Improving Efficiency of the Barbershop Model of Hypertension Care for Black Men With Virtual Visits

Background The LABBPS (Los Angeles Barbershop Blood Pressure Study) developed a new model of hypertension care for non‐Hispanic Black men that links health promotion by barbers to medication management by pharmacists. Barriers to scaling the model include inefficiencies that contribute to the cost of the intervention, most notably, pharmacist travel time. To address this, we tested whether virtual visits could be substituted for in‐person visits after blood pressure (BP) control was achieved. Methods and Results We enrolled 10 Black male patrons with systolic BP ≥140 mm Hg into a 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 mm Hg. Once BP goal was reached, visits were done by videoconference. Final BP and safety outcomes were assessed at 12 months. Nine patients completed the intervention. Baseline BP of 155±14/83.9±11 mm Hg decreased by −28.7±13/−8.9±15 mm Hg ( P <0.0001). These data are statistically indistinguishable from prior LABBPS data ( P =0.8 for change in systolic BP and diastolic BP). Hypertension control (≤130/80 mm Hg) was 67% (6 of 9), numerically greater than the 63% observed in LABBPS ( P =not significant). As intended, the mean number of in‐person visits decreased from 11 in LABBPS to 6.6 visits over 12 months. No treatment‐related serious adverse events occurred. Conclusions Virtual visits represent a viable substitute for in‐person visits, both improving pharmacist efficiency and reducing cost while preserving intervention potency. Registration URL: https://www.clinicaltrials.gov ; Unique identifier: NCT 03726710.

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

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.

Associations Between Day-by-Day Home Blood Pressure Variability and Renal Function and Albuminuria in Patients With and Without Diabetes

BACKGROUND The phenotype of diabetic kidney disease represents a lower estimated glomerular filtration rate (eGFR) and albuminuria. We investigated the association between day-by-day home blood pressure (BP) variability and the eGFR in subjects with diabetes and compared this association with that in subjects without diabetes. We then attempted to determine whether the association is present in albuminuria. METHODS We analyzed 4,231 patients with risk factors of cardiovascular disease (24.4% with diabetes) from the J-HOP (Japan Morning Surge-Home Blood Pressure) study. Home BP was measured in the morning and evening for 14 days. We calculated the SD, coefficient of variation, average real variability (ARV), and variation independent of the mean of the subjects’ morning and evening home systolic BP (SBP) as the indexes of day-by-day home BP variability. RESULTS A multiple linear regression analysis adjusted for covariates showed both average morning and evening SBP were associated with the log-transformed urine albumin-to-creatinine ratio (UACR) with and without diabetes (all P &lt; 0.05), but not with the eGFR except for an association of average evening SBP in the no-diabetes group. None of the indexes of day-by-day morning and evening home SBP variability were associated with the log-transformed UACR except for the association between the ARV of home morning SBP in the diabetes group. All of the indexes of day-by-day morning and evening home SBP variability were associated with the eGFR only in the diabetes group (all P &lt; 0.05). CONCLUSIONS The association between increased day-by-day home BP variability and impaired renal function was unique in diabetes.

The Combination of Non-dipper Heart Rate and High Brain Natriuretic Peptide Predicts Cardiovascular Events: The Japan Morning Surge-Home Blood Pressure (J-HOP) Study

BACKGROUND We hypothesized that the association between the dipping heart rate (HR) pattern and cardiovascular (CV) events differs according to the brain natriuretic peptide (BNP) level. METHODS We examined a subgroup of 1,369 patients from the Japan Morning Surge Home Blood Pressure study; these were patients who had CV risk factors and had undergone ambulatory blood pressure (BP) monitoring. HR non-dipping status was defined as (awake HR − sleep HR)/awake HR &lt;0.1, and high BNP was defined as ≥35 pg/ml. We divided the patients into four groups according to their HR dipper status (dipping or non-dipping) and BNP level (normal or high). RESULTS The mean follow-up period was 60 ± 30 months. The primary endpoints were fatal/nonfatal CV events (myocardial infarction, angina pectoris, stroke, hospitalization for heart failure, and aortic dissection). During the follow-up period, 23 patients (2.8%) in the dipper HR with normal BNP group, 8 patients (4.4%) in the non-dipper HR with normal BNP group, 24 patients (9.5%) in the dipper HR with high-BNP group, and 25 patients (21.0%) in the non-dipper HR with high-BNP group suffered primary endpoints (log rank 78.8, P &lt; 0.001). Non-dipper HR was revealed as an independent predictor of CV events (hazard ratio, 2.13; 95% confidence interval, 1.35–3.36; P = 0.001) after adjusting for age, gender and smoking, dyslipidemia, diabetes mellitus, chronic kidney disease, BNP, non-dipper BP, 24-h HR, and 24-h systolic blood pressure. CONCLUSIONS The combination of non-dipper HR and higher BNP was associated with a higher incidence of CV events.