DealBook: Top Federal Prosecutor of Corporate Crime Will Resign

1:42 p.m. | Updated with formal announcement

Lanny A. Breuer, the federal prosecutor who led the Justice Department’s response to corporate crime in the wake of the financial crisis, announced on Wednesday that he is stepping down after nearly four years in the post.

As head of the Justice Department’s criminal division, one of the most senior roles at the agency, Mr. Breuer tackled corporate bribery and public corruption. But it was his focus on Wall Street that received the most attention, from supporters and critics alike.

While he has come under fire for a dearth of prosecutions on Wall Street in response to the crisis, Mr. Breuer also oversaw an aggressive crackdown on money-laundering and interest-rate manipulation at some of the world’s biggest banks. In two weeks last month, he joined a nearly $2 billion case against HSBC for money-laundering and a $1.5 billion settlement with UBS for rate-rigging. Next week, he is expected to take a similar rate-rigging action against the Royal Bank of Scotland.

“I think the criminal division is a fundamentally different place than it was four years ago,” Mr. Breuer said in an interview on Tuesday. “It’s the highlight of my professional career.”

His departure, effective March 1, was widely expected. Mr. Breuer had told friends for weeks that he was ready to leave the public sector. While he has not announced his next step, it is expected that he will return to private practice. He was previously a partner at Covington & Burling, a white-shoe law firm.

By virtue of his perch at the Justice Department in Washington, Mr. Breuer became the face of Wall Street prosecutions in the aftermath of the financial crisis. But when few such cases materialized, critics like the Occupy Wall Street protesters turned on him, portraying him as an apologist for banks at the center of the mortgage mess.

In contrast, he drew praise for the sweeping crackdown on rate-rigging in the banking industry, which has largely involved international benchmark rates.

In a rate manipulation case last month, Mr. Breuer’s team secured a major payout from UBS and a guilty plea from the bank’s Japanese unit, making UBS the first big global bank in more than two decades to have a subsidiary plead guilty to fraud. Mr. Breuer, who announced the action after rejecting a last-minute plea from the bank’s chairman, also filed criminal charges against two former employees at the bank.

The deal sent a strong signal that the authorities wanted to hold banks responsible for their wrongdoing.

Following the UBS model, the Justice Department is now pursuing a guilty plea from a Royal Bank of Scotland subsidiary in Asia over its role in the interest rate manipulation scandal, people briefed on the matter said. That settlement, which could come as soon as next week, is likely to include more than $650 million in fines imposed by American and British authorities, two other people with direct knowledge of the matter said.

In an interview, Mr. Breuer said the rate-rigging case amounted to “egregious criminal conduct.” He struck a similar tone about two other major financial cases — the convictions of executives from Taylor, Bean & Whitaker, a now-defunct mortgage lender, and the 110-year prison term imposed on R. Allen Stanford for his Ponzi scheme.

Mr. Breuer has also focused on money-laundering, creating a task force in 2010 that has levied more than $3 billion in fines from banks, including the record fine against HSBC. He stopped short of indicting HSBC after some regulators warned that doing so could destabilize the global financial system.

Mr. Breuer argued that the charges he did not bring — for example, against Goldman Sachs and other banks suspected of fraud after selling toxic mortgage securities to investors — could not have been proved. It was not for a lack of trying, he said, noting that United States attorneys across the country, after reviewing the same evidence he did, also declined to act.

“It’s important for me to hold the financial institutions accountable,” he said. “There’s never been a time that a prosecutor said we should bring a securitization case and I said no.”

Under Mr. Breuer, the division has also increasingly used a 1977 law, the Foreign Corrupt Practices Act, to prosecute corporate bribery.

He also helped run the Justice Department’s investigation of the BP oil spill in the Gulf of Mexico, resulting in the company paying $4.5 billion in fines and other penalties and pleading guilty to 14 criminal charges related to the rig explosion in 2010.

In a statement, Attorney General Eric H. Holder Jr. praised Mr. Breuer. “Lanny has led one of the most successful and aggressive criminal divisions in the history of the Department of Justice,” he said.

Mr. Holder stood behind Mr. Breuer when questions arose about his involvement in the botched gun-trafficking case known as Operation Fast and Furious. The pair, who were both largely cleared after an inspector general investigation, worked together at Covington.

For years, Mr. Breuer moved in and out of government. The son of Holocaust survivors who fled Europe and settled in Queens, he landed at the Manhattan district attorney’s office after graduating from Columbia Law School. In between stints at Covington, he worked as a White House special counsel, defending President Bill Clinton amid federal investigations and impeachment proceedings.

In the interview on Tuesday, Mr. Breuer reflected on his unusual path to the Justice Department.

“The fact that I got to go from Elmhurst, Queens, to the criminal division is remarkable,” he said.

A version of this article appeared in print on 01/30/2013, on page B3 of the NewYork edition with the headline: Top Federal Prosecutor of Corporate Crime Will Resign.
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Sheriff's response time is longer in unincorporated areas, audit finds









It took Los Angeles County sheriff's deputies a minute longer to respond to emergency calls from unincorporated parts of the county than from cities that contract with the department for police services, according to a county audit.


The finding comes days after Supervisor Gloria Molina accused Sheriff Lee Baca of "stealing" police resources from residents in unincorporated neighborhoods and threatened to hire "independent private patrol cars" to backfill cuts in sheriff's patrols. She has accused Baca of providing better service to contract cities than to unincorporated areas.


According to the audit, which examined the last fiscal year, it took deputies, on average, 4.8 minutes to respond to emergency calls in contract cities compared with 5.8 minutes in unincorporated areas.





Sheriff's officials said the extra minute was because neighborhoods in unincorporated areas are more spread out and have more difficult road conditions.


The audit also found that Baca provided 91% of promised patrol hours to unincorporated areas, compared with 99% for cities and agencies that buy his services. Sheriff's officials blamed the difference on deep budget cuts imposed by the board that caused the department to leave dozens of deputy positions unfilled.


Adjusted for those cuts, the department was much closer to its goal — averaging 98.5% fulfillment of its pledged patrol hours, according to the audit.


The findings by the county's auditor-controller are expected to add more fuel to the ongoing debate between the sheriff and the board about whether the sheriff is shortchanging county residents who live outside city borders.


Baca and his predecessors have long wrangled with supervisors over funding and patrol resources.


Although the board sets the sheriff's budget, Baca, an elected official, has wide discretion on how to spend it. The Sheriff's Department polices about three-fourths of the county. Along with the unincorporated areas, Baca's deputies patrol more than 40 cities within the county that don't have their own police forces. The patrol obligations for those cities are set in contracts with the department, so county budget cuts are more likely to affect unincorporated areas.


On Tuesday, the board is expected to discuss Molina's idea to empower unincorporated neighborhoods to negotiate police contracts with the Sheriff's Department or some other agency — the same way incorporated cities do.


According to the audit, it costs the sheriff about $552 million to provide police services for contract cities and agencies, but the department gets approximately $371 million back. The auditor-controller suggested pursuing changes in state law or board policy to allow the sheriff to recoup more.


State law prohibits sheriffs from billing contract cities for non-patrol services provided countywide. So the department has provided a broad range of services — such as homicide and narcotics detectives, bomb squads and the county crime lab — at no extra charge.


Sheriff's spokesman Steve Whitmore said those rigid agreements — with contract cities, the county's courts, community colleges and public transit lines — limited where the sheriff could slash in the face of county budget woes.


The board has cut the sheriff's budget — now at $2.8 billion — by $128 million in 2010, $96 million in 2011 and $140 million last year, according to Whitmore.


The sheriff has already reassigned about two dozen gang enforcement deputies to patrol in unincorporated areas and has identified more than 90 other deputies to do the same, Whitmore said.


Molina's spokeswoman declined to suggest other areas where sheriff's officials should slash in light of funding cuts from the board but said that services to unincorporated areas should not be one of them.


"We respectfully request they go back to the drawing board," spokeswoman Roxane Márquez said.


robert.faturechi@latimes.com





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Disney Shuts Down <cite>Epic Mickey</cite> Studio, Warren Spector Out











Disney will close Junction Point, the Austin, Texas, game development studio responsible for the Epic Mickey series, it said on Tuesday.


“It was with much sadness that we informed our teams today of changes to our Games organization, which include the closure of Junction Point Studios,” a Disney spokesperson said in an emailed statement. “These changes are part of our ongoing effort to address the fast-evolving gaming platforms and marketplace and to align resources against our key priorities. We’re extremely grateful to Warren Spector and the Junction Point team for their creative contributions to Disney with Disney Epic Mickey and Disney Epic Mickey 2.”


A Disney representative confirmed to Wired that vice president and studio head Warren Spector will not be staying on with Disney following the studio closure. Spector and Art Min founded the studio in 2004 after the closure of Ion Storm, where he created the Deus Ex series. Disney acquired Junction Point in 2007, before it had released any titles.


Sales of last year’s Epic Mickey 2 may be partially to blame. Although sales data has not been made public, the Los Angeles Times reported that the multi-platform action game only sold a total of 270,000 copies in 2012. Disney recently announced a major new game series called Infinity, developed by another in-house unit, Avalanche Studios.


Today’s news comes as a surprise considering that Spector, a lifelong Disney fan with an innate passion for its history, had seemed a perfect fit for the company.


Spector is currently scheduled to speak at the upcoming DICE Summit on Feb. 7, with a session titled “Hey, You kids! Get Outta My Yard! or The Graying of Gaming.”






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Dior: Jennifer Lawrence dress had no malfunction






LOS ANGELES (AP) — That was no wardrobe malfunction — that was couture.


When Jennifer Lawrence ascended the stairs to accept her SAG Award Sunday night, a bit of skin showed through the skirt of her gown, leading to some speculation that it had ripped.






Dior Couture told The Associated Press that wasn’t so.


The design house said Lawrence’s gown was designed by Raf Simons “with different levels of tulle and satin.” That was what viewers saw on television when she lifted her gown to walk upstairs.


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Well: Ask Well: Long-Term Use of Nicotine Gum

In small doses, like those contained in the gum, nicotine is generally considered safe. But it does have stimulant properties that can raise blood pressure, increase heart rate and constrict blood vessels. One large report from 2010 found that compared to people given a placebo, those who used nicotine replacement therapies had a higher risk of heart palpitations and chest pains.

That’s one reason that nicotine gum should, ideally, be used for no more than four to six months, said Lauren Indorf, a nurse practitioner with the Cleveland Clinic’s Tobacco Treatment Center. Yet up to 10 percent of people use it for longer periods, in some cases for a decade or more she said.

Some research has raised speculation that long-term use of nicotine might also raise the risk of cancer, though it has mostly involved laboratory and animal research, and there have not been any long-term randomized studies specifically addressing this question in people. One recent report that reviewed the evidence on nicotine replacement therapy and cancer concluded that, “the risk, if any, seems small compared with continued smoking.”

Ultimately, the biggest problem with using nicotine gum for long periods is that the longer you stay on it, the longer you remain dependent on nicotine, and thus the greater your odds of a smoking relapse, said Ms. Indorf. “What if the gum is not available one day?” she said. “Your body is still relying on nicotine.”

If you find yourself using it for longer than six months, it may be time to consider switching to sugar-free gum or even another replacement therapy, like the patch or nasal spray.

“Getting people on a different regimen helps them break the gum habit and can help taper them off nicotine,” Ms. Indorf said.

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Streaming Shakes Up Music Industry’s Model for Royalties


Jim Wilson/The New York Times


Zoe Keating published on her blog the details of what she made in royalties from the Web streaming of her music. It wasn’t a lot.







Like plenty of music fans, Sam Broe jumped at the chance to join Spotify two summers ago, and he hasn’t looked back.




Spotify, which began streaming music in Sweden in 2008, lets users choose from millions of songs over the Internet free or by subscription, and is increasingly seen as representing the future of music consumption. Mr. Broe, a 26-year-old from Brooklyn, said that having all that music at his fingertips helped him trim his monthly music budget from $30 to the $10 fee he pays for Spotify’s premium service.


“The only time I download anything on iTunes is in the rare case that I can’t find it on Spotify,” he said.


A decade after Apple revolutionized the music world with its iTunes store, the music industry is undergoing another, even more radical, digital transformation as listeners begin to move from CDs and downloads to streaming services like Spotify, Pandora and YouTube.


As purveyors of legally licensed music, they have been largely welcomed by an industry still buffeted by piracy. But as the companies behind these digital services swell into multibillion-dollar enterprises, the relative trickle of money that has made its way to artists is causing anxiety at every level of the business.


Late last year, Zoe Keating, an independent musician from Northern California, provided an unusually detailed case in point. In voluminous spreadsheets posted to her Tumblr blog, she revealed the royalties she gets from various services, down to the ten-thousandth of a cent.


Even for an under-the-radar artist like Ms. Keating, who describes her style as “avant cello,” the numbers painted a stark picture of what it is like to be a working musician these days. After her songs had been played more than 1.5 million times on Pandora over six months, she earned $1,652.74. On Spotify, 131,000 plays last year netted just $547.71, or an average of 0.42 cent a play.


“In certain types of music, like classical or jazz, we are condemning them to poverty if this is going to be the only way people consume music,” Ms. Keating said.


The way streaming services pay royalties represents a major shift in the economic gears that have been underlying the industry for decades.


From 78 r.p.m. records to the age of iTunes, artists’ record royalties have been counted as a percentage of a sale price. On a 99-cent download, a typical artist may earn 7 to 10 cents after deductions for the retailer, the record company and the songwriter, music executives say. One industry joke calls the flow of these royalties a “river of nickels.”


In the new economics of streaming music, however, the river of nickels looks more like a torrent of micropennies.


Spotify, Pandora and others like them pay fractions of a cent to record companies and publishers each time a song is played, some portion of which goes to performers and songwriters as royalties. Unlike the royalties from a sale, these payments accrue every time a listener clicks on a song, year after year.


The question dogging the music industry is whether these micropayments can add up to anything substantial.


“No artist will be able to survive to be professionals except those who have a significant live business, and that’s very few,” said Hartwig Masuch, chief executive of BMG Rights Management.


Spotify has 20 million users in 17 countries, with five million of them paying $5 to $10 a month to eliminate the ads seen by freeloaders.


In a recent interview, Sean Parker, a board member, said he believed Spotify would eventually attract enough subscribers to help return the music industry to its former glory — that is, to the days before Mr. Parker’s first major enterprise, Napster, came along.


“I believe that Spotify is the company that will make it succeed,” said Mr. Parker, who is also a former president of Facebook. “It’s the right model if you want to build the pot of money back up to where it was in the late ’90s, when the industry was at its peak. This is the only model that’s going to get you there.”


This article has been revised to reflect the following correction:

Correction: January 29, 2013

An earlier version of this article gave an incorrect estimate of the potential earnings of a song on Spotify’s paid tier. According to a number of music executives, Spotify generally pays 0.5 to 0.7 cent a stream for the paid tier, which results in $5,000 to $7,000 per million plays, not $5,000 to $8,000.



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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."





SAG 2013: Winners | Quotes | Photo BoothRed carpet | Backstage | Best & Worst


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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China's Giant Transport Plane Takes Flight



The Chinese military’s first homegrown long-range transport plane has flown for the first time, extending Beijing’s impressive record of new warplane development.


But the Xian Y-20 (“Y” for Yun, meaning “transport”), roughly in the same class as the U.S. C-17 or the Russian Il-76, is probably still a long way from being fully operational — to say nothing of it being militarily effective. A lack of custom engines limits the new plane’s potential.


State-owned China Central Television depicted the four-engine jet transport taking off from what was probably the military airfield in Yanliang, central China, home of the People’s Liberation Army Air Force testing establishment. The Y-20, still wearing only its yellow primer paint, flew what appeared to be a short test flight and landed in front of a crowd waving Chinese flags. It seems the transport’s landing gear stayed down for the entire sortie — a standard precaution in early tests of new planes.


“The successful maiden flight of Yun-20 is significant in promoting China’s economic and national defense buildup as well as bettering its emergency handling such as disaster relief and humanitarian aid,” the government-run Xinhua news service announced Saturday.


Development of the new transport began no later than 2005, and was possibly spurred in part by the massive earthquake that killed tens of thousands in Sichuan in 2008. In the disaster’s aftermath, the PLAAF — which has long favored jet fighters over more mundane support aircraft — was able to deploy only a handful of small cargo planes carrying relief supplies. The U.S., by contrast, sent in two Boeing C-17s — welcome assistance but also embarrassing for the Chinese Communist Party.


The Y-20 is the latest in a chain of new Chinese airplanes. Since late 2010 Beijing has debuted two stealth fighter prototypes; a new carrier-based naval fighter; plus radar and patrol planes, two gunship helicopters and, now, a heavyweight cargo plane at least as capacious as Russia’s workhorse Il-76, which China also possesses and which seems to provide the basis of the Y-20′s design. Beijing may also have acquired some of the C-17′s blueprints from a spy working at Boeing.


The Y-20 first appeared in blurry snapshots posted to Party-friendly Chinese Internet forums in December — Beijing’s standard procedure for rolling out major new prototype weapons. A series of overhead images provided by U.S. commercial satellite operator GeoEye in early January provided more detail. In contrast to the high degree of official secrecy surrounding other new warplanes, Beijing promptly announced the Y-20′s existence — a move that trade magazine Flightglobal called “remarkable.”


As with China’s other new warplanes, the Y-20 prototype is apparently fitted with older, Russian-made engines rather than purpose-designed motors. A lack of suitable powerplants has slowed progress on many of the new planes. The Y-20′s current D-30 engines are low-bypass models better suited for supersonic fighters than an efficient, slow-flying cargo hauler. Beijing has poured billions of dollars into developing new engines but so far has little to show for it.


“The giant aircraft will continue to undergo experiments and test flights as scheduled,” Xinhua said of the Y-20. But that doesn’t mean the new transport is close to being ready for frontline use.


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Barbara Walters hospitalized with chickenpox






NEW YORK (AP) — Barbara Walters would probably like to hit the reset button on 2013.


She’s got the chickenpox and remains hospitalized more than a week after going in after falling and hitting her head at a pre-inaugural party in Washington on Jan. 19. A fellow host on the “The View,” Whoopi Goldberg, said Monday that Walters has been transferred to a New York hospital and hopes to go home soon.






“She’s been told to rest. She’s not allowed any visitors,” Goldberg said. “And we’re telling you, Barbara, no scratching!”


The 83-year-old news veteran, who underwent heart surgery in May 2010, apparently avoided a disease that hits most people when they are children. It can be serious in older people because of the possibility of complications like pneumonia.


Even after concern about her fall had subsided, Walters had been kept hospitalized last week because of a lingering fever, and doctors found the unexpected cause.


“We love you, we miss you,” Goldberg said on “The View,” in a message to the show’s inventor. “We just don’t want to hug you.”


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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:

¶ 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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