Illness Walks the Runway





A top fashion designer quarantines a sneezing underling, forcing her to work in a closet. An industry P.R. executive makes colleagues douse their hands with Purell. Germ-phobic magazine editors are powerblasting offices with antiseptic wipes and Lysol.




Such is the dread gripping the fashion world as it prepares for New York Fashion Week, beginning Feb. 7, with a killer flu and a stomach-bug norovirus on the loose.


The eight-day event, when fashionistas from around the world pack into small spaces to attend runway shows and parties — only to cram onto the same flights and repeat the process in London, Milan and Paris — is always an occasion for sickness paranoia. In past years, sniffles in the front row could prompt icy stares and social ostracism.


But with this season’s flu panic, the fear is approaching hysteria. Stressed-out designers recoil in horror if someone coughs within earshot. Frail models shiver their way between fittings, terrified someone will spy their runny noses. And frenemies everywhere are reconsidering the wisdom of the double-cheek kiss, the standard greeting of the global fashion tribe. Air kissing seems safe for now.


“This will be the season where everyone in fashion becomes mysteriously nonaffectionate,” said Laura Brown, executive editor of Harper’s Bazaar. Staff members in her West 57th Street offices, she added, have been scouring doorknobs with sanitizing wipes. “We can give a nudge and a wink instead.”


To be fair, much of the paranoia is founded. According to the Centers for Disease Control and Prevention, deaths from the current flu season reached “epidemic” levels, in part because of an unusually severe flu strain. Adding to the flulike epidemic is a surging new strain of norovirus, which can cause sudden diarrhea and projectile vomiting, and the worst whooping cough outbreak in 60 years.


And while there is some evidence that the flu season has peaked almost everywhere in the country, except for the West Coast, flu activity continued to be high in New York through the week ending Jan. 19, as tracked by the C.D.C., and on the rise in parts of Europe including Italy. (Milan hosts a fashion week starting Feb. 20.)


Norovirus also seems to be surging abroad; it has reached epidemic levels in France, according to the latest report from the country’s doctor network Réseau Sentinelles, with more than one million French people visiting doctors for it in the past five weeks.


Yet even as flu season appears to be ebbing in New York, it remains a worry inside the fashion bubble. With sleep-deprived colleagues huddled in close quarters day and night, things can go viral quickly, especially in the petri dish that is Fashion Week.


“Fashion people are at risk for a variety of viral syndromes because they work long hours and they move in a pack,” said Dr. Robert Glatter, known in fashion circles for making house (or studio) calls.


Dr. Barry Cohen, whose primary-care office on Spring Street faces Marc Jacobs’s studios, says he has been bombarded with rheumy-eyed industry divas begging for quick fixes. “Fashion people touch each other all day, so they get exposed over and over,” he said.


And when the pack is moving fast and furious, it can’t slow down for the weak. “Fashion Week season is a nonstop assault on the immune system,” said Derek Blasberg, an editor at large for Harper’s Bazaar. “Early shows, late dinners, crammed into tents and airplanes: you don’t want to sit next to anyone coughing, because if you get sick, you’re screwed.”


The viral assault does not end with New York. “By the time we finish the New York shows, we’re already a wreck, because New York simply has too many shows,” said Mickey Boardman, editorial director of Paper magazine. “Then you get on a plane and hit the ground running in London, where there’s always fun parties. You’re eating French fries for dinner and drinking Cokes from your minibar, and your sleep patterns are messed up.”


“You’re putting your life at risk,” he added.


WHILE KEEPING THE WORLD trendy has its hazards, fashionistas have developed stylish tactics to avoid getting the bug. Many have dutifully gotten their flu shots. (It’s not too late, though it takes about two weeks to build up immunity — just in time for London Fashion Week.)


Others follow variations of what could be called the standard fashion-world starvation diet, whether it’s drinking large quantities of SmartWater fortified with packets of the vitamin supplement Emergen-C, or force-feeding themselves nothing but raw greens, like koalas munching eucalyptus leaves. Dr. Glatter says he has even treated some fashion people for diarrhea from eating too much kale.


Then there are the juicers. The designer Cynthia Rowley swears by Juice Press, the three-year-old Manhattan chain popular with fashion insiders for its 17-ounce $10 bottles of cold-pressed fruits and vegetables. “I’m addicted,” said Ms. Rowley, who added that she chugged the stuff with staff members when they were not taking spin classes en masse at SoulCycle.


“Nobody’s sick at my office,” she bragged dangerously. “We work in one room, so if one person drops, they take down the whole team.”


Read More..

High-end home sales on a roll in state









California's luxury housing market is booming.


In activity reminiscent of real estate's bubble years, the number of homes statewide selling at more than $5 million reached an all-time high last year, while those selling at $1 million or more rose to the highest level since 2007, a real estate information service has reported.


Sales are up because well-heeled U.S. and international buyers, confident that the housing recovery is solid, are looking for places to park their cash, real estate experts said. Also playing a role was a rush among the very wealthy to take advantage of lower capital gains taxes by selling before year end.





"Last year was gangbusters," said Dave Fratello, an agent with the Real Group in Manhattan Beach, the busiest Southern California community for $1-million-plus sales in 2012. "We flipped very quickly from a buyer's market to a seller's market."


Across California, 697 homes sold for more than $5 million, beating the previous high of 491 in 2011, according to San Diego-based DataQuick. The 2012 sales mark was the highest since DataQuick began tracking such sales in 1988.


The 26,993 homes sold at $1-million-plus represented a 26.9% jump from 2011, DataQuick said. In comparison, 42,502 home sales exceeded the million-dollar mark in 2007, before the mortgage meltdown dragged down prices across the housing market.


The record was set in 2005, when 54,773 homes sold for $1 million or more. The luxury market outpaced overall sales, which were up 8.2% statewide.


"The very top, it is a record level — well beyond what it was in the bubble period," said John Karevoll, analyst for DataQuick.


Hillsborough, in the San Francisco Bay Area, claimed the top spot with 422 sales at $1 million-plus. Like many neighborhoods in Silicon Valley and environs, Hillsborough's sales growth was driven by a wave of buyers from the technology sector.


Southern California communities with the most $1-million-plus sales included Manhattan Beach, Newport Beach, La Jolla, Brentwood, Beverly Hills and Laguna Beach.


"We're hitting that perfect storm of buyer demand, low inventory and attractive housing prices," said Paul Habibi, who teaches real estate at the UCLA Anderson School of Management.


Gary Painter, director of research and an economist with the USC Lusk Center for Real Estate, said the high-end niche is more likely to be driven by the international economy rather than what is going on in the U.S. — which suffered an unexpected economic contraction during the last three months of the year, the Commerce Department said Wednesday.


As a result, the luxury market is benefiting from a continued influx of wealthy international buyers who are betting on the potential of prime housing to appreciate and view luxury home prices in the U.S. as bargains versus other parts of the world.


Foreign buyers spent 24% more on U.S. real estate last year than in 2011, according to an annual survey by the National Assn. of Realtors. These buyers represented 8.9% of all housing spending. Asian shoppers are particularly interested in California homes, the study said.


Sandra Miller of Engel & Volkers, a broker who specializes in international buyers and luxury properties, said that "the money is really coming from everywhere."


While her office is dealing with an onslaught of Italians, buyers are coming from London and Germany. Chinese buyers are snapping up homes in the $1-million to $5-million range for their children, she said, but not ultra-luxurious estates.


"The very, very large sales last year were done with Russian money," Miller said.


DataQuick's Karevoll cautioned that the boom at the luxury level doesn't automatically translate to continued sales and price improvement for all homes.


"As a bellwether for a market as a whole, however, it is really hard to read what it means," he said. "The broader market and what we call the 'prestige' market — homes from about $2 million to $3 million and up — seem to dance to two different tunes."


In Manhattan Beach, most homes are priced at more than $1 million, said Fratello, who is also a housing market blogger at MB Confidential. "The days of little cottages for under $1 million are mostly behind us."


A low supply of homes for sale kept a lid on sales in the sought-after beach community, Fratello added. Bidding wars returned.


"With another 10% in sales our volume would have matched all the bubble years," he said, referring to 2004 to 2006.


A tear-down in the so-called Tree Section of Manhattan Beach drew 20 offers in March, selling for $1.352 million — $250,000 above the asking price. A 2,600-square-foot Midcentury-style house in need of work in the same block attracted 15 bidders. Listed at $1.6 million, it sold for $1.88 million.


"Everybody is shaking their heads," Fratello said. "This is crazy."


Cash buyers accounted for a record 7,791 of the million-dollar home sales, up from 5,802 in 2011. Many of those presumably are investors looking for better places to put their money than the stock market or other investments.


The most expensive transaction to appear in public records was the $117.5-million sale of an 8,930-square-foot mansion on nine acres in the Northern California community of Woodside.


Among top sales in the Los Angeles area was billionaire Larry Ellison's purchase of a three-structure compound in Malibu for $36.9 million. "American Idol" host Ryan Seacrest paid $36.5 million for talk show host Ellen DeGeneres' three-property spread in Beverly Hills, and the family of the late philanthropist Max Palevsky sold his Malibu mansion for $36.5 million just before the end of last year.


Almost all home sales were in $1-million-plus territory in the communities of Ross in Marin County; San Marino and Santa Monica in Los Angeles County; Los Altos in Santa Clara County; Atherton and Hillsborough in San Mateo County; and Rancho Santa Fe in San Diego County.


lauren.beale@latimes.com





Read More..

Senate overwhelmingly approves John Kerry for secretary of State









WASHINGTON — The Senate voted overwhelmingly Tuesday to confirm Sen. John F. Kerry (D-Mass.) as the next secretary of State, filling a crucial national security spot in President Obama’s second-term Cabinet.

The 94-3 vote clears the way for Kerry to replace Hillary Rodham Clinton after she steps down Friday.


Kerry, who will become America’s 68th top diplomat, failed to win only three Republican votes — those of Sens. John Cornyn and Rafael “Ted” Cruz, both of Texas, and Sen. James M. Inhofe of Oklahoma. 

A spokesman for Cornyn said Kerry supported liberal positions that most Texans oppose. Cruz has criticized Kerry, who fought in the Vietnam War, as anti-military.





Earlier Tuesday, Kerry received the unanimous endorsement of the Senate Foreign Relations Committee in a voice vote. He served on the committee for 28 years and chaired it for the last four.


Sen. Bob Corker (R-Tenn.), the ranking Republican on the committee, praised Kerry as a “realist” on foreign affairs issues, and said he was always “open to discussion” with colleagues of the opposite party.


Corker, noting that Kerry’s father was a foreign service officer, said he knew of no one “who’s lived a life that’s been ultimately more oriented toward being secretary of State.”

Leading Republican senators had promoted Kerry as an alternative to Susan Rice, the U.S. ambassador to the United Nations, for the job. Rice withdrew her name from consideration after Republicans criticized her for statements she made on TV talk shows after the deadly Sept. 11 attack on the U.S. mission in Benghazi, Libya.


Follow Politics Now on Twitter and Facebook


mike.memoli@latimes.com


Twitter: @mikememoli


paul.richter@latimes.com





Read More..

RIM faces its day of reckoning with BlackBerry 10 launch






NEW YORK (Reuters) – The innovative line of BlackBerry smartphones that Research In Motion Ltd will formally unveil on Wednesday has already succeeded on one crucial count – getting RIM back in the conversation.


The new BlackBerry 10 has created a buzz among technology watchers and financial analysts, thanks to nifty features that may set it apart in an overcrowded smartphone market. RIM stock has almost tripled over the past four months on hopes the devices can restore RIM to sustained prosperity.






Reviewers like the browser speed and the intuitive keyboard on RIM’s new touchscreen. A feature called BlackBerry Balance, which keeps corporate and personal data separate, could help RIM rebuild its traditional base of big business customers.


It’s a welcome start for RIM, the smartphone pioneer that has teetered on the brink of irrelevance. But success will come only if consumer and business customers embrace the new technology in the weeks and months after CEO Thorsten Heins takes the wraps off the phone at a glitzy New York launch.


RIM is gambling its survival on the much-delayed BlackBerry 10, hoping to claw its way back into an industry now dominated by Apple Inc’s iPhone and Samsung Electronics Co Ltd’s Galaxy.


The timing may be just right. The new phone hits the market just as the iPhone’s remarkable run is showing some signs of slowing.


“I really do believe that the consumer market as a whole is ready for something new,” said Kevin Burden, head of mobility at Strategy Analytics, an industry consulting firm.


“I have to believe that there is some level of user fatigue that plays into the longevity of some of these platforms,” he added, referring to Google Inc’s Android and Apple’s iOS, which are both more than five years old. “RIM is probably timing it right.”


U.S. BATTLEGROUND


To be sure, RIM shares are about 90 percent below a 2008 peak near $ 150 a share and the company still has a tough fight ahead. It may take investors some time to determine whether RIM’s big gamble on an untested technology has paid off.


RIM’s market share collapsed in the three years ahead of the launch. Strategy Analytics data shows RIM’s global share of the smartphone market was about 3.4 percent in the fourth quarter, down from around 20 percent just three years ago.


While RIM has done well in developing markets, it has hemorrhaged customers in the United States, a market that sets technology trends. RIM’s fourth-quarter North American market share fell to 2 percent from more than 40 percent three years ago.


Acknowledging that it is crucial to win back U.S. customers, RIM will hold its main BlackBerry 10 launch in New York, although there are simultaneous events in six cities across the globe.


Underscoring the point, RIM is splurging on a costly Super Bowl ad to tout its new devices and attempt to brighten its faded image in the U.S. market.


BIG QUESTIONS


Over 150 carriers already have tested the new devices and RIM has said the launch will be the largest ever global rollout of a new platform.


The two big questions the market expects RIM to answer on Wednesday are when the phones – a full touch-screen device and one with a traditional physical keyboard – will hit store shelves, and how much they will cost.


The company is expected to unveil specifics on pricing and availability in different regions at the launch.


“The Street is expecting mid-February for a launch. Anything earlier than that is a positive, anything later will be viewed as negative,” said RBC Dominion Securities analyst Paul Treiber.


That said, there are few mysteries to be cleared up on Wednesday. Leaked photos and specifications of the devices have been splashed across the tech world.


“We’ve had the beta devices for a few weeks and in terms of the devices, they are right up there with the competition,” said Andy Ambrozic, head of IT Infrastructure at Ricoh Canada. “The Balance feature is crucial for corporations that are becoming increasingly concerned about data security.”


Scotiabank analyst Gus Papageorgiou feels RIM has a good chance of a comeback. He says the new BB10 operating system outpaces Apple’s iOS platform and Google’s market-leading Android system in every category except app selection and content.


“There is, we believe, huge potential for the platform and devices to bring people back to BlackBerry or draw entirely new users into the platform,” said Papageorgiou, who has a “sector outperform” rating on the stock.


BlackBerry 10 will not be able to compete on the number of apps, but RIM says its operating system will have the largest application library for any new platform at launch, with more than 70,000 apps available.


It has already gathered big-name music and video partners for its BlackBerry 10 storefront, including Walt Disney Studios and Sony Pictures, Universal Music and Warner Music Group.


Wireless carriers already report strong demand for the new devices. Rogers Communications Inc, Canada’s top wireless carrier and the first globally to take pre-orders for the new devices, said orders are already in the thousands.


“Our customers are excited,” said John Boynton, Rogers’ head of marketing, adding that some users are holding off on upgrades in anticipation of the BB10 launch.


(Additional reporting by Alastair Sharp and Allison Martell in Toronto; Editing by Frank McGurty, Janet Guttsman and Andre Grenon)


Gadgets News Headlines – Yahoo! News





Title Post: RIM faces its day of reckoning with BlackBerry 10 launch
Url Post: http://www.news.fluser.com/rim-faces-its-day-of-reckoning-with-blackberry-10-launch/
Link To Post : RIM faces its day of reckoning with BlackBerry 10 launch
Rating:
100%

based on 99998 ratings.
5 user reviews.
Author: Fluser SeoLink
Thanks for visiting the blog, If any criticism and suggestions please leave a comment




Read More..

ABC: Barbara Walters is out of the hospital


LOS ANGELES (AP) — ABC says Barbara Walters is out of the hospital and recovering from chicken pox at home.


ABC said Tuesday that the 83-year-old host on "The View" is resting comfortably and "getting stronger." There was no indication of when she might return to work.


Walters was hospitalized after falling and cutting her head at a pre-inaugural party in Washington on Jan. 19. The news veteran later was diagnosed with chicken pox, which typically hits people when they are children.


The disease can be serious in older people because of the possibility of complications like pneumonia.


Read More..

Well: Ask Well: Squats for Aging Knees

You are already doing many things right, in terms of taking care of your aging knees. In particular, it sounds as if you are keeping your weight under control. Carrying extra pounds undoubtedly strains knees and contributes to pain and eventually arthritis.

You mention weight training, too, which is also valuable. Sturdy leg muscles, particularly those at the front and back of the thighs, stabilize the knee, says Joseph Hart, an assistant professor of kinesiology and certified athletic trainer at the University of Virginia, who often works with patients with knee pain.

An easy exercise to target those muscles is the squat. Although many of us have heard that squats harm knees, the exercise is actually “quite good for the knees, if you do the squats correctly,” Dr. Hart says. Simply stand with your legs shoulder-width apart and bend your legs until your thighs are almost, but not completely, parallel to the ground. Keep your upper body straight. Don’t bend forward, he says, since that movement can strain the knees. Try to complete 20 squats, using no weight at first. When that becomes easy, Dr. Hart suggests, hold a barbell with weights attached. Or simply clutch a full milk carton, which is my cheapskate’s squats routine.

Straight leg lifts are also useful for knee health. Sit on the floor with your back straight and one leg extended and the other bent toward your chest. In this position, lift the straight leg slightly off the ground and hold for 10 seconds. Repeat 10 to 20 times and then switch legs.

You can also find other exercises that target the knees in this video, “Increasing Knee Stability.”

Of course, before starting any exercise program, consult a physician, especially, Dr. Hart says, if your knees often ache, feel stiff or emit a strange, clicking noise, which could be symptoms of arthritis.

Read More..

Is Softbank CEO the buyer of $117.5-million Silicon Valley estate?









SAN FRANCISCO -- Tongues are wagging that SoftBank's billionaire founder, Masayoshi Son, may be the buyer of a $117.5-million estate in Woodside.


No one is willing to go on the record -- everyone involved signed non-disclosure agreements. But one real estate source who requested anonymity because he didn't want to jeopardize future business relations said Son bought the exclusive property in the woodsy and very wealthy heart of Silicon Valley.


Son is one of the richest men in Japan. He owns nearly 30% of Softbank and serves as its chief executive.





Softbank has significant business dealings in the United States. It holds large stakes in Yahoo Japan and China's Alibaba Group. In October, Softbank announced a $20-billion deal to buy a majority stake in Sprint Nextel, the wireless carrier that trails AT&T and Verizon.


Son also has strong ties to the Bay Area. He moved from Japan to California when he was 16 and finished high school while staying with family and friends in South San Francisco. Son studied at UC Berkeley, where he got a first-hand look at technological innovation in the Bay Area. He returned to Japan and later started Softbank.


Representatives of Softbank could not be reached for comment.


Real estate agents in Silicon Valley say the buyer of the Woodside estate went to great lengths to keep the transaction hush hush. Son is known for protecting his privacy with Steve Jobs-worthy zeal.


The blockbuster price has been the talk of the town in Woodside, which endured hovering helicopters after the news of the sale broke last week.


It's one of the highest-priced residential sales ever in the U.S., topping the $100-million sale of a Los Altos Hills estate to Russian investor Yuri Milner in 2011. The neoclassical-style house was built in 2005 and was designed by architect Allan Greenberg. It sits on nearly 9 acres.


The seller was Tully Friedman, chief executive of Friedman, Fleischer and Lowe, a San Francisco private equity firm. The property was purchased in the name of SV Projects LLC.


SV Projects LLC has the same address as law firm Morrison-Foerster’s Los Angeles office. Morrison & Foerster is representing Softbank in its acquisition of Sprint.


-- Times staff writers Lauren Beale and Chris O'Brien contributed to this report.


ALSO:


Estate in Woodside, a Silicon Valley haven, sells for $117.5 million


Follow me on Twitter @jguynn



Read More..

What the ‘Bqhatevwr’ Did Scott Brown Tweet?






What do politicians do after losing their re-election bids? Take to Twitter, of course. Former Sen. Scott Brown of Massachusetts has been doing just that.


Brown has been tweeting about his everyday life post-politics, posting blurbs about house chores, football, and his family, but Brown’s tweets are somewhat less refined than those tweeted by his skilled staffers when he was serving in Congress.






On his verified Twitter account on Friday morning, the former senator tweeted about seeing his daughter, Ayla perform at Pejamajo Café in Holliston.


“Yes. Get ready.” The tweet read, but without the finesse of Brown’s tweeting staff, one of his followers misunderstood the message.


“Oh we are. You have no idea how ready #MaPoli is to vote to keep you in the private sector & out of #MASen” @MattinSomerville tweeted back.


Brown responded with a series of three tweets delivered after midnight.


“Your brilliant Matt,” he first tweeted.


“Whatever,” followed.


And finally Brown tweeted, “Bqhatevwr.”


Though he deleted his tweets, “Bqhatevwr” trended on Twitter nearly as quickly as #eastwooding.


The trending typo drew both bipartisan support and mockery. Some taunted the former senator for his late night slip-up, creating Internet memes and “Bqhatevwr” quips, while others defended Brown, saying that he is just an average Joe who committed a typical Twitter faux pas.


But what most Twitter enthusiast failed to recognize what that Brown’s first “Your brilliant” tweet was grammatically incorrect, too.


Also Read
Social Media News Headlines – Yahoo! News





Title Post: What the ‘Bqhatevwr’ Did Scott Brown Tweet?
Url Post: http://www.news.fluser.com/what-the-bqhatevwr-did-scott-brown-tweet/
Link To Post : What the ‘Bqhatevwr’ Did Scott Brown Tweet?
Rating:
100%

based on 99998 ratings.
5 user reviews.
Author: Fluser SeoLink
Thanks for visiting the blog, If any criticism and suggestions please leave a comment




Read More..

Conference suggests ways Broadway can be better


NEW YORK (AP) — A conference on how to make the Broadway experience better for theatergoers has come up with some prescriptions: Be brave in the stories that are told onstage and embrace youth and technology.


The second TEDxBroadway conference on Monday brought together 16 speakersproducers, marketers, entrepreneurs, academics and artists — to try to answer the question: "What is the best Broadway can be?"


Three speakers argued that new technology means the stage experience doesn't need to be confined to the four walls of the theater. One attendee said theater owners need to rethink their lobbies and several said customer service must be enhanced.


And Kristoffer Diaz, the playwright of the Pulitzer Prize finalist "The Elaborate Entrance of Chad Deity," urged producers to embrace different voices.


Read More..

Personal Health: Keeping Blood Pressure in Check

Since the start of the 21st century, Americans have made great progress in controlling high blood pressure, though it remains a leading cause of heart attacks, strokes, congestive heart failure and kidney disease.

Now 48 percent of the more than 76 million adults with hypertension have it under control, up from 29 percent in 2000.

But that means more than half, including many receiving treatment, have blood pressure that remains too high to be healthy. (A normal blood pressure is lower than 120 over 80.) With a plethora of drugs available to normalize blood pressure, why are so many people still at increased risk of disease, disability and premature death? Hypertension experts offer a few common, and correctable, reasons:


Jane Brody speaks about hypertension.




¶ About 20 percent of affected adults don’t know they have high blood pressure, perhaps because they never or rarely see a doctor who checks their pressure.

¶ Of the 80 percent who are aware of their condition, some don’t appreciate how serious it can be and fail to get treated, even when their doctors say they should.

¶ Some who have been treated develop bothersome side effects, causing them to abandon therapy or to use it haphazardly.

¶ Many others do little to change lifestyle factors, like obesity, lack of exercise and a high-salt diet, that can make hypertension harder to control.

Dr. Samuel J. Mann, a hypertension specialist and professor of clinical medicine at Weill-Cornell Medical College, adds another factor that may be the most important. Of the 71 percent of people with hypertension who are currently being treated, too many are taking the wrong drugs or the wrong dosages of the right ones.

Dr. Mann, author of “Hypertension and You: Old Drugs, New Drugs, and the Right Drugs for Your High Blood Pressure,” says that doctors should take into account the underlying causes of each patient’s blood pressure problem and the side effects that may prompt patients to abandon therapy. He has found that when treatment is tailored to the individual, nearly all cases of high blood pressure can be brought and kept under control with available drugs.

Plus, he said in an interview, it can be done with minimal, if any, side effects and at a reasonable cost.

“For most people, no new drugs need to be developed,” Dr. Mann said. “What we need, in terms of medication, is already out there. We just need to use it better.”

But many doctors who are generalists do not understand the “intricacies and nuances” of the dozens of available medications to determine which is appropriate to a certain patient.

“Prescribing the same medication to patient after patient just does not cut it,” Dr. Mann wrote in his book.

The trick to prescribing the best treatment for each patient is to first determine which of three mechanisms, or combination of mechanisms, is responsible for a patient’s hypertension, he said.

¶ Salt-sensitive hypertension, more common in older people and African-Americans, responds well to diuretics and calcium channel blockers.

¶ Hypertension driven by the kidney hormone renin responds best to ACE inhibitors and angiotensin receptor blockers, as well as direct renin inhibitors and beta-blockers.

¶ Neurogenic hypertension is a product of the sympathetic nervous system and is best treated with beta-blockers, alpha-blockers and drugs like clonidine.

According to Dr. Mann, neurogenic hypertension results from repressed emotions. He has found that many patients with it suffered trauma early in life or abuse. They seem calm and content on the surface but continually suppress their distress, he said.

One of Dr. Mann’s patients had had high blood pressure since her late 20s that remained well-controlled by the three drugs her family doctor prescribed. Then in her 40s, periodic checks showed it was often too high. When taking more of the prescribed medication did not result in lasting control, she sought Dr. Mann’s help.

After a thorough work-up, he said she had a textbook case of neurogenic hypertension, was taking too much medication and needed different drugs. Her condition soon became far better managed, with side effects she could easily tolerate, and she no longer feared she would die young of a heart attack or stroke.

But most patients should not have to consult a specialist. They can be well-treated by an internist or family physician who approaches the condition systematically, Dr. Mann said. Patients should be started on low doses of one or more drugs, including a diuretic; the dosage or number of drugs can be slowly increased as needed to achieve a normal pressure.

Specialists, he said, are most useful for treating the 10 percent to 15 percent of patients with so-called resistant hypertension that remains uncontrolled despite treatment with three drugs, including a diuretic, and for those whose treatment is effective but causing distressing side effects.

Hypertension sometimes fails to respond to routine care, he noted, because it results from an underlying medical problem that needs to be addressed.

“Some patients are on a lot of blood pressure drugs — four or five — who probably don’t need so many, and if they do, the question is why,” Dr. Mann said.


How to Measure Your Blood Pressure

Mistaken readings, which can occur in doctors’ offices as well as at home, can result in misdiagnosis of hypertension and improper treatment. Dr. Samuel J. Mann, of Weill Cornell Medical College, suggests these guidelines to reduce the risk of errors:

¶ Use an automatic monitor rather than a manual one, and check the accuracy of your home monitor at the doctor’s office.

¶ Use a monitor with an arm cuff, not a wrist or finger cuff, and use a large cuff if you have a large arm.

¶ Sit quietly for a few minutes, without talking, after putting on the cuff and before checking your pressure.

¶ Check your pressure in one arm only, and take three readings (not more) one or two minutes apart.

¶ Measure your blood pressure no more than twice a week unless you have severe hypertension or are changing medications.

¶ Check your pressure at random, ordinary times of the day, not just when you think it is high.

Read More..