Screening and Awareness for Blood Pressure in a Non-Medical Setting: The Vienna Hairdresser Initiative

Background: Arterial hypertension (HTN) is the leading modifiable cardiovascular risk factor for overall mortality worldwide. In Austria, 1.6 million individuals above the age of 15, representing 20% of the total population and 70% of adults aged 65 and older, suffer from HTN. Despite numerous antihypertensive treatment options on the European market, only 38.8% of patients on optimal medical treatment (OMT) reach their treatment goal. Primary prevention remains a challenge, particularly for HTN and the consequential risk of cardiovascular diseases (CVDs). Thus, there is an urgent need for Disease Management Programs (DMPs). We sought to study a possible trial to diagnose hypertension in a non-medical setting at a very early stage of the disease and raise awareness for hypertension in affected people to avoid future complications of unrecognized and untreated HTN. For a non-medical setting, hairdressers fulfil many criteria for an optimal blood pressure (BP) measurement. Methods: This is a pilot study. A total of 193 individuals were included at a Viennese hairdresser. Metric data were described either using mean ± SD given normal distribution or median otherwise. Categorical data were described using absolute frequencies and percentages. For comparison, either independent t-tests or Mann–Whitney U tests or chi² tests were assessed. The staff received expert training on how to measure blood pressure in a guideline-compliant way. All members signed the written and informed consent and received a questionnaire about their demographic data and cardiovascular risk factors. Results: Of the 193 participants in this study, 56.5% (109/193) were female and 43.5% (84/193) were male. The mean age was 54 ± 15.1 years. In the automatically measured office blood pressure (AOBP) measurement, the mean systolic BP was 137.1 ± 17.8 and the mean diastolic BP was 91.6 ± 11.2. Of all participants, 65.8% (127/193) were hypertensive, whereof 74.8% (95/127) had no treatment at all. Among 127 individuals evaluated, 63% (80/127) were unaware of their elevated blood pressure levels, while 28% (44/127) had a prior diagnosis of HTN. The control rate of the individuals with previously diagnosed HTN was very low, with only 18.5% [10.4; 30.9] reaching normotensive values in the current measurement. There was no difference in BP values of patients with previously diagnosed HTN and patients who were unaware of their disease. Antihypertensive treatment was being received by 20.2% (39/193), while 62.2% had not taken their prescribed blood pressure medication on the day of recruitment. Conclusions: This is the first Austrian study to show that screening for HTN in an unconventional non-medical setting is effective to diagnose HTN and raise awareness. Based on the even-higher-than-expected prevalence of HTN, we plan to conduct a cohort study in Vienna, inviting all hairdressers in socially deprived districts to act as gate openers for hypertensive subjects to raise awareness and to contact a regional GP for provision of medical care. An implementation of such a cost-effective and feasible disease management program in Austria might therefore reduce the burden of preventable cardiovascular events associated with HTN.