Key Points
- A barbershop-based, community health worker (CHW)-led intervention successfully engaged Black men at high risk for hypertension (HTN).
- A self-directed implementation strategy was as effective as a facilitated approach in preventing blood pressure rise.
- Both strategies blunted the expected age-related increase in systolic blood pressure over 12-18 months.
- The intervention reduced progression to stage 2 HTN, supporting community-based prevention models.
Black men in the United States experience disproportionately high rates of hypertension (HTN) and related mortality, driven by structural barriers, reduced healthcare engagement, and adverse social determinants of health. Traditional clinic-based prevention strategies often fail to reach this population. Barbershops – trusted, culturally relevant community spaces – have previously demonstrated success in hypertension treatment, but their role in prevention has remained unclear. The Community-to-Clinic Linkage Implementation Program (CLIP) was developed to address this gap through CHW-led screening, counseling, and care linkage.
CLIP (NCT05447962) was a cluster randomized controlled trial conducted in 22 barbershops in Staten Island, NY, enrolling 430 Black men with elevated blood pressure or untreated stage 1 hypertension. Barbershops were randomized to either a barbershop facilitation (BF) strategy, featuring structured support for implementation, or a self-directed (SD) approach without facilitation. All participants received BP screening, CHW-led lifestyle counseling, social needs assessment, and referral to primary care. The primary outcome was change in systolic blood pressure (SBP) at 12 months, with secondary outcomes including incident HTN, care linkage, and sustainability at 18 months. The trial design was published in American Journal of Hypertension in November 2025.
Retention was high (90% at 12 months; 95% at 18 months). At 12 months, SBP remained stable in the BF arm and decreased modestly (about 1 mm Hg) in the SD arm. The adjusted between-group difference slightly favored the SD strategy (about 1.6 mm Hg; p=0.03), though absolute changes were small. Importantly, both strategies mitigated the expected age-related increase in SBP. Progression to stage 2 HTN was lower in the BF arm at 12 months (2.9% vs. 6.9%; p=0.03), though this difference attenuated by 18 months. Diastolic BP (DBP) changes were minimal and similar between groups.
CLIP demonstrates that community-engaged, barbershop-based interventions can be effectively implemented to prevent HTN in Black men. Notably, the lack of superiority of the facilitated approach suggests that scalable, lower-resource self-directed strategies may achieve similar outcomes. The intervention’s success likely reflects its integration of culturally trusted settings, CHW engagement, and attention to social determinants of health. Limitations include single-city implementation and difficulty isolating the most effective components of the multi-level intervention. While BP reductions were modest, preventing upward BP trajectories and delaying progression to stage 2 HTN may yield meaningful long-term cardiovascular benefits.
As noted by principal investigator Dr. Joseph Ravenell, the study highlights that “community-engaged implementation strategies can have major implications for the prevention of hypertension in Black men,” underscoring the importance of meeting patients where they are.