1. BARBER-1 (Barber-Assisted Reduction in Blood Pressure in Ethnic Residents) A randomized study investigating the effect of having the local barber encourage hypertensive men to visit their healthcare professional to get their blood pressure under control Population and treatment: 17 black-owned barbershops with clienteles consisting almost entirely of African American men. Participants were randomized to the intervention barbershops (n=9, mean 75 hypertensive patrons per shop) or comparator shops (n=8, mean 77 hypertensive patrons per shop). Post hoc analysis: Analysis of the follow-up of patients in the intervention arm who were seen by hypertension specialists and those treated by primary-care physicians (PCPs), as well as follow-up data of patients in the comparator arm F Rader (Cedars-Sinai Medical Center, Los Angeles, CA) ASH 2013

2. BARBER-1: Results (efficacy) Results showed that a barber-based referral system reduced systolic blood pressure by only 2.5 mm Hg vs a comparator group. Overall, the blood-pressure reduction among men treated by PCPs was similar to the change in blood pressure among those randomized to the comparator group. In BARBER-1, in the comparator arm, men received standard educational pamphlets about hypertension in African Americans, but were not given any other encouragement to get their blood pressure checked. In contrast, men who were treated by hypertension specialists had a significant 16.6-mm-Hg reduction in systolic blood pressure vs the comparator arm, suggesting that physician inertia among primary-care physicians might be the reason for the small reductions observed in BARBER-1. Patients treated by hypertension experts were more likely to be treated with ACE inhibitors and calcium-channel blockers and on three or more medications. Medication adherence was no different among the three treatment arms.

3. BARBER-1: Commentary* *All comments from Physician inertia to blame for small BP changes in BARBER-1 (http://www.theheart.org/article/1541125.do) "Quite likely, the undertreatment of hypertension in primary care limited the ability of the barber-based intervention to lower blood pressure. Hypertension specialists should be made accessible to all hypertensive black patrons to realize the full promise of the barber-based intervention. "The blood-pressure reduction at 10 months was huge among the patients treated by a hypertension specialist. It was greater than 40 mm Hg. However, these patients started with a higher baseline systolic blood pressure, so we would expect a large reduction. On the other hand, the patrons treated by primary-care physicians saw the exact same reduction in systolic blood pressure as those in the comparison group. "When we design future interventions, we must not only focus on the diagnosis and referral of black men with uncontrolled hypertension, but must include a physician and treatment component as part of the intervention to really have an effect on hypertension." - Dr Florian Rader