BlackBerry Maker Unveils Its New Line

Marcus Yam for The New York Times

Thorsten Heins, the chief executive of BlackBerry, which was known as Research in Motion, introduces the company's new phones.

BlackBerry’s maker unveiled a new operating system and a new line of phones on Wednesday, along with a new corporate name, with the hope of restoring its products’ status as a symbol of executive cool.

Analysts, technology reviewers and app developers with advance access to the BlackBerry Z10 and the BlackBerry 10 operating system have said it is the company’s first competitive touch-screen phone. But BlackBerry 10 arrives long after Apple’s iPhone and phones using Google’s Android operating system have come to dominate the smartphone market that the BlackBerry effectively created. According to IDC, BlackBerry now holds just 4.6 percent of that market, about one-tenth of its historic peak.

To emphasize the changes brought by the new operating system, Thorsten Heins, who took over as chief executive a year ago, said the company, known until now as Research In Motion, had adopted BlackBerry as its corporate name. Its Nasdaq trading symbol will become BBRY, and it will trade as BB in Toronto.

In addition to the BlackBerry Z10 phone, there will be a second model, the Q10, that includes one of the line’s signature physical keyboards. Verizon Wireless announced that it would price the Z10 at $200 with a two-year contract. BlackBerry 10 phones will also be carried by AT&T, Sprint and T-Mobile.

“Today represents a new day in the history of BlackBerry,” Mr. Heins said. “These BlackBerry 10 devices are absolutely the best typing experiences in the industry.”

BlackBerry said the Z10 would be available in the United States in March and in Canada on Feb. 5.

There were few surprises in the initial portion of Mr. Heins’s presentation at an event in New York. The company began demonstrating the touch-screen phone and operating system in May and also made prototypes available to app developers at the time. In recent weeks, photographs of the final version of the phones have made their way to various American and European technology Web sites.

Physically, the Z10 resembles an iPhone 5 with its corners snipped off.

But unlike its competitors, the Z10 lacks a button to take users back to a home page and relies entirely on users swiping their fingers across the 4.2-inch screen from different directions to summon features or menus.

While the Z10 lacks a physical keyboard, the main attraction of BlackBerrys for many current users, the company said that it had developed software which should alleviate some of the inadequacies of on-screen typing. According to BlackBerry, its software studies users’ common typing mistakes over time and then starts automatically correcting them. It will also build up a list of commonly used words and offer them as suggestions that can be selected with a flick of a finger.

While developing the new operating system, the company took great pains to improve its strained relationship with app developers. The operating system was also designed in a way that allows them to adapt Android apps for BlackBerry 10 by making some relatively minor modifications.

BlackBerry said Wednesday that more than 70,000 BlackBerry 10 apps were now available.

For corporate and government users, BlackBerry 10 server software will allow them to divide employees’ BlackBerry 10 phones into separate work and personal spheres and give I.T. managers complete control over the former.

This article has been revised to reflect the following correction:

Correction: January 30, 2013

Because of an editing error, an earlier version of this article referred imprecisely to the plans of major American carriers to offer the two new BlackBerry models. While Verizon Wireless, AT&T, Sprint and T-Mobile will all carry new BlackBerrys, not all will offer the Z10; Sprint has so far announced plans only to offer the other model, the Q10.

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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.

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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)

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Singer Frank Ocean wants Chris Brown charged over brawl

LOS ANGELES (Reuters) – Rising R&B artist Frank Ocean wants fellow singer Chris Brown prosecuted following a brawl over a parking space at a Los Angeles-area recording studio, authorities said on Monday.

Brown is serving five years probation for assaulting his on-and-off girlfriend Rihanna in 2009 and risks having his probation revoked should charges be filed.

In the incident on Sunday, sheriff’s deputies responded to a call about a fight involving six men in West Hollywood. The deputies cited witnesses as saying that the Grammy-winning Brown, 23, punched Ocean during the brief altercation.

No charges have yet been filed, but Ocean “is desirous of prosecution in this incident,” said Los Angeles County Sheriff‘s spokesman Steve Whitmore.

Ocean, 25, who is nominated for best new artist and best record for “Thinkin Bout You” at the Grammys in February, said on Twitter on Sunday night that he “got jumped by Chris and a couple guys.” He said this resulted in a cut finger.

A representative for Brown has yet to comment.

The “Look at me Now” singer has attempted to rebuild his career and public image since 2009, but his entourage and that of Canadian rapper Drake were involved in a June 2012 brawl in a New York nightclub. No arrests or charges were brought in that case.

Brown and Ocean are both nominated in the best urban contemporary album category at the Grammys, which take place on February 10 in Los Angeles.

(Reporting by Eric Kelsey and Colleen Jenkins; Editing by David Brunnstrom)

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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: Chesapeake Energy Chief Steps Down

Chesapeake Energy’s co-founder and chief executive, Aubrey McClendon, will retire on April 1, the producer of oil and natural gas announced on Tuesday, almost eight months after investors complained about a contentious compensation plan.

Mr. McClendon, who gave up his chairman role last May, will also leave Chesapeake’s board on that date. Until then, he will transfer daily management responsibilities to other executives. A successor wasn’t named, though the company said that it had hired an executive search firm to find his replacement.

In an internal e-mail, Archie Dunham assured employees that “the company is not for sale.”

The surprise announcement of Mr. McClendon’s departure followed months of investor dissatisfaction with Chesapeake, which has struggled with prolonged low natural gas prices and efforts to move into more lucrative oil production. But shareholder ire spiked last spring, after Reuters reported on an unusual executive perquisite in which he was allowed to buy stakes in each well the company drilled.

To help finance those investments, Mr. McClendon often borrowed from companies that had conducted business with Chesapeake, raising concerns that he faced a conflict of interest.

In an attempt to quell the turmoil, Mr. McClendon agreed last May to give up his chairman role and to end the compensation plan ahead of schedule.

Chesapeake said on Tuesday that it expected to announce the results of a monthslong review into the compensation plan when it discloses its earnings next month. In the interim, the company said that the inquiry has not unveiled any improper conduct.

“Over the past 24 years, I have had the privilege of developing Chesapeake into one of the world’s premier energy companies,” Mr. McClendon said in a statement. “While I have certain philosophical differences with the new board, I look forward to working collaboratively with the company and the Board to provide a smooth transition to new leadership for the company.”

Below is a copy of Mr. Dunham’s e-mail to employees:

As you may have just read in an e-mail from Aubrey and will see in the press release this evening, the board of directors of Chesapeake has mutually agreed and accepted Aubrey McClendon’s resignation as C.E.O. effective upon appointment of his successor, and retirement from the company, effective April 1, 2013. The decision was made in full recognition and appreciation for the enormous achievements Aubrey has made in founding and building Chesapeake into the extraordinary enterprise it is today.

Over the past 24 years, Aubrey has created one of the most valuable companies in the energy industry. Under his strong leadership, Chesapeake has built an unmatched portfolio of natural gas and oil assets in creating one of the world’s leading energy companies. Aubrey has been a pioneer in the development of unconventional resources, and he has also been a leader in the effort to make the United States energy independent. Aubrey has done all of this with the support and expertise of the world-class senior management team he recruited to Chesapeake and the dedication of our employees.

For the transition, Aubrey remains our C.E.O. During this interim period, he will work closely with Steve Dixon, chief operating officer, and Nick Dell’Osso, chief financial officer, to transition certain day-to-day management responsibilities and assure that the company maintains the highest degree of operational excellence and strategic execution of our business plan. The board of directors and the senior management team are counting on your continued dedication and focus as we execute our strategy of developing our world-class assets and maintain our performance as a low-cost producer of oil and gas while further strengthening the balance sheet.

I would also like to address certain likely points of concern among you. First, the company is not for sale. Second, the board has confirmed the current drilling and completion budget of six billion dollars and is eager to see the exciting recent results of the company’s core of the core development strategy continue. Lastly, the board and management believe strongly in the culture of excellence at Chesapeake and are committed to seeing this culture thrive in the future. The board has no intention of eliminating childcare, shutting down the fitness center, or selling the company cafeterias. I’m sure that other false rumors will appear, so when they surface, ask Steve or Nick if they are true. Our truly top notch 12,000 employees remain the company’s best asset, and we will continue to retain and attract the best talent in the industry.

We are at an important transition point for our company, but it is also a point of great opportunity. Thank you for all you do to make Chesapeake a great company.

Warm regards,

Archie Dunham

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Bipartisan group sees change in politics on immigration reform

A bipartisan coalition of senators said Monday they have created a set of principles based upon which they hope lawmakers will pass immigration reform by summer.

WASHINGTON — Declaring that the politics of immigration  “have been turned upside down,” a bipartisan group of senators Monday outlined common principles for comprehensive immigration reform and expressed optimism that legislation granting legal status to most of the country's 11 million illegal immigrants could be realized by this summer.

One day before President Obama launches a campaign-style push for his vision of immigration reform, representatives of the so-called Group of Eight senators acknowledged previous false starts on the issue, and obstacles that probably lie ahead — particularly in determining how to increase the flow of legal immigration.

But, after an election in which the share of the nonwhite vote continued to grow and swung overwhelmingly toward Obama, the lawmakers said that the path forward was as clear as ever.

Arizona Sen. John McCain, the GOP’s 2008 presidential nominee and a past proponent of comprehensive reform, said the change in favor of taking action came down to one word: “Elections.”

PHOTOS: President Obama’s second inauguration

“The Republican Party is losing the support of our Hispanic citizens. And we realize that there are many issues in which we think we are in agreement with our Hispanic citizens, but this is a preeminent issue with those citizens,” he said at a Capitol Hill news conference. 

“For the first time ever, there's more political risk in opposing immigration reform than in supporting it,” added Sen. Charles E. Schumer (D-N.Y.).

The Senate blueprint, drafted during weeks of closed-door meetings by leading senators from each party, is more conservative than Obama's proposal, which the president plans to unveil Tuesday in a speech in Las Vegas. But its provisions for legalizing millions of undocumented immigrants go further than measures that failed to advance in Congress in previous years — a reminder of how swiftly the politics of immigration have shifted since the November election.

The Senate proposal would allow most of those in the country illegally to obtain probationary legal status immediately by paying a fine and back taxes and passing a background check. That would make them eligible to work and live in the U.S. They could earn a green card — permanent residency — after the government certifies that the U.S.-Mexican border has become secure, but might face a lengthy process before becoming citizens.

Obama is expected to push for a faster citizenship process that would not be conditional on border security standards being met first. The structure of the citizenship process will probably be among the most hotly debated parts of any immigration plan.

PHOTOS: A look ahead at 2013’s political battles

Less controversial provisions would tighten requirements on employers to check the immigration status of new workers; increase the number of visas for high-skill jobs; provide green cards automatically to people who earn master's degrees or PhDs in science, technology or math at U.S. universities; and create an agricultural guest-worker program.

Schumer said lawmakers are aiming for full legislative language to be put forward by March, which will then work its way through the committee process. A vote in the Senate could come by late spring or summer, he said.

“We still have a long way to go, but this bipartisan blueprint is a major breakthrough,” he said.

Though their effort was running parallel to the president’s, Democratic Sen. Richard J. Durbin of Illinois said he and Schumer spoke with Obama on Sunday and that the president “cheered us on.” McCain said Obama’s public campaign for it would be helpful to their cause.

Still, many conservatives on Capitol Hill remain skeptical about sweeping immigration legislation and could prove a major obstacle to any compromise.

“The last time we talked about this in 2007, it sounded very seductive. When we saw the details, it was clear it wouldn’t work,” Sen. Jeff Sessions (R-Ala.) said in an interview Monday. Sessions said he was particularly concerned that the Obama administration is not committed to securing the borders against future illegal immigration.

Similar criticism from Republican lawmakers doomed a 2007 immigration bill pushed by President George W. Bush and seniors Senate Democrats.

PHOTOS: President Obama’s past

Today, 22 GOP senators who opposed the 2007 plan remain in the Senate, including Minority Leader Mitch McConnell (R-Ky.). By contrast, just two of the 12 Republicans who backed the compromise six years ago are still in Congress — McCain and South Carolina's Lindsey Graham.

Republican resistance to an immigration overhaul promises to be even more intense in the House, where many conservative lawmakers are leery of any proposal that would provide a mechanism for immigrants here illegally to gain citizenship, a key demand on the left.

“When you legalize those who are in the country illegally, it costs taxpayers millions of dollars, costs American workers thousands of jobs and encourages more illegal immigration,” said Rep. Lamar Smith (R-Texas), the former chairman of the House Judiciary Committee. “By granting amnesty, the Senate proposal actually compounds the problem by encouraging more illegal immigration.”

Staff writers Brian Bennett and Lisa Mascaro contributed to this report.

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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.

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Rock singer Morrissey postpones six more shows due to bleeding ulcer

LOS ANGELES (Reuters) – British rock singer Morrissey is postponing six performances on his U.S. tour due to a bleeding ulcer, his spokeswoman said on Sunday.

“Morrissey is expected to make a full recovery and thanks everyone concerned for their support during this time,” his representative Lauren Papapietro said in a statement.

Morrissey, the former lead singer for 1980s alternative rock band The Smiths, checked into Beaumont Hospital on Friday in the Detroit suburb of Royal Oak, Papapietro said.

She declined to say if he remains hospitalized.

Due to his bleeding ulcer, Morrissey is postponing his upcoming shows in Asheville, North Carolina; Nashville, Tennessee; Atlanta, Georgia; Lawrence, Kansas; Clear Lake, Iowa; and Lincoln, Nebraska, Papapietro said.

He plans to resume his tour on February 9 in Las Vegas.

Due to an illness in his band, Morrissey, 53, canceled his show Thursday in Flint, Michigan, and postponed a Friday night performance in Minneapolis and another engagement set for Saturday night in Chicago, Papapietro said.

Morrissey, whose hits include “First of the Gang to Die” and “Irish Blood, English Heart,” toured North America last fall, played some shows in Australia and New Zealand in December and returned to the United States this month.

He kicked off his latest tour with a performance of his unreleased song “Action is My Middle Name” on “The Late Show with David Letterman” in New York.

(Reporting by Alex Dobuzinskis; Editing by Kevin Gray and Stacey Joyce)

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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:

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Jane Brody speaks about hypertension.

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¶ 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.

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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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