We read a number of interesting articles this week:
1) Is your home blood pressure cuff accurate?
It is well established that one random in office blood pressure measurement is likely not how physicians should be managing / adjusting blood pressure medications. Most commonly we ask patient's to take an ambulatory blood pressure log and report back to us. However, a new study questions how accurate those home blood pressure devices really are. Writing in the medical journal JAMA (https://pubmed.ncbi.nlm.nih.gov/37129661/), the authors found that 80% of the most frequently purchased home BP devices (both arm and wrist versions) were not validated for accuracy.
While the study doesn't necessarily comment no whether or not the devices themselves were found to be accurate, it suggests that the onerous is really on physician and patients to ensure this is the case before making medical decisions. A simple approach and one we use frequently is to have the patient bring his/her cuff to an appointment and correlate a reading they take with an in office measurement to ensure the cuff accuracy.
2) Over-the-counter melatonin, what are you really getting?
Insomnia is one of the more frequent complaints we receive, and while there are a host of non-evidenced based and frankly dangerous pharmaceuticals, over the counter melatonin is a relatively safe, naturally-occurring neurohormone that patients often try. Generally, the highest recommended dose is 9-10mg per day. A recent study (https://pubmed.ncbi.nlm.nih.gov/37097362/) in the same journal looked at what the actual concentration of melatonin is as compared to the listed concentration in over 20 different brands. Only 3 of the products contained a concentration that was within 10% of the listed amount, and some brands had over 3x the concentration listed.
Of note these were products for children, but I suspect that this is generally applicable to all products on the market. While this wouldn't necessarily change our use of melatonin, it will make us more cognizant, as we should always be doing anyway, of starting at the lowest doses and then only increasing if needed; furthermore, as we often stress to patients, supplemental OTC products are regulated much differently and less stringently than prescription medications and patients really need to be aware of this issue.
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