Shell Wins 3 Pollution Suits Filed by Nigerians


In a legal dispute that had been closely watched by multinational companies and environmental organizations, a Dutch court Wednesday dismissed most of the claims brought by Nigerian farmers seeking to hold Royal Dutch Shell accountable for damage by oil spilled from its pipelines.


The decision, by the District Court of the Hague, was unusual in that it was brought in a Dutch jurisdiction against a Dutch company for activities overseas by a foreign subsidiary.


Shell, which has its headquarters in the Hague and its registered offices in London, acclaimed the decision as a vindication.


The company had argued that the oil spills were not its fault, but the result of criminal tampering.


“This ruling will enable more people to understand what is happening on the ground in Nigeria,” Jonathan French, a Shell spokesman, said. “We have this rampant problem of criminal activities: oil theft, sabotage, and illegal refining. That is the real tragedy of the Niger Delta.”


The company, which obtains 12 percent of its oil and gas from Nigeria, has long been dogged by accusations that its activities there cause serious environmental problems and human rights abuses.


In 2009 it agreed to pay $15.5 million to end a lawsuit brought under the U.S. Alien Tort Claims Act arising from the 1995 execution of the author Ken Saro-Wiwa, a critic of the company and the Nigerian government’s actions in the Niger Delta.


That U.S. law has been interpreted as having broad jurisdiction, even over foreign multinationals.


Shell denied that it bore any responsibility for Mr. Saro-Wiwa’s death, but said it wanted to end the litigation and move on.


In the case decided Wednesday, which was filed in 2008, four Nigerian farmers and fishermen, working with the environmentalist group Friends of the Earth, claimed that their livelihoods had been ruined by oil that spilled from Shell pipelines in their villages.


While the pollution damage itself was not in dispute, Shell argued that the spills had been caused by so-called bunkering — oil theft from the pipelines — as well as outright sabotage.


The court agreed with Shell in most of those spills, around the villages of Goi and Oruma.


But it held that in one spill, near the village of Ikot Ada Udo, the local subsidiary, Shell Petroleum Development Co. of Nigeria, was liable for damages — as yet unspecified — to one farmer.


In that case, the court said, “sabotage was committed in a very simple way in 2006 and 2007 by opening the overground valves with a monkey wrench,” something that “Shell Nigeria could and should have prevented.”


“I am not surprised at the decision because there was divine intervention in the court,” Reuters quoted the farmer, Friday Akpan, as saying. “The spill damaged 47 fishing ponds, killed all the fish and rendered the ponds useless.”


Joel Trachtman, a professor of international law at the Fletcher School of Law and Diplomacy in Medford, Massachusetts, said that, in theory, the court’s finding in favor of Mr. Akpan meant that “multinational companies could find their foreign subsidiaries held to a higher standard, higher even than locally owned companies.”


That, he said, “conceivably could deter foreign investment in Nigeria.”


But Mr. Trachtman noted that the court also rejected any liability for the parent company. That limited the implications of the ruling. Mr. Trachtman said that facet of the decision was in keeping with global legal principles. “Usually courts around the world accept the separate existence of a subsidiary corporation,” he said. “They don’t pierce the veil to hold the parent responsible.”


Evert Hassink, a spokesman for the Dutch chapter of Friends of the Earth, described the court ruling as “mixed.” The court’s refusal to assign any responsibility to the parent company was disappointing, he said. But “we’ve succeeded in establishing the principle of going to court in the Netherlands or Europe because of what happened in another country,” he said.


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Egyptian general warns against continued unrest









CAIRO — Egypt’s top military commander warned President Mohamed Morsi and opposition parties Tuesday to end days of bloodshed and unrest before the nation slides into chaos that may jeopardize the economy and “lead to the collapse of the state.”


The ominous statement from Gen. Abdel Fattah Sisi signaled that the military, which ruled Egypt for months before Morsi was elected in June, wanted to quickly stem an uprising against the Islamist-led government. At least 52 people have died in riots since Friday.


“The continuing conflict between political forces and their differences concerning the management of the country could lead to a collapse of the state and threaten future generations,” Sisi said on the army’s Facebook page. He added that political turmoil and attacks on state targets were a “real threat to the security of Egypt.”





Despite its much criticized rule, marked by political repression and human rights violations, the military is largely revered. It is regarded by many Egyptians as the single stabilizing force across a spectrum of failed institutions and Morsi’s authoritarian moves to consolidate the Muslim Brotherhood’s grip on power.


It did not appear the army was preparing to seize control of the country. The generals’ tenure running the government after the February 2011 toppling of Hosni Mubarak left them bitter and tainted the military’s reputation, especially after crackdowns on demonstrators. The army prefers playing behind-the-scenes power broker.


The statement, though, suggested the military was losing patience with protesters and questioning Morsi’s ability to contain the crisis. The army has been loyal to the president; Morsi supported a new constitution that gives the generals wide autonomy. But the Islamist president has been unable to sway protesters or the opposition away from conflict.


The military did not clarify how it “might interfere in coming days,” said Talaat Mosallam, a retired major general and security analyst. “Their experience before in politics was not a comfortable one. But their feeling that the political powers might be losing control compelled them to issue a statement.”


Troops have been deployed and given emergency arrest powers to guard public buildings and shipping docks in the vital coastal cities of Suez, Port Said and Ismailia. Ports in those towns serve the Suez Canal, whose stability is a potent economic symbol for foreign capitals and investors.


Violence and protests eased a bit on Tuesday. However, clashes between rock-throwing youths and police rumbled at the edges of Tahrir Square in Cairo. Unrest continued in Suez and Port Said, where protesters defied curfews and the government had lost control amid burned police stations and well-armed residents.


The main opposition coalition, the National Salvation Front, has rejected Morsi’s call for political talks. The organization, headed by reformers, including Nobel Peace Prize laureate Mohamed ElBaradei, has accused the president and the Muslim Brotherhood of hijacking the revolution that overthrew Mubarak.


But the opposition’s influence on the streets is questionable. Many protesters criticize it as disorganized, divided and unable to articulate a galvanizing message. The opposition epitomizes a major shortcoming of the revolution: the absence of a charismatic figure capable of bridging political differences and fixing the economy.


The military’s statement highlighted the failure of the Interior Ministry, which controls the nation’s police forces, to keep order. The ministry backed Mubarak’s 30 years of repressive rule and lacks the reforms to gain the confidence of Egyptians. It is mistrusted by the Muslim Brotherhood, whose members for decades were persecuted and tortured by police.


The unrest has been further complicated by disparate interests converging around a protest movement. Peaceful demonstrations have often been overshadowed by young men and boys hurling stones and firebombs at police. Soccer fans, known as Ultras, have acted as shock troops. Looters and gunmen roam cities.


More recently an anarchist group calling itself the Black Bloc has battled security forces along barricades leading to the parliament. The country’s general prosecutor Tuesday called it a terrorist organization after the ransacking of the lobby in the Intercontinental Hotel near Tahrir Square. The Black Bloc denied it was involved.


Frightened hotel workers sent out tweets, including one that read: “SOS If anyone knows anyone in #Military #Police #Government, please send help! Thugs in Lobby.”


Hesham Abdel-Wahab, a hotel security guard, told the Ahram Online news website: “We called the police and requested they send forces. But when I spoke to the police, they just continued to ask me for my name. They were very hesitant. I kept saying to them that my name doesn't matter, we were under attack.”


ALSO:


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Controversial Spanish doctor testifies in huge sports doping trial


Special correspondent Reem Abdellatif contributed to this report.





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Next Up for SEALs: Upgraded Batman-Style Grappling Hook Gun



Even Navy SEALs need to feel like Batman sometimes. Especially when they’re trying to scale walls or board ships.


Enter Jim LaBine of the defense company Battelle. For years, Battelle has manufactured a tool for SEALs that the Dark Knight might haul from the Batcave: a pneumatically fired grappling hook, launched from an intimidating black cannon about the size of your arm. It’s called the Tactical Air Initiated Launch, or TAIL, and LaBine designed it. It’s even been featured on MythBusters. Six months ago, LaBine opted to upgrade it.


SEALs wanted something “that could clear a two-story building,” LaBine explains during a Washington, D.C. special-operations conference. So he designed something that’s meant for scaling a much, much taller building instead. Pictured above, the RAIL, or Rescue Air Initiated Launch, is a collapsible metal grappling hook. It’s given a lot of extra lift to the gun’s ability to get a SEAL over an obstacle.



The grapple on the TAIL is an unyielding metal claw. It’s good for getting its hook into a surface 100 feet high and towing a sturdy, nylon-jacketed line or ladder for someone to ascend. But the claw is inflexible, and that poses problems for its use. “I’m limited by it,” LaBine says, “but it’s got elements that want to let me go further and higher.”


The RAIL operates more like Batman’s actual climbing tools (with the caveat being that neither Batman nor his gadgets are real). It folds like an umbrella into the TAIL’s barrel, and only flexes after firing, opening into a claw shape at the end of the drag. According to LaBine, it more than doubled the TAIL’s upward maximum range, to 250 feet. Search-and-rescue teams might want to use it as well as the military, he thinks.


One problem: according to a video LaBine showed me, the RAIL makes a loud, whistling sound as it sails through the air, so it’s not good for a stealth raid like on the bin Laden compound. (There’s “some loud noise,” LaBine concedes.) It’s not yet for sale, according to Battelle, so it may have some tweaks on the way before SEALs get to use it for, say, getting aboard a hostile ship. Or even swooping across Gotham’s rooftops.


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Clinton coy about political future in joint interview with Obama






WASHINGTON (Reuters) – Outgoing U.S. Secretary of State Hillary Clinton sidestepped questions about whether she would run for president in 2016 in a CBS television interview done jointly with President Barack Obama, her rival in the 2008 race.


Clinton, 65, denied there were any political tea leaves to read in the unusual joint interview for the CBS show “60 Minutes,” and acknowledged that she still has “some lingering effects” from a recent concussion and blood clot that she said doctors expect to disappear over time.






“The president and I care deeply about what’s going to happen for our country in the future. And I don’t think, you know, either he or I can make predictions about what’s going to happen tomorrow, or the next year,” Clinton said, according to a transcript of the interview, which was taped at the White House on Friday and aired on Sunday.


Obama beat Clinton in a bitter Democratic primary campaign to run for president in 2008. He surprised many by choosing her as his secretary of state, a job she said she initially turned down.


Clinton traveled to a record 112 countries as secretary of state. She has said she wants to take a break from public life, but has not said she will retire.


Democratic Senator John Kerry, who unsuccessfully ran for president in 2004, is expected to be confirmed as Obama’s new secretary of state as early as this week.


After Obama heaped praise on Clinton’s diplomatic achievements, he chided the show’s host, Steve Kroft, who asked about “the date of expiration on this endorsement” of Clinton.


“You guys in the press are incorrigible. I was literally inaugurated four days ago. And you’re talking about elections four years from now,” Obama said.


‘LINGERING EFFECTS’ FROM FALL


Clinton has been in the public eye for 34 years, since her husband, former President Bill Clinton, was governor of Arkansas.


Her cautious answer about her future on Sunday was less definitive than one she gave in an ABC interview in December, when she said in reference to another bid for the presidency: “I’ve said I really don’t believe that that’s something I will do again.”


Many Democrats hope that Clinton will run in 2016. Vice President Joe Biden‘s name has also been frequently mentioned among Democrats. He has said he has not decided whether to run.


Clinton also addressed a recent health issue: a concussion and blood clot that sent her to the hospital.


“The doctors tell me that that will all recede. And so thankfully I’m, you know, looking forward to being at full speed,” she said.


She said she had since been wearing glasses instead of contact lenses because of “lingering effects” from the concussion “that are decreasing, and will disappear.”


Clinton returned from a European tour on December 7 suffering from a stomach virus. On December 15, the State Department announced she had become dehydrated, fainted and suffered a concussion.


During a check-up afterwards, she was diagnosed with the blood clot, hospitalized and treated with blood thinners.


(Additional reporting by Paul Eckert; Editing by David Brunnstrom)


TV News Headlines – Yahoo! News





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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.

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DealBook: Jefferies C.E.O. Earned $19 Million in 2012

3:48 p.m. | Updated

The head of the Jefferies Group was one of the better-paid chief executives on Wall Street in 2012, as the firm put a difficult period behind it.

Richard B. Handler, the chief executive of Jefferies, earned a total of $19 million for 2012, the firm said in a filing on Tuesday. That included a $5 million cash bonus and a $13 million long-term equity incentive award, on top of a $1 million base salary.

The board’s compensation committee was “unanimously impressed with our financial performance and Mr. Handler’s role in that performance,” Jefferies said in the filing. The board said that Mr. Handler was eligible for a bonus of $8.1 million but volunteered to take a smaller amount.

Jefferies reported a profit of $71.6 million in the fourth quarter, an increase of 48 percent from a year earlier. It was the final independent earnings report for the boutique investment bank, which is becoming part of the Leucadia National Corporation in a $3.6 billion deal. Mr. Handler is set to become Leucadia’s chief executive.

Jefferies said in the filing on Tuesday that Mr. Handler was also granted restricted stock worth $39 million to cover three future years: 2013, 2014 and 2015.

Mr. Handler’s pay package for 2012 was higher than that of Jamie Dimon, head of JPMorgan Chase. Mr. Dimon earned $11.5 million, compared with $23 million a year earlier.

Mr. Handler got a significant raise from 2011, when he earned $14 million. That year, he declined to accept a bonus after a period in which investors feared for the firm’s health.

But those fears, which emerged in the wake of MF Global‘s collapse, appear to have largely receded. The firm’s shares rose about 35 percent in 2012 and were virtually flat on Tuesday.

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'Argo' producer scours for the next stranger-than-fiction story









Hunched over a desk in his spartan Westwood apartment, David Klawans squints at his computer monitor and knits his brow in concentration. "I'm perusing," he says.


His eyes dart between headlines almost indecipherable on a Web page displaying about 800 stamp-sized images of newspapers from 90 different countries.


"Two kids running? What's that?" he exclaims before clicking on a photo. "Oh, it's refugees. Whatever. Moving on."





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Nearly every day, for upward of 10-hour stretches, the independent film producer speed-reads police blogs, articles from RSS feeds and niche-interest journals in dogged pursuit of an elusive prize: a story on which to base his next movie.


His biggest hit to date is "Argo." Before the film landed seven Oscar nominations (including one for best picture) and two Golden Globes (including best drama picture), before it generated more than $180 million in worldwide grosses, "Argo" existed as a declassified story in the quarterly CIA journal Studies in Intelligence, which Klawans happens to have been perusing one day in 1998.


"It's like going on the beach with a metal detector," the self-described news junkie says of his process. "Like Kanye West looks through records to sample on his songs, I'm looking for stories to turn into films."


Klawans, 44, has established himself as Hollywood's least likely movie macher by heeding the advice of his mentor, the old-school producer David Brown ("Jaws," "A Few Good Men"): "Read everything you can get your hands on."


Indefatigable in his quest to root out oddball, overlooked true-life stories, Klawans spins material most others ignore into cinematic gold.


OSCAR WATCH: "ARGO"


"Argo" took nearly 14 years to reach the big screen after Klawans read about CIA exfiltration expert Tony Mendez's rescue of six American diplomats hiding in Tehran during the 1979 Iran hostage crisis. Mendez (portrayed in the movie by "Argo's" director, Ben Affleck) posed the group as Canadian filmmakers scouting locations for a science-fiction film, created a fictitious production company and planted articles about the bogus project in Hollywood trade papers.


Throughout the '90s Klawans was scraping by as a production assistant for an L.A.-based Japanese TV commercial firm. He didn't own a car, so he bicycled to UCLA's magazine archive to check the story. In microfiche files, he came across the CIA's planted articles in the Hollywood Reporter and Variety from January 1980. "My jaw dropped," he says.


Problem was, Mendez already had representation at Creative Artists Agency and was preparing to publish a memoir, "The Master of Disguise." Even so, Klawans persuaded Mendez to let him attempt to set up a movie project. He eventually bought the rights to Mendez's life story as well.


OSCARS 2013: Nominations


"I'm cycling to pitch meetings wearing a backpack with a change of clothes. It's summertime and I'm sweating. And I'm getting to know studio security. They call me 'bike boy,'" remembers Klawans, who would switch from bike to business attire outside the studio gates. "I would basically throw my backpack behind a bush — I was embarrassed to look like a messenger guy."


The New York University film school graduate was born in Chicago. His family moved to Belgium when he was 2 and he grew up in Europe and the U.S. consuming a steady diet of sci-fi and fantasy films including "Star Wars."


He came close to setting up the "Argo" project as a cable TV movie. But when that deal fell through, Klawans says, "it hit me that Tony had planted stories in Variety and Hollywood Reporter as a cover. For the CIA, it's all about illusions and perception. I thought, 'That's what I'm going to do. I'm going to plant an "Argo" story in a magazine.'"


The producer had met former L.A. Weekly staff writer and "This American Life" contributor Joshuah Bearman through friends who thought the two shared an appreciation for offbeat material. Bearman also had experience turning a magazine story into a movie; an article he reported for Harper's became the 2007 documentary "The King of Kong: A Fistful of Quarters," about two die-hard video game players vying for the world's highest score in the vintage arcade game "Donkey Kong."


Klawans handed over his research and contacts to Bearman and proposed that the journalist write "Argo" as a magazine article that would entice movie backers.


Bearman landed an assignment from Wired magazine, then interviewed everyone he could: Mendez, officials in the State Department with knowledge of the exfiltration and Ken Taylor, the Canadian ambassador to Iran who housed some of the fugitive American diplomats, as well as the six embassy "houseguests."





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Dubai's Underwater Hotel Promises Submersible Luxury











Dubai’s fascination with overblown architecture has moved below sea level thanks to the announcement of The Water Discus — billed as the world’s largest underwater hotel.


With an aesthetic not too many light years removed from the Starship Enterprise and an evacuation mechanism not dissimilar to that of a cafetiere plunger in reverse, the design by Polish firm Deep Ocean Technology reveals a hotel split into two parts — one permanently above the water and the other capable of submerging to a depth of 33 feet.


The submersible part of the hotel is intended to contain 21 hotel rooms as well as an underwater diving facility and a bar. Deep Ocean Technology are also keen to point out that from this location visitors will be able to observe the minutiae of the lives of their aquatic neighbours:

“Special lighting system of the area around the room and the miniature underwater vehicles which can be operated from inside will allow you to take a closer look at even the most microscopic underwater creatures using macro photography.”


Although, that said, they are less keen on fish and fellow guests being afforded the same prurient privileges:


“We also ensure that our guests can protect their privacy whenever necessary. All rooms are sound-proof and have curtains of different levels of transparency.”


President of BIG InvestConsult AG (a Swiss firm who have partnered with Deep Ocean Technology for the project) Bogdan Gutkowski previously informed World Architecture News that The Water Discus is also intended as an environmentally conscious research center as well as a tourism hub.


“We would like to create here in the UAE the International Environmental Program and Center of the Underwater World Protection — with Water Discus Hotel as a laboratory tool for ocean and sea environment protection and research.”






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Barbara Walters, hospitalized after fall, recovering from chicken pox






NEW YORK (Reuters) – Celebrity newswoman Barbara Walters, who was hospitalized earlier this month after falling and injuring her head, is recovering from chicken pox, her co-host Whoopi Goldberg said Monday on “The View” talk show.


Goldberg said Walters, 83, who is in a New York hospital, has been told to rest and is not receiving visitors.






“You all know that she fell and cut her head 10 days ago and then was running a temperature,” Goldberg said on the show.


“But it turns out it is all the result of a delayed childhood. Barbara has the chicken pox,” Goldberg adding, saying Walters had never had the illness as a child.


Walters, 83, had been admitted to a Washington hospital during President Barack Obama‘s inauguration weekend after she fell and cut her head at the British ambassador’s residence, her network ABC said.


Goldberg joked: “She’s been told to rest, she’s not allowed any visitors, and we’re telling you, Barbara, no scratching.”


ABC-TV said Walters, who created the long-running talk show after working decades as one of television news’ best-known journalists, was transferred to a New York hospital late last week from Washington and was expected to be discharged soon.


Despite Goldberg’s light-hearted remarks about the illness, usually associated with children, chicken pox can be serious for adults and the elderly, accompanied by more severe itching from hundreds of blisters.


Headaches, fever and chills, sometimes leading to pneumonia, can follow if the illness is not properly treated and precautions are not taken, or if the patient has a compromised immune system.


(Reporting by Chris Michaud; Editing by Patricia Reaney and Philip Barbara)


Celebrity News Headlines – Yahoo! News





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Well: 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.

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