Faculty Bibliography

BACKGROUND: Barbershop-based hypertension (HTN) outreach programs for black men are becoming increasingly common, but whether they are an effective approach for improving HTN control remains uncertain. METHODS: To evaluate whether a continuous high blood pressure (BP) monitoring and referral program conducted by barbers motivates male patrons with elevated BP to pursue physician follow-up, leading to improved HTN control, a cluster randomized trial (BARBER-1) of HTN control was conducted among black male patrons of 17 black-owned barbershops in Dallas County, Texas (March 2006-December 2008). Participants underwent 10-week baseline BP screening, and then study sites were randomized to a comparison group that received standard BP pamphlets (8 shops, 77 hypertensive patrons per shop) or an intervention group in which barbers continually offered BP checks with haircuts and promoted physician follow-up with sex-specific peer-based health messaging (9 shops, 75 hypertensive patrons per shop). After 10 months, follow-up data were obtained. The primary outcome measure was change in HTN control rate for each barbershop. RESULTS: The HTN control rate increased more in intervention barbershops than in comparison barbershops (absolute group difference, 8.8% [95% confidence interval (CI), 0.8%-16.9%]) (P = .04); the intervention effect persisted after adjustment for covariates (P = .03). A marginal intervention effect was found for systolic BP change (absolute group difference, -2.5 mm Hg [95% CI, -5.3 to 0.3 mm Hg]) (P = .08). CONCLUSIONS: The effect of BP screening on HTN control among black male barbershop patrons was improved when barbers were enabled to become health educators, monitor BP, and promote physician follow-up. Further research is warranted. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT00325533.

Resistant hypertension is common among adults with hypertension affecting up to 30% of patients. The treatment of resistant hypertension is important because suboptimal blood pressure control is the leading preventable cause of death worldwide. A frequent comorbid condition in patients with resistant hypertension is obstructive sleep apnea. The pathophysiology of sleep apnea-associated hypertension is characterized by sustained adrenergic activation and volume retention often posing treatment challenges in patients with resistant hypertension. This review will address some of the epidemiologic data associating apnea with the pathogenesis of resistant hypertension. Diagnosis and management of apnea and its associated hypertension will also be considered

The diagnosis of masked hypertension has been made easier with the widespread availability of home blood pressure monitoring devices with levels of accuracy comparable to ambulatory blood pressure monitoring. The negative impact of masked hypertension on cardiovascular morbidity and mortality is evidenced by numerous well-designed clinic-based and population-based studies. The relationship of masked hypertension and target organ damage is also well documented. These two factors, combined with the robust evidence of reduced cardiovascular morbidity and mortality achieved with blood pressure treatment, makes the argument for actively identifying patients with masked hypertension and prescribing treatment similar to that for patients with sustained hypertension. In this paper, we review the evidence for the cardiovascular prognosis of masked hypertension compared with sustained hypertension, we review its impact on target organ damage, we propose an algorithm for the treatment of patients with masked hypertension, and we point out the pitfalls in adopting such an approach

OBJECTIVE: To apply qualitative research methods in developing a culturally tailored, educational workbook for hypertensive black patients. METHODS: The workbook was developed using formative qualitative data from 60 black primary care patients with hypertension. Participants were interviewed using qualitative methods and data were analyzed through sequential steps of open coding, axial coding, and selective coding. From these analyses, themes describing patients' cultural beliefs about hypertension were derived and used to develop the workbook. RESULTS: The workbook, 'Living With Hypertension: Taking Control' is a 37-page illustrated workbook with 11 chapters based on patients' perceptions of hypertension. These chapters focus on strengthening participants' ability to take control and manage hypertension and on providing knowledge and health behavior techniques. CONCLUSION: Qualitative research methods were used to inform the development of a culturally tailored educational workbook. PRACTICE IMPLICATIONS: The workbook developed in this study may offer a practical and effective means of educating patients about blood pressure control in primary care settings