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Dear Dr. Roach: I monitor my blood pressure at home as part of my regular wellness routine. The instructions for the BP monitor say to sit upright, keep my feet on the floor and to not place the cuff over clothing. In addition, directions indicate that the cuff should be placed at the level of the heart.

I have rarely been in a doctor’s office where the staff taking my blood pressure follows this procedure. I am almost always sitting on the exam table with my legs dangling, and the cuff is always placed over my clothing. When I have raised this with the staff taking the reading, my comments usually are brushed off. My BP is usually a little high when I am in a doctor’s office (compared with my home readings), and I understand that this is not uncommon. How can a doctor really identify that I might have a blood pressure problem if the basic procedure isn’t properly administered for the only monitoring of BP he or she does?

M.D.W.

Dear M.D.W.: You are right that your blood pressure was not measured correctly. Worse, the error in the blood pressure measurement could adversely affect your treatment, potentially causing you to be over- or undertreated. Worse still, when you tried to make sure your blood pressure was measured correctly, you weren’t listened to.

When it really matters — for example, when taking care of a person with high blood pressure — the blood pressure should be measured carefully. The home measurements may be more useful, as there are more results, which minimizes random error, and they are taken in the situation where people live, not the artificial situation of a physician’s office. However, the doctor should make sure the device is accurate before relying on the readings.

Finally, there is rising evidence that measuring the blood pressure many times over 24 hours may be useful, especially in cases of suspected “white coat” hypertension.

Dear Dr. Roach: There is an “anti-aging” cosmetic product containing oleander that is applied around the eyes. Could prolonged, daily use of this product cause chronic headaches? Scans, MRIs, etc., are normal. Should a person using this product who has headaches seek further testing for toxicity from the oleander?

N.T.

Dear N.T.: I was unable to find a good study evaluating the safety and efficacy of oleander extracts used as a skin cream. I would not recommend using oleander extracts without good safety data, because oleander leaves contain several potent cardiotoxins.

I have read anecdotal reports of headaches among users of these products, but without a well-done study, I can’t guess how often they might occur.

Testing for toxicity is problematic, since the type of toxicity isn’t known. I would recommend simply stopping the oleander product. If the headaches are due to the product, they should go away within a few days.

Email questions to ToYourGoodHealth@med.cornell.edu.

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