The 27.0-mm Hg systolic blood pressure reduction achieved by a specialty pharmacist intervention for black men at barbershops -- reported at the American College of Cardiology meeting and New England Journal of Medicine last month -- was on par with the early promise of renal denervation.
But does the "astounding" benefit stand a better chance in real-world use? Leslie Cho, MD, head of preventive cardiology at the Cleveland Clinic, discusses the implications in this exclusive 鶹ý video.
A transcript of her comments follows:
The Barbershop Study was a very interesting study. It's a cluster, randomized control study of blood pressure control in African American men using barbershop as the intervention place and pharmacists with physician supervision as the focal person for adjusting blood pressure medicine.
The intervention arm where patients were seen every 2 weeks at the barbershop and had their medication adjusted had an astounding 27-mm Hg decrease in their systolic blood pressure. This is if those of you who know anything about hypertension trials knows that that is an amazing result in terms of blood pressure reduction. The study brings up three very interesting questions and that is: Number 1, all of us have done trials, we've done trials in a hospital and physician's office -- this takes it to where patients are, in their community, and addressing them at that point of contact.
The second very interesting question is in very difficult-to-manage hypertension patients, like African American men who have greater than 80% risk of having cardiovascular disease compared to their Caucasian counterpart, really doing a targeted, culturally sensitive, focused intervention and seeing the result that's so spectacular as you saw in the Barbershop Study.
Then the third is the economic impact of doing something like this in an everyday clinical setting.
Let's just talk about the interesting trial design and that is taking the trial outside of hospitals and physician's office and going to your local community. I think we'll be seeing more and more of these kind of trials. In the era of social media, in an era of smartphones, I think you will see more and more of these kind of patient-directed, culturally-sensitive trials coming down the line. For that, this trial is spectacular in terms of bringing that first of that kind of trial to light.
In terms of the patient population and really catering our treatment to patient preference and their cultural needs, I think that's also great. Now the issue about how to target individual patients so it really is a personalized medicine. We always talk about personalized medicine and think about genes. But honestly, the personalized medicine aspect is meeting patients where they're at and finding what works for them. I think trials like this really bring that to fruition, and I think it's really important that we target patients and treat them appropriately to whatever that they need. I think for that this trial is also excellent.
The thing about this trial that I think will be a little problematic is how to do something like this in a clinical setting, because it requires so much money. Economically, I think it's a little bit unfeasible to have a pharmacist in barbershops, seeing patients every 2 weeks, adjusting, very aggressive medication adjustment, going from calcium channel blockers plus ACE inhibitors and escalating to Aldactone [spironolactone] and then escalating to a fourth drug. I think that economic-wise we really, as a society, need to think about how else we can do something similar to this, but would make more economic sense.
But I think, overall, it's a really great study, taking us to a new paradigm in terms of patient contact, patient intervention, and thinking about economic implication.