High blood pressure worried Mark Sims, but the 43-year-old law firm clerk wasn’t eager to take part in an unusual project. He doesn’t like taking pills. And he had never thought of his favorite barbershop as a place to get medical treatment.
But Sims succumbed to the persuasive charms of barbershop owner Eric Muhammad and signed up for a trial to see if measuring and treating blood pressure in barbershops could help African-American men.
The experiment, reported in the New England Journal of Medicine and presented to a meeting of the American College of Cardiology, was a resounding success and provides strong evidence that taking medicine to the people — in the places they go regularly, with people they trust — can achieve remarkable results.
At the beginning of the study, Sims felt fine and was startled at how high his blood pressure was.
“It was, like, 175 over, like, 125,” he told NBC News. “I was stroke-bound. That scared me.”
After a few months of treatment, Sims’ blood pressure is now close to optimal, 125 over 95.
"These are very large changes for any high blood pressure trial.”
The barbershop study points to new ways to treat African-American men, the group most at risk from high blood pressure.
The researchers did it by taking the treatment to the men's regular hangout: the barbershop.
“It's always been the meeting place ... a place where you might catch a domino game or a chess game, good conversation,” said Muhammad, who owns A New You Barber And Beauty Salon in Inglewood, California. “For black men, it's always been a great place for us to have time with our sons. It's the man cave.”
Dr. Ronald Victor of the Cedars Sinai Medical Center in Los Angeles and colleagues were looking for ways to reach black men, who have extraordinarily high rates of heart attacks, sudden cardiac arrest, heart failure and stroke.
“Black men have the highest rates of high-blood-pressure-related disability and death of any group in the United States,” said Victor.
Nearly half of all Americans have high blood pressure, according to the American Heart Association. High blood pressure damages blood vessels and can lead to organ damage such as kidney and heart failure, as well as heart attacks and stroke. It’s hard to detect because it does not make people feel bad.
Only a blood pressure reading by a professional can diagnose the condition.
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- blood pressure of 120/80 or above is considered elevated
- 130/80 to 139/89 is considered Stage 1 hypertension
- anything 140/90 or above is considered stage 2 hypertension
If blood pressure reaches 180/120 or higher — and either number in the blood pressure reading counts — people are in hypertensive crisis, with need for immediate treatment or hospitalization.
But black men often don’t trust doctors and it can be hard for working people to get to one, anyway. Primary care offices are usually only open during the hours that people have to be at work.
“A lot of the men in our study were working at least two jobs to make ends meet,” Victor said.
“To set a schedule for seeing a doctor, in an inconvenient place, in a medical building, finding a place to park, having to go there to get your blood pressure checked and go to a clinical laboratory maybe three weeks from now at 3:00 in the afternoon just isn't a possibility,” said Victor.
“We made it really convenient. We brought the medicine to them, rather than the usual of having patients come to us.”
And, Muhammad added, men, in general, don't want to go to the doctor. “In the inner cities, it's even worse, because we don't have the best of health care in the inner cities,” he said.
'If you can't relax in a barber's chair ...'
The barbershop team, which included a pharmacist with special training to treat blood pressure, made it convenient for the men.
“So, the men came in and got their hair cut and they got their blood pressure cut at the same time,” Victor said. “We brought the medicine to them, rather than the usual of having patients come to us.”
Over the course of the study, there were large changes in the men’s blood pressure, which fell from an average of 152.8 mm of mercury (the top reading) to 125.8 mm, the team reported.
“A blood-pressure level of less than 130/80 mm was achieved among 63.6 percent of the participants in the intervention group,” they wrote in their report.
“It's humongous,” said Victor. “It's a very large change, more than 20 millimeters of mercury in the top number, which is the systolic number. The bottom number, the diastolic, fell by about — was about 15 millimeters mercury lower.”
The team worked with 319 volunteers. Half were randomly assigned just to get advice about blood pressure, without specific medical treatment. Their blood pressure fell, too — but by far less, from 150 mm to 145 mm.
“We saw nothing but results. Every single one of my clients that was involved in the study, during the time of the study their blood pressure went down,” Muhammad said.
It wasn’t just the interaction and conversation about how to lower blood pressure with a better diet and exercise. It was the treatment, too: the trained pharmacists tended to be more aggressive about using drugs to treat blood pressure than physicians usually are, Victor said.
They followed a set protocol and used drugs that the patients’ health insurance could be counted on to pay for.
Turns out, a comfortable, straight-back barber’s chair, with footrests and arms at heart level, may be the perfect place to measure blood pressure, said Dr. Ronald Victor of the Cedars Sinai Medical Center in Los Angeles.
“If you can't relax in a barbershop, you can't relax,” he said.
Sims said it changed his life.
“I have an eight-year-old son,” he said. "And I need to be here for him."
Now, Sims eats less fast food and more salads and home-made food. He works out every morning.
"I do little routines. Some push-ups. Jogging in place. Some curls,” he said. “It makes me feel better every day.”
The study changed Victor’s life, too.
“I have high blood pressure myself. And my high blood pressure was diagnosed by a barber,” he said.
"His name is Steve Burrell and he worked at Van Russell's Red Bird Corners Barber Shop in Dallas, Texas.”
Victor, who was training his barber to measure blood pressure, agreed to be tested.
“And so my blood pressure was high," Victor said. "And he said, ‘Now, Doc, you know, if you're going to talk the talk, you'd better walk the walk.’ So I really felt like a damn fool and I went and saw my doctor and got treated.”