by a pharmacist in collaboration with a barber can make a key difference in the health of the barber’s regular patrons. The study also showed that the familiar and encouraging nature of the environment helped spur an unusually high retention rate: Nearly 95 percent of participants stayed with the program throughout its initial six-month duration. The researchers published their results in the New England Journal of Medicine.
The success of the program could have far-reaching implications for larger efforts to improve health among black men: High blood pressure, or hypertension, is a major risk factor for developing heart attacks, chronic kidney disease, stroke, and other health problems. Known as the “silent killer,” it affects millions, but less than half those who have it have their blood pressure controlled.
“This study represents a new model for managing blood pressure in black men,” says Ronald G. Victor, M.D., associate director of the Smidt Heart Institute of Cedars-Sinai and the study's lead author. “If implemented widely, it could go a long way toward reducing health disparities and preventing needless death and disability caused by high blood pressure.”
Sims, who now counts himself among the lucky ones, says the intervention forced him to look at his entire lifestyle differently. He admits he smoked, rarely exercised, and ate too much fried food. After the pharmacist consulted with his physician, Sims began dutifully following their advice. He started taking medicine to lower his blood pressure, and he ate more salads and started lifting weights. Importantly, he also stopped smoking and cut down on drinking. And with the added encouragement of Muhammad, his barber, he began getting his blood pressure checked whenever he sat down for a haircut. On many occasions, Muhammad took the measurements himself. After just six months, Sims was able to bring his blood pressure down to 125/85 mm Hg.
Sims says he couldn’t have done it without Muhammad, 39, who was one of the first to sign up his shop, A New You, for the study, which randomly assigned it to the intervention group. About a week after the program began, Muhammad became directly involved in measuring his clients blood pressure, strapping them up to the cuff after they received their haircut. For accuracy, he took up to five quick measurements of the same person in one sitting.
“I’ve watched the blood pressure of my clients go down, and that’s a big win,” Muhammad said. “Almost all of my clients had a lower blood pressure reading than when they first came in the door of my shop.”
Some clients rejected the offer to join the intervention program, despite having received diagnoses of high blood pressure. And two of those, Muhammed says, went on to develop strokes and are in recovery. “Both are in their sixties and are now taking their blood pressure medications very seriously now,” Muhammad adds. “I just wish they had done that before.”
Researchers are currently examining whether the improvements in blood pressure can be sustained over an additional six months and study-leader Victor says they plan to submit the findings for publication in a peer-reviewed journal soon. He is considering bringing a similar intervention study to beauty salons to target black women with high blood pressure, who are also at high risk.
In the meantime, Sims continues to visit his barber regularly for haircuts, all the while keeping up with his new lifestyle regimen. He even has his own blood pressure monitor at home to make sure he’s keeping his numbers under control.
“I not only feel better, but I know that I have information that I can pass along to my community, my peers, and especially, my son,” says Sims, noting that high blood pressure runs in his family.
“My advice to people: get tested for high blood pressure regularly,” he adds. “It can save your life.”