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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9/11 Health Compensation Fund Makes First Payouts

A federal fund set up to compensate people sickened by the Sept. 11 terrorist attacks made its first awards on Tuesday, to 15 first responders.

The recipients’ names were not released, but 14 are firefighters and one is a correction officer who responded to the disaster early on, mainly on the first day, said Sheila Birnbaum, the special master of the $2.8 billion victim compensation fund.

Most of them had respiratory illnesses and none of them had cancer, she said. Their awards, which are tax-free, ranged from $10,000 to $1.5 million. But they are receiving only 10 percent at first because of uncertainty about how many people will ultimately apply for the benefits, which are available to first responders, volunteers, workers and residents who were in Lower Manhattan in the months after the attacks.

Ms. Birnbaum could not provide the total dollar amount awarded in this round.

The fund expires in October 2016. With thousands of people potentially eligible, it could in theory, according to an actuarial calculation, have to pay out $8.5 billion, far more than it can afford.

“If our estimates have been too conservative and there’s money we can afford, we’ll give you another check,” Ms. Birnbaum said.

Richard Alles, a deputy fire chief and legislative chairman of the Uniformed Fire Officers Association, said his members were pleased to see the money finally being disbursed. “It’s a tremendous relief for many people who are sick and dying from 9/11-related illnesses,” he said.

In late 2010, Congress approved the $2.8 billion compensation fund, along with a $1.5 billion fund for health monitoring and treatment. Dr. James Melius, chairman of the steering committee for the World Trade Center Medical Monitoring and Treatment Program, said he hoped the reality of the awards would encourage others to fill out their paperwork.

Ms. Birnbaum said $10,000 would be the lowest amount awarded.

The highest awards, she said, represented lost income for firefighters who were relatively young and mostly or completely disabled. The awards are compensation for lost wages, out-of-pocket expenses for doctors, medications and other health costs, and pain and suffering, which is based on the extent of someone’s disability. Other sources of compensation, like pensions, disability money and court settlements, are deducted from the amount before it is paid.

Ms. Birnbaum said she had not awarded money for cancer yet because she had not received any completed applications from people with cancer, and not because of any medical judgment. Fifty kinds of cancer were added to the list of eligible sicknesses last year despite a lack of evidence tying Sept. 11 to cancer.

“Each claim is looked at individually,” Ms. Birnbaum said. “The type of illness is not important. What is important is your economic loss.”

Ms. Birnbaum said one reason for the small number of payments was the glacial pace at which the paperwork was being filled out. More than 16,000 people have registered for the victim compensation fund, but only 2,500 have gone the next step and submitted eligibility forms, showing, for instance, that they were present at the disaster sites: the World Trade Center, the Pentagon, Shanksville, Pa., or the landfill and routes where debris was taken.

Of those, only 190 have submitted compensation forms, and many lack documentation, Ms. Birnbaum said.

She said her staff had been meeting with lawyers to advise them on how to get better affidavits from witnesses for people who did not have other ways to document that they had been at the disaster sites. “These affidavits are so bare,” she said, “that nobody could say that these showed anything.”

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To Open Eyes, W-2s List Cost of Health Plans

WASHINGTON — As workers open their W-2 forms this month, many will see a new box with information on the total cost of employer-sponsored health insurance coverage. To some, it will be a surprise, perhaps even a shock.

Workers often have little idea how much they and their employers are paying for coverage. In many cases, economists say, workers give up cash compensation to get and keep health benefits.

The disclosures, required by the 2010 health care law, are meant to make workers more cost-conscious. Health benefits are still tax-free. But labor unions and employer groups say it could be easier to tax them in the future, now that employers must report their value to the government.

The new information appears in Box 12 of the standard W-2 form, with a two-letter code, DD. The box shows the “cost of employer-sponsored health coverage.” And that amount is not taxable, the Internal Revenue Service says on the back of the form.

Jay J. Makled, a union steward for the United Automobile Workers at the Ford plant in Dearborn, Mich., described his reaction after seeing that his health coverage cost nearly $16,000 last year: “It’s quite expensive. I was surprised to see how much the company was paying for that benefit.”

Hourly employees represented by the union there said they generally did not pay any of the premium.

The number on the W-2 form is supposed to reflect the part of the cost paid by the employer and the part paid by the employee.

Prof. Nicole Huberfeld, an expert on health law at the University of Kentucky, who received her W-2 form on Monday, said, “Most people who get health insurance from their employers have no idea how much it costs.”

“People are often shocked when they see the cost, $12,000 to $16,000 a year,” Ms. Huberfeld said. “Many Americans believe this is something they get free. But employers pay lower wages because they provide insurance.”

In 2012, according to an annual survey by the Kaiser Family Foundation, premiums for employer-sponsored health insurance averaged $5,615 a year for single coverage and $15,745 for family coverage. Over five years, the costs have increased 25 percent for individual coverage and 30 percent for family coverage.

“Health coverage is a big piece of people’s income and a large part of the social welfare budget,” said C. Eugene Steuerle, a tax economist at the Urban Institute. “But the benefits are not taxable, and most of the spending is hidden, so we don’t consider the trade-offs. If we want to get control of health care costs, people have to be aware of them.”

That is the goal of the disclosure requirement, which was proposed by a bipartisan group of senators: two Republicans, Charles E. Grassley of Iowa and Michael B. Enzi of Wyoming, and two Democrats, Max Baucus of Montana and Ron Wyden of Oregon.

Congress acted after Peter R. Orszag, then the director of the Congressional Budget Office, told lawmakers: “The economic evidence is overwhelming, the theory is overwhelming, that when your firm pays for your health insurance, you actually pay through reduced take-home pay. The firm is not giving that to you for free.”

The tax-free treatment of employer-provided health benefits is the largest tax break in the tax code, costing the government roughly $180 billion a year in lost revenue, or 80 percent more than the home mortgage interest deduction, according to the administration.

Katie W. Mahoney, the executive director of health policy at the U.S. Chamber of Commerce, said, “It’s useful for employees to know the value of coverage their employers provide.” But she said some employers worried that reporting the benefit on the W-2 form could lead to taxing the benefit.

“That’s not the intent of the current requirement,” Ms. Mahoney said. “But once the information is collected by the government, it’s very easy for another administration to have a different intent.”

An employee of the A.F.L.-C.I.O. whose health coverage was listed as costing more than $20,000 said: “That knocks my socks off. When I saw the number, my eyes popped out. I appreciate my employer all the more.”

The employee said he had been told not to discuss the cost publicly because the union did not want to suggest that some employees had “Cadillac coverage.”

An employer that fails to comply with the reporting requirement could be subject to penalties of $200 per W-2 form, up to a maximum of $3 million, tax lawyers said.

Employers are exempt from the reporting obligation if they are required to file fewer than 250 W-2 forms, the I.R.S. said. That could change, but the agency said employers would be given at least six months’ notice.

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Investors Shrug Off a Weak Earnings Report From Amazon

A glorious future beats a glorious past.

Investors decimated Apple last week when it appeared that the world’s mightiest profit machine might be slowing down just a tad. But they cheered on Tuesday when Amazon said its fourth-quarter sales and earnings fell short of expectations. Oh, and expect a miserable first quarter, too.

Shares in Amazon immediately jumped nearly 10 percent in after-hours trading, about the same amount that Apple fell after releasing its news.

What caught the eye of investors was that operating margins as a percent of consolidated sales rose to 3.2 percent, from 2.7 percent a year ago.

“The carrot for Amazon investors is improvements to margin over time,” said Gene Munster, an analyst with Piper Jaffray. Apple, on the other hand, would need to build a cheaper iPhone to keep growing as fast as it has been, which would slice into its margins.

For more than a decade, Amazon has teetered between minimal profits and no profits. In 2012, it said Tuesday, it lost money. But Wall Street has always been more about promises than results, and Amazon is always on the verge of converting its overwhelming online presence into buckets of cash.

“As long as the dream is there, the stock is going to go up,” Mr. Munster said.

The short-term news Tuesday was not good. Earnings per share fell to 21 cents from 38 cents in the fourth quarter of 2011. Although fourth-quarter revenue went up 22 percent to $21.27 billion, both revenue and earnings did not meet expectations. Analysts had predicted revenue of $22.2 billion and earnings of 27 cents a share.

Forget about all that. What mattered was the improvement in margin.

Amazon has had plenty of opportunities to raise its margins in the past, but has instead routinely chosen to reward customers with subsidized shipping and higher discounts. In a conference call with analysts on Tuesday, Tom Szkutak, Amazon’s chief financial officer, repeated this mantra.

“Putting customers first is the only reliable way to create lasting value for shareholders,” he said.

Investors took some time to buy into this idea. “Wall Street gets in a kerfuffle when we lower product prices and invest heavily in the future,” Jeff Bezos, Amazon’s chief executive, acknowledged in 2005, at a point when the stock had tumbled 40 percent in less than a year. “So don’t buy our stock — instead buy our products and enjoy our investments.”

That was bad advice. The stock is up almost 700 percent since then, hitting a record this month.

Shares in Amazon fell nearly $16 in regular trading Tuesday, to $260.35. After-hours, shares went up more than $22.

Jason Moser, an analyst with the Motley Fool, who owns shares in the retailer, said that “many investors, myself included, will more than likely watch this story play out for as long as it takes.”

Mr. Moser added in an e-mail message that the market was “betting a lot on what Amazon hasn’t done yet and betting on the fact that it will do it based on what it’s doing now.” He added, “Kind of a ‘build it and they will come’ sort of thing.”

Some analysts are still skeptical.

“It’s much easier to sell goods at cost the way Amazon does than sell goods at a 40 percent margin like Apple,” said Colin Gillis of BGC Partners. “Once you’ve trained your customers to buy at cost, it’s difficult to train them away from it.”

Still, Mr. Gillis said: “Who’s going to undercut Amazon? They’re only making half a cent on every dollar. Who can run a business at less profit?”

Amazon continues to expand. Last year, the retailer announced it was building a million-square-foot warehouse in Patterson, Calif., about 85 miles southeast of San Francisco. Last week, it announced another million-square-foot warehouse barely 30 miles north of Patterson, in Tracy. It obviously has designs on fast (if not quite same-day) shipping to the seven million generally affluent, Internet-using residents of the Bay Area.

“We’ll continue to expand our footprint over time and become even closer and closer to customers,” Mr. Szkutak said on the conference call.

Many of those shoppers will be buying material that originated not with Amazon but with more than two million third-party sellers. The volume of items sold by these firms during the 2012 holidays was up 40 percent from 2011. Some of these sellers merely used Amazon to digitally display their goods, while others also used the retailer to ship it.

Amazon said earlier this month that third-party sellers sold enough Santa hats during the holiday for Santa to wear a new hat every day for the next 127 years, and enough guitar picks to give one to every attendee of Woodstock — about a half-million. Analysts expect third-party sales to outpace Amazon deals over the next few years.

Recently several states, including California, successfully made deals with Amazon to collect sales tax. That had the effect of raising prices on many Amazon items by more than 5 percent. Land-based retailers, which had agitated for years for such a move, thought the tax might finally level the playing field.

Their hopes might be misplaced. Any drop in online sales from the collecting of sales tax tends to be temporary, said Scot Wingo, chief executive of ChannelAdvisor, which helps retailers sell online, including on Amazon.

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Thaksin Shinawatra of Thailand Wields Influence From Afar

Philippe Lopez/Agence France-Presse — Getty Images

Thaksin Shinawatra, the former prime minister of Thailand, has been in self-imposed exile since 2008 to escape corruption charges.

BANGKOK — Millions of people across the globe have cut the tethers to their offices, working remotely from home, airport lounges or just about anywhere they can get an Internet connection. But the political party governing Thailand has taken telecommuting into an altogether different realm.

For the past year and a half, by the party’s own admission, the most important political decisions in this country of 65 million people have been made from abroad, by a former prime minister who has been in self-imposed exile since 2008 to escape corruption charges.

The country’s most famous fugitive, Thaksin Shinawatra, circles the globe in his private jet, chatting with ministers over his dozen cellphones, texting over various social media platforms and reading government documents e-mailed to him from civil servants, party officials say.

It might be described as rule by Skype. Or governance by instant messenger, a way for Mr. Thaksin to help run the country without having to face the warrant for his arrest in a case that many believe is politically motivated.

His (remote control) return to power, even if somewhat limited by distance, is a remarkable turnaround for the brash telecommunications billionaire who was deposed in a military coup in 2006, the catalyst for several years of brinkmanship between critics and supporters that led to four changes of government and violent street protests that left nearly 100 people dead.

Officially, his sister, Yingluck Shinawatra, is the prime minister (he nominated her for the job in 2011). But from his homes in Dubai and London, from the gold mines he owns in Africa and during regular visits to nearby Asian countries, Mr. Thaksin, 63, has harnessed the Internet and mobile technology to create one of the most unusual ways of governing a country.

“We can contact him at all hours,” said Charupong Ruangsuwan, the interior minister and secretary general of Mr. Thaksin’s Pheu Thai Party. “The world has changed. It’s a boundless world. It’s not like a hundred years ago when you had to use a telegraph.”

To illustrate the point during an interview, Mr. Charupong took out his iPhone and scrolled through a list of phone numbers for Mr. Thaksin. (Mr. Thaksin gives different numbers to different people, often depending on seniority, party officials say.)

“If we’ve got any problem, we give him a call,” Mr. Charupong said.

Mr. Thaksin himself declined to talk by phone, or Skype, for this article.

The day-to-day governance of the country is carried out by Ms. Yingluck, who is genial, photogenic and 18 years younger than Mr. Thaksin. She cuts the ribbons and makes the speeches.

Ms. Yingluck, 45, has on occasion sought to play down her brother’s role. Soon after taking office, when Mr. Thaksin joined a weekly cabinet meeting via Skype, reporters asked who was really the head of the government. Ms. Yingluck insisted that she was in charge and said Mr. Thaksin had joined the discussion to offer “moral support.” She has since consistently said she is in charge.

But if there is one thing that allies and enemies of Mr. Thaksin agree on, it is that he is the one making the big decisions.

“He’s the one who formulates the Pheu Thai policies,” said Noppadon Pattama, a senior official in Mr. Thaksin’s party who also serves as his personal lawyer. “Almost all the policies put forward during the last election came from him.”

Sondhi Limthongkul, a leader of the “yellow shirt” movement that has taken to the streets many times to demonstrate against Mr. Thaksin, agreed, saying, “He’s running the whole show.”

“If you want a huge project in Thailand worth billions of baht, you have to talk to Thaksin,” Mr. Sondhi, who seemed resigned to the turn of events, said in an interview.

Besides Skype, Mr. Thaksin uses various social media applications, including WhatsApp and Line, to keep in touch with the leaders of the party, senior party members say.

Many of the Skype sessions are reported in the Thai news media. This month, Mr. Thaksin had a video chat to discuss coming elections for governor in Bangkok. The one-hour video chat made news because party officials reported that Mr. Thaksin had told his colleagues that it did not matter whom they nominated because even a utility pole would defeat the opposition.

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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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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.

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.

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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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Yahoo Earnings Handily Beat Forecasts

SAN FRANCISCO — Marissa Mayer, just by being Marissa Mayer, has done more to move Yahoo forward in her first six months as chief executive than any of her five predecessors did over as many years.

An accomplished engineer and executive, Ms. Mayer joined Yahoo from Google as a Silicon Valley celebrity. Since then, just her presence at the company’s Sunnyvale, Calif., headquarters seems to have jolted Yahoo back to life. On Monday, Yahoo reported a good quarter, increasing revenue for the first time in four years and beating Wall Street expectations by 30 percent.

That pushed Yahoo’s stock to $20.91 in after-hours trading — a four-year high (but still well below the $31 Microsoft offered the company back in 2008).

Ms. Mayer attributed growth to a renewed focus on “people and products” in a call with analysts on Monday.

She has added new Yahoo fans by revamping Yahoo’s e-mail service and redesigning Flickr, the firm’s photo-sharing app, which sent the number of photo uploads rising 25 percent. Ms. Mayer said those improvements were a hint of more under way.

“We are off to a very good start,” Ms. Mayer told analysts. “We are making the world’s habits more inspiring and entertaining.”

She has also introduced several morale boosters since joining the company — including free cafeteria food and new iPhones and Android-powered phones — to staff members who were more accustomed to cost cutting and layoffs. In a further sign that the company was no longer considered a sinking ship, she lured another Silicon Valley tech star, Max Levchin, a PayPal co-founder, to Yahoo’s board last month.

But those were just the office things. Analysts were more impressed with improvements to the company’s search business. Yahoo outsourced it to Microsoft in 2009 and it has languished ever since, propped up only because of a revenue-guarantee clause in its contract with Microsoft that is set to expire in March. Yahoo’s search revenue rose 4 percent in the fourth quarter, to $482 million, compared with $465 million for the period a year earlier.

Over all, Yahoo reported net income in the fourth quarter of $272.3 million, or 23 cents a share, compared with $295.6 million, or 24 cents a share, in the period a year earlier.

The company said revenue was up 1.6 percent, to $1.35 billion.

The improvement to its search business was offset by continued declines in Yahoo’s display ad revenue. The company said it made $591 million in display ad sales last quarter, a 3 percent decline from the $612 million in the quarter a year ago.

Yahoo, once the biggest seller of display ads in the United States, went from a leading 15.5 percent share of all digital ad revenues in the United States in 2009, to an 8.4 percent share last year, even as total digital ad spending grew, according to eMarketer. Meanwhile, its competitor, Google, increased its share to 41 percent.

“More personalized content and increased product innovation will be key to getting us back to the path for display revenue growth,” Ms. Mayer said on the call.

The fourth-quarter results impressed analysts, but many remained skeptical.

“Marissa will have to protect Yahoo’s legacy business while positioning the company for future growth,” Colin Gillis, an Internet analyst at BGC Partners, said in an interview Monday. “That is not easy.”

With Ms. Mayer’s honeymoon with Wall Street expected to end soon, investors are eager to see whether she can deliver sustained growth. Yahoo, with 700 million monthly users, commands one of the largest audiences on the Web. But the company, an Internet pioneer, has been unable to attract advertisers and increase revenue.

As Ms. Mayer has acknowledged, Yahoo’s future growth may well depend on its mobile strategy. And without mobile hardware like a tablet computer, a browser or a social networking platform of its own, Yahoo has a long way to go.

The company continues to be outspent in research and development by Google, Apple, Facebook and Amazon. It also continues to have a hard time convincing Silicon Valley’s engineering talent to join Yahoo instead of its competitors.

Ms. Mayer has said Yahoo’s mobile growth may come from acquisitions of mobile app companies. In six months, Ms. Mayer has acquired three start-ups — Stamped, OnTheAir and Snip.it — for undisclosed sums, more for the engineering talent than the products.

“The road will only get harder,” said Mr. Gillis. But compared to Ms. Mayer’s disgraced immediate predecessor, Scott Thompson, who left the company after four months over embellishments on his résumé, Mr. Gillis added, “at least she got a honeymoon.”

This article has been revised to reflect the following correction:

Correction: January 28, 2013

Because of an editing error, an earlier version of this article misstated the percentage increase in Yahoo’s quarterly revenue. It was 1.6 percent, not 1.5 percent.

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Protests Grow on Fifth Day of Unrest in Egypt

Tara Todras-Whitehill for The New York Times

Egyptians in Port Said mourned on Monday for people killed in clashes with the police a day earlier.

PORT SAID, Egypt — The police fired indiscriminately into the streets outside their besieged station, a group of protesters arrived with a crate of gasoline bombs, and others cheered a masked man on a motorcycle who arrived with a Kalashnikov.

The growing chaos along the vital canal zone showed little sign of abating on Monday as President Mohamed Morsi called out the army to try to regain control of three cities along the Suez Canal whose growing lawlessness is testing the integrity of the Egyptian state.

In Port Said, street battles reached a bloody new peak with a death toll over three days of at least 45, with at least five more protesters killed by bullet wounds, hospital officials said.

Such violence has flared across Egypt with increasing frequency since President Hosni Mubarak was forced out by the revolution two years ago.

President Morsi had already declared a monthlong state of emergency here and in the other canal towns of Suez and Ismailia, applying a Mubarak-era law that virtually eliminates due process protections against abuse by the police. Angry crowds burned tires and hurled rocks at the police. And the police, with little training and less credibility, hunkered down behind barrages of tear gas, birdshot and occasional bullets.

The sense that the state was unraveling may have been strongest here in Port Said, where demonstrators have proclaimed their city an independent nation. But in recent days the unrest has risen in towns across the country and in Cairo as well. In the capital on Monday, a mob of protesters managed to steal an armored police vehicle, drive it to Tahrir Square and make it a bonfire.

After two years of torturous transition, Egyptians have watched with growing anxiety as the erosion of the public trust in the government and a persistent security vacuum have fostered a new temptation to resort to violence to resolve disputes, said Michael Hanna, a researcher at the New York-based Century Foundation who is now in Cairo. “There is a clear political crisis that has eroded the moral authority of the state,” he said.

And the spectacular evaporation of the government’s authority here in Port Said has put that crisis on vivid display, most conspicuously in the rejection of Mr. Morsi’s declarations of the curfew and state of emergency.

As in Suez and Ismailia, tens of thousands residents of Port Said poured into the streets in defiance just as a 9 p.m. curfew was set to begin. Bursts of gunfire echoed through the city for the next hours, and between 9 and 11 p.m. hospital officials raised the death count to seven from two.

When two armored personnel carriers approached a funeral Monday morning for some of the seven protesters killed the day before, a stone-throwing mob of thousands quickly chased them away. And within a few hours the demonstrators had resumed their siege of a nearby police station, burning tires to create a smoke screen to hide behind amid tear gas and gunfire.

Many in the city said they saw no alternative but to continue to stay in the streets. They complained that the hated security police remained unchanged and unaccountable even after Mr. Mubarak had been ousted. They saw no recourse in the justice system, which is also unchanged; they dismissed the courts as politicized, especially after the acquittals of all those accused of killing protesters during the revolution. Then came the death sentences handed down Saturday to 21 Port Said soccer fans for their role in a deadly brawl. The death sentences set off the current unrest here.

Nor, they said, did they trust the political process that brought to power Mr. Morsi and his Islamist allies in the Muslim Brotherhood. He had vowed to usher in the rule of law as “a president for all Egyptians.” But in November he used a presidential decree to temporarily stifle potential legal objections so that his Islamist allies could rushed out a new Constitution. His authoritarian move kicked off a sharp uptick in street violence leading to this weekend’s Port Said clashes.

“Injustice beyond imagination,” one man outside the morning funeral said of Mr. Morsi’s emergency decree, before he was drowned out a crowd of others echoing the sentiment.

“He declared a curfew, and we declare civil disobedience,” another man said.

“This doesn’t apply to Port Said because we don’t recognize him as our president,” said a third. “He is the president of the Muslim Brotherhood only.”

Kareem Fahim contributed reporting from Cairo.

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