Karen Booker plunked into a reclining shampoo chair after measuring her blood pressure with a hand-held monitor.
She knows how important it is to know the numbers behind the force that moves blood through vessels, especially for African-American adults, more than half of whom have high blood pressure.
"You need to get it checked. African-American women are in denial about taking their medications," she said on a recent afternoon at the Head Quarters Design Studio on Kensington Avenue.
Salon owner Tasha Burrell, standing a few feet away, nodded in agreement.
"Knowledge is power," she said.
This is the low-tech side of health care, a community initiative in barber shops and hair salons in Buffalo and Niagara Falls to take on a condition considered the "silent killer" because it does its damage initially without obvious symptoms.
High blood pressure, or hypertension, occurs when pressure in the arteries is elevated, making the heart work harder to circulate blood. More than 103 million adults in the United States have it, based on guidelines of the American Heart Association, American College of Cardiology and nine other medical groups that were updated in 2017 to include millions more people, including many young men and women.
Despite advances in treatment and decades of prevention campaigns, high blood pressure remains a major public health problem, taking a toll as a leading cause of strokes, heart failure and kidney disease. Hypertension contributes to more than 1,000 deaths a day, according to the federal Centers for Disease Control and Prevention.
For blacks, especially, the numbers are alarming. Their prevalence of high blood pressure in the U.S. ranks among the highest in the world, with 59 percent of black men and 56 percent of women having the condition under the newer guidelines.
"The health care disparity in Western New York is huge," said Al Hammonds, executive director of Millennium Collaborative Care.
Statistics for Erie County reveal the stark differences. For blacks age 35 and older, the death rate from hypertension stands at 367.4 deaths per 100,000 people in the population. For whites, it's 206.7, while for Hispanics, it's 160.8 and for Asians 86.8.
Millennium, in partnership with the National Witness Project, last year started a blood pressure self-screening program in barber shops and hair salons in Niagara County, and expanded the program this year into Erie County – targeting "hot spot" neighborhoods where hypertension is likely to be highest.
Millennium is a key player in an ambitious plan in New York State to reform Medicaid, the state-federal program that provides health care for Americans with low income and the disabled, as well as services to older individuals needing long-term services in nursing homes or in the community.
New York received a waiver in 2015 from the federal government that allows the state to keep $8 billion of savings the state expects to see over five years from changes to Medicaid. The state, now in the third year of the plan, is trying to reduce avoidable hospital use by 25 percent, focus on such social determinants of health as poverty, education and transportation, and shift hospital and doctor Medicaid payments from fee-for-service to a value-based system tied to performance goals.
To accomplish this, 25 groups, including Millennium Collaborative Care and Community Partners of Western New York, formed across the state to organize doctors, hospitals and others. Millennium is responsible for projects big and small involving 231,000 Medicaid recipients in this region.
To address hypertension, doctors and health officials are working on many fronts. The idea of measuring blood pressure while getting your hair cut grew out of community outreach efforts over the last few decades outside of traditional medical settings. The thinking goes that the barbershop or hair salon is a comfortable neighborhood place where customers frequently visit, tend to linger and chat, and often enjoy trusting relationships.
"It's a conversation-starter in a casual and comfortable place, a way to talk about symptoms that could alert someone to get health care they may need," said Ebony Patterson-White, community health worker coordinator for Millennium.
Burrell, the salon owner, said many people don't realize that high blood pressure is a major risk for serious medical problems. Her salon, like the 11 others currently in the program, is outfitted with information about the condition and a digital blood pressure monitor she encourages clients to use on their wrists. A representative from the National Witness Project visits weekly to see if anyone has questions or wants a referral to a primary care doctor.
Nearby, at the Heaven Sent Barber Shop, owner Lonnie Green is doing the same.
"Anything I can do to bring awareness I'll try," he said. "You can be 18-19 years old and have high blood pressure and not know it."
Green learned about the dangers of hypertension the hard way 14 years ago, when he bent over to tie his shoe and lost consciousness. He landed in the hospital, and found out he suffered from very high blood pressure.
"I ask, and a lot of people are willing to get their pressure measured," he said. "I tell them that if they don't know, they could be walking around unnecessarily with this risk. It works."
Blood pressure is measured as two numbers. An upper number – systolic pressure – shows the pressure of blood against artery walls when the heart beats. A lower number – diastolic – shows the pressure while the heart is resting between beats. Normal blood pressure is less than 120 systolic over 80 diastolic.
The newer guidelines lowered the threshold for a diagnosis of hypertension from 140/90 to 130/80, labeling nearly half the U.S. population as hypertensive and setting off a debate in the medical community over whether such a major change was warranted based on the scientific evidence. Two organizations that represent primary care doctors – the American College of Physicians and the American College of Family Physicians – refused to accept the guidelines released by the specialty organizations. Among the issues: There are adverse effects and big costs associated with subjecting healthy people to treatment they don't need.
It's not entirely clear why blacks in the U.S. have an earlier onset, higher prevalence, and disproportionately high risk of complications for hypertension, especially since hypertension awareness and treatment rates nationally are generally higher for blacks, according to a 2016 report from the National Heart, Lung, and Blood Institute in the journal "Hypertension."
Experts suggest a host of reasons. Social factors, for instance, can influence blood pressure, including poverty and racial discrimination. Poor adherence to medication is another possible explanation, experts say.
Do community-based barbershop initiatives actually work?
Since the start in 2010 of a similar program in the Rochester area in 25 barbershops and salons, a larger share of adults who have their hypertension under control has increased, according to the High Blood Pressure Collaborative in the Finger Lakes region. Officials say the campaign has contributed to the percentage of blacks with high blood pressure of 160/100 or higher decreasing from 13.4 percent to 9.3 percent by 2017. Significant reductions were also seen among Hispanics and whites.
"The data suggest we are changing behaviors that lead to a decrease in hypertension – diet, exercise, taking your meds," said Phyllis Jackson, community wellness project manager for Common Ground Health, one of the organizations involved.
A study published in March in the New England Journal of Medicine focused national attention on the question by examining 319 black men with high blood pressure who got their hair cut at 52 barbershops in Los Angeles County.
Some barbers encouraged patrons in the study to meet with pharmacists monthly when they came in for a regular hair appointment. The pharmacists prescribed blood pressure medication and communicated with the men’s primary care physicians about the treatment. Other barbers encouraged men to follow up with their doctors and suggested lifestyle changes to help lower blood pressure.
There were limitations to the study. It was not blinded, as the most rigorous studies are, meaning researchers and participants knew who was assigned to each group. It also didn't follow the men for a prolonged time.
However, nearly 64 percent of the men who met with the pharmacists regularly at the shop lowered their blood pressure to the normal range in six months, compared with about 12 percent of the men in the other group.
“When we provide convenient and rigorous medical care to African-American men by coming to them – in this case having pharmacists deliver that care in barbershops – blood pressure can be controlled and lives can be saved,” Dr. Ronald G. Victor, director of the Hypertension Center at Cedars Sinai Medical Center in Los Angeles and the study’s lead author, said in a statement.