John Henryism and blood pressure differences among black men

Introduction It is well known that blood pressure (BP) is inversely related to socioeconomic status (SES). John Henryism Active Coping (JHAC) is defined as a strong behavioral predisposition to cope with psychosocial stressors in an active and determined manner, and has been used to explain cardiovascular disparity in African Americans. According to JHAC hypothesis, the inverse relationship between cardiovascular risk and SES is more prominent for the individuals with high JHAC. High levels of psychological stress and high prevalence of hypertension (32%) have been reported in Korean Americans (KAs). Purpose The study was conducted to examine the main effects and the interaction effect of SES and JHAC on cardiovascular risk (measured by BP and arterial stiffness) in KAs. Methods Sample - 102 KAs (aged 21-60 years, 60% women) Measures - Age, gender, BMI, SES (measured by education and income), JHAC(measured by the 12-item JHAC Scale), BP, Arterial stiffness (measured by carotid and femoral pulse wave velocity [PWV]) Data Analysis - Two way factorial ANOVA and Duncan’s test by SAS 9.2. Results SBP (p=.03) and DBP (p=.01) were significantly higher in the low education group. The interaction effect of education and JHAC on SBP was significant (p=0.02), indicating that the education effect on SBP was greater in the low JHAC group. The main effect of education on PWV was not significant (p=0.64). However, the JHAC had a significant main effect on PWV (p=0.02), showing that the group with low JHAC score had higher PWV than the group with high JHAC. The interaction between education and JHAC on PWV was also significant (p=0.02), thus the effect of JHAC on PWV was greater in the low education group. Discussion The results demonstrated that the inverse relationship between education and cardiovascular measures was more severe in the low JHAC group, contrary to JHAC hypothesis. Furthermore, arterial stiffness, an important biomarker of cardiovascular disease, was predicted by JHAC, but not by education, showing the subjects with low JHAC had significantly higher arterial stiffness. This phenomenon was also more prominent in the subjects with low education. The findings suggest that JHAC has beneficial effect on cardiovascular health in KAs.

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Abstract 21: Telemedicine And The Barbershop Model Of Hypertension Care For Black Men

Hypertension ◽

10.1161/hyp.76.suppl_1.21 ◽

2020 ◽

Vol 76 (Suppl_1) ◽

Author(s):

Ciantel A Blyler ◽

Mohamad Rashid ◽

Norma B Moy ◽

Kayslee A Kemp ◽

Florian Rader

Keyword(s):

Blood Pressure ◽

Los Angeles ◽

Black Men ◽

Medication Management ◽

Cost Effective ◽

Serious Adverse Events ◽

Blood Pressure Study ◽

Collaborative Practice Agreement ◽

The Cost

Background: The Los Angeles Barbershop Blood Pressure Study (LABBPS) demonstrated both efficacy and sustainability of a new model of hypertension (HTN) care for non-Hispanic black men that links health promotion by barbers to medication management by specialty-trained pharmacists. Barriers to scaling the model include logistical inefficiencies that contribute to the cost of the intervention. Most notable was the amount of time pharmacists spent traveling between barbershops. To address this, we tested whether telemedicine (remote follow-up) could be substituted for in-person visits after blood pressure (BP) control was achieved. Methods: We enrolled 10 black male patrons with systolic BP ≥ 140 mm Hg in this proof-of-concept study in which barbers promoted follow-up with pharmacists who initially met each patron in the barbershop where they prescribed BP medication under a collaborative practice agreement with the patrons’ physician. Medications were titrated during bimonthly in-person visits to achieve a BP goal of ≤130/80 mmHg. Once BP goal was reached, monthly visits were done by videoconference while barbers assisted with BP checks. Final BP and safety outcomes were assessed at 12 months. Results: After exclusion of one participant who declined adherence, 9 patients completed the intervention. Baseline BP of 155 + 14 / 83 + 11 mmHg decreased by 29 + 13 / 8.9 + 15 mmHg (p<.0001), with eight participants (89%) achieving systolic control and seven (78%) diastolic control at 12 months. These new data are statistically indistinguishable from our previous LABBPS data (p=0.8 for both change in systolic BP and diastolic BP). Overall HTN control (≤ 130/80) was 67% (6 of 9), numerically greater than the 63% observed in LABBPS (p=N.S.). As intended, the mean number of in-person pharmacist visits per patron fell from 11 in LABBPS to 6.6 visits over 12 months. No treatment-related serious adverse events occurred. Cohort retention was 90%. Conclusions: Telemedicine represents a viable substitute for in-person visits, both improving pharmacist efficiency and reducing cost while preserving intervention potency. These findings are crucial for future broad-scale implementation efforts and development of cost-effective barbershop HTN management programs for black men.

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