Activists Claim Massacre in Syria as Refugee Exodus Swells

Thomas Rassloff/European Pressphoto Agency

People gathered at the banks of a small canal coming from a government-controlled suburb of Aleppo, Syria, to view dozens of bodies on Tuesday.

BEIRUT, Lebanon — An activist group in Syria said on Tuesday that the muddied bodies of scores of people, most of them men in their 20s and 30s, had been found in a suburb of the northern city of Aleppo. Video posted by opponents of President Bashar al-Assad seemed to show that many had been shot in the back of the head while their hands were bound.

The Syrian Observatory for Human Rights, an activist organization based in Britain with a network of contacts in Syria, said at least 50 bodies had been located, some scattered along the banks of a small river in the Bustan al-Kaser neighborhood. Other reports put the grim tally at 65.

“This is another new massacre that has been committed in Syria, adding to the constant massacres that have been occurring, while the world watches silently and the international and Arab community are being hypocrites,” the Syrian Observatory said in statement.

The gruesome video emerged as the United Nations reported a fresh upsurge in the number of refugees known officially to have fled the country, bolstering the total in neighboring countries to more than 700,000 from 500,000 in December.

At the same time, rebel fighters seeking Mr. Assad’s overthrow appeared to have made lightning advances in the east of the country, raiding a security office in the eastern city of Deir al-Zour, where government forces have seemed to reduce their presence to concentrate on the center, giving rebels more freedom to maneuver and in some cases siphon fuel from gas and oil fields there.

In Aleppo, Syria’s most populous city, video on YouTube — which was not independently verifiable — showed the shadow of a cameraman moving from one corpse to the next, briefly halting at each body. Another video showed five bodies jammed into a metal container with more corpses lined up on the street outside and yet more on the flatbed of a pickup truck.

Crowds of civilians milled around, some of them wearing blue surgical gloves.

It was not clear when the men had died or who they were. One man said the killers had chosen their victims because they were Sunni Muslims.

The ever-bloodier conflict began in March, 2011, as a peaceful protest but has since spiraled into civil war.

In Geneva, the United Nations High Commissioner for Refugees said on Tuesday that there had been an “unrelenting flow of refugees” across Syria’s borders with other countries, principally Jordan, Lebanon, Iraq and Turkey, Reuters reported.

The highest numbers were in Turkey, Jordan and Lebanon but smaller numbers had been registered in Egypt and North Africa, Sybella Wilkes, a spokesman for the refugee agency, told Reuters.

The total now stood at around 712,000, meaning that some 200,000 have fled in less than two months.

“We are trying to clear a backlog of people because the numbers have gone up so dramatically” in Jordan and Lebanon particularly, Ms. Wilkes was quoted as saying.

Hala Droubi contributed from Dubai, United Arab Emirates, Anne Barnard and Hwaida Saad from Beirut and Alan Cowell from London.

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Children’s magazine promotes adult video games

LONDON (Reuters) – A British magazine distributed by a joint venture of Conde Nast and Hearst Corporation and aimed at primary school children has been featuring images of adult-rated video games.

The most recent issue of Cool Kidz, which is published by privately-owned LCD Publishing, contained images of five games that carried age ratings of 18 years, under the European gaming industry’s PEGI rating scheme.

Screenshots appeared as double-page spreads, for use as posters, and were reproduced in spot-the-difference and other puzzles. Earlier issues also had images from 18- and 16-rated games.

Children’s campaigners said the images reflected a growing problem of young children being exposed to violent video games, thereby increasing the chance they start playing them earlier.

It also highlighted what some critics describe as an apparent gap in regulation of children’s magazines since LCD does not appear to have broken any law or industry rule.

LCD Publishing, which is based in Exeter, southwest England, said it took its responsibilities to young readers seriously.

“We censor the images we use to ensure that there is no blood or apparent body damage,” owner Allen Trump said in an emailed statement.

He said the images used were suitable for children 12 or older, although he added the magazine was targeted at children up to 12 years.

The pictures printed depicted life-like computer generated images of men carrying weapons including assault rifles, Bowie knives, an axe, an anti-tank weapon and pistols.

The images showed explosions but not the visceral, bloody combat or scenes of a sexual nature for which the games are frequently criticized by parents’ groups and women’s rights advocates.

Cool Kidz is distributed by Comag, which is controlled by privately-owned U.S. magazine publishers Conde Nast, owners of Vogue magazine, and the Hearst Corporation, owner of Cosmopolitan magazine.

All three groups declined repeated requests for comment.

London-based Comag is one of the largest magazine distributors in the UK with annual turnover of around 230 million pounds ($ 360 million), according to its most recent accounts.

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Trump said LCD downloaded the game images from the Internet although he was also occasionally approached by public relations firms seeking coverage of their clients’ games.

Games publishers regularly post images on their websites, for use by online and print publishers, thus helping create awareness of their game.

Games firms contacted by Reuters said they were unaware Cool Kidz, which has been published for seven years, had been using their images.

The adult games Cool Kidz featured included Hitman: Absolution, Call of Duty Black Ops II, Assassins Creed III, Farcry 3 and Dishonored.

Representatives for Japan’s Square Enix, publisher of the Hitman series, privately-owned Bethesda Softworks, publisher of Dishonored, and Ubisoft Entertainment, publisher of Assassins Creed III and Farcry 3, said they opposed the use but declined to say whether they would take any legal action against LCD.

Call of Duty publisher Activision declined to comment.

Alison Sherratt, senior vice-president of teachers union ATL, said publishers and government needed to do more to limit children’s’ exposure to games.

“It puts peer pressure on children .. If they see these images, it gives them the idea it’s ok, it’s all right to play these games,” she added.

A spokeswoman for the Advertising Standards Authority said games companies could not advertise 18 rated games in children’s magazines and a spokesman for the Video Standards Council (VSC), the UK affiliate of PEGI, said its rules also prohibited this.

However, since the images were not paid-for advertising, or supplied to Cool Kidz by the games publishers, these rules do not apply.

The Press Complaints Commission can adjudicate on complaints against magazines but only in respect of its members. LCD is not one.

The Office of Fair Trade and the Professional Publishers Association, trade group for magazine publishers, said they were unaware of any bodies that had regulatory powers over the content of children’s magazines.

(Reporting by Tom Bergin; Editing by Jon Boyle)

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Rupert Sanders' wife files for divorce in LA

LOS ANGELES (AP) — Rupert Sanders' wife has filed for divorce five months after it was revealed the director had a brief affair with actress Kristen Stewart.

Liberty Ross, Sanders' wife of more than nine years, filed for divorce Friday in Los Angeles citing irreconcilable differences.

Ross' filing cites irreconcilable differences for the couple's breakup. They have two children, an 8-year-old daughter and 6-year-old son.

The model-actress is seeking joint custody of the children and spousal support from her estranged husband, who directed Stewart in "Snow White and the Huntsman."

TMZ, which first reported the filing, stated that Sanders also filed divorce paperwork but it was not available on Monday.

Stewart, who has been dating "Twilight" co-star Robert Pattinson, apologized for her fling with Sanders in July after it was revealed by US Weekly.

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Rescuer Appears for New York Downtown Hospital

Manhattan’s only remaining hospital south of 14th Street, New York Downtown, has found a white knight willing to take over its debt and return it to good health, hospital officials said Monday.

NewYork-Presbyterian Hospital, one of New York City’s largest academic medical centers, has proposed to take over New York Downtown in a “certificate of need” filed with the State Health Department. The three-page proposal argues that though New York Downtown is projected to have a significant operating loss in 2013, it is vital to Lower Manhattan, including Wall Street, Chinatown and the Lower East Side, especially since the closing of St. Vincent’s Hospital after it declared bankruptcy in 2010.

The rescue proposal, which would need the Health Department’s approval, comes at a precarious time for hospitals in the city. Long Island College Hospital, just across the river in Cobble Hill, Brooklyn, has been threatened with closing after a failed merger with SUNY Downstate Medical Center, and several other Brooklyn hospitals are considering mergers to stem losses.

New York Downtown has been affiliated with the NewYork-Presbyterian health care system while maintaining separate operations.

“We are looking forward to having them become a sixth campus so the people in that community can continue to have a community hospital that continues to serve them,” Myrna Manners, a spokeswoman for NewYork-Presbyterian, said.

Fred Winters, a spokesman for New York Downtown, declined to comment.

Presbyterian’s proposal emphasized that it would acquire New York Downtown’s debt at no cost to the state, a critical point at a time when the state has shown little interest in bailing out failing hospitals.

The proposal said that if New York Downtown were to close, it would leave more than 300,000 residents of Lower Manhattan, including the financial district, Greenwich Village, SoHo, the Lower East Side and Chinatown, without a community hospital. In addition, it said, 750,000 people work and visit in the area every day, a number that is expected to grow with the construction of 1 World Trade Center and related buildings.

The proposal argues that New York Downtown is essential partly because of its long history of responding to disasters in the city. One of its predecessors was founded as a direct result of the 1920 terrorist bombing outside the J. P. Morgan Building, and the hospital has responded to the 1975 bombing of Fraunces Tavern, the 1993 and 2001 attacks on the World Trade Center, and, this month, the crash of a commuter ferry from New Jersey.

Like other fragile hospitals in the city, New York Downtown has shrunk, going to 180 beds, down from the 254 beds it was certified for in 2006, partly because the more affluent residents of Lower Manhattan often go to bigger hospitals for elective care.

The proposal says that half of the emergency department patients at New York Downtown either are on Medicaid, the program for the poor, or are uninsured.

NewYork-Presbyterian would absorb the cost of the hospital’s maternity and neonatal intensive care units, which have been expanding because of demand, but have been operating at a deficit of more than $1 million a year, the proposal said.

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Pfizer’s Profit Jumps on Sale of Nutrition Business

Pfizer Inc.'s fourth-quarter profit more than quadrupled, despite competition from generic drugs hurting sales of Lipitor and other medicines, because of a $4.8 billion gain from selling its nutrition business. The drugmaker's profit and sales both beat Wall Street expectations.

The world's biggest drugmaker said Tuesday that its net income was $6.32 billion, or 85 cents per share, up from $1.44 billion, or 19 cents per share, a year earlier.

Excluding the windfall from selling its nutrition business to Nestle SA for $11.5 billion on Nov. 30, and a total of $888 million for restructuring, legal and other one-time items, the Viagra maker would have had a profit of $3.51 billion, or 47 cents per share. That's 3 cents more than analysts surveyed by FactSet were expecting.

In early trading, the New York-based company's shares rose 26 cents, or 1 percent, to $27.10.

Revenue fell 7 percent to $15.1 billion, mainly due to generic competition to cholesterol blockbuster Lipitor. Analysts expected $14.35 billion.

"Overall, a good quarter driven by the revenue beat," BernsteinResearch analyst Dr. Timothy Anderson wrote to investors, calling Pfizer's 2013 financial forecast "a bit underwhelming."

Pfizer said it expects 2013 earnings per share of $2.20 to $2.30, excluding one-time items, and revenue of $56.2 billion to $58.2 billion. Analysts are expecting $2.28 per share and revenue of $57.55 billion.

Lipitor, which had reigned as the world's top-selling drug ever for nearly a decade, got U.S. generic competition in December 2011 and now has generic rivals in many major markets. The pill had been bringing Pfizer nearly $11 billion a year before then, down from its peak of $13 billion a year.

In the fourth quarter, Lipitor sales plunged 91 percent in the U.S. and 71 percent worldwide, to $584 million. A dozen other medicines also had lower sales due to generic competition.

Altogether, generic competition reduced prescription drug revenue by more than $2.1 billion. Unfavorable currency exchange rates lopped off another 2 percent, or $271 million.

However, several key newer drugs had double-digit sales increases, including fibromyalgia and pain treatment Lyrica, at $1.13 billion, painkiller Celebrex at $750 million, and the Prevnar 13 vaccine against meningitis and other pneumococcal infections, at $993 million. Viagra was up 6 percent at $553 million.

Altogether, Pfizer's prescription drug revenue fell 9 percent in the quarter, to $12.89 billion. The division was led by sales of primary-care medicines, which totaled $3.83 billion. Still, that was down 29 percent as Lipitor's sales in the two biggest markets, the U.S. and Japan, where shifted into the established products category. That segment, which markets off-patent drugs still popular in many countries, posted a 3 percent rise in revenue, to $2.37 billion.

Specialty products, such as Enbrel for psoriasis and rheumatoid arthritis, and hemophilia treatments Refacto AF and Benefix, had revenue dip 4 percent, to a combined $3.67 billion. Sales in emerging markets such as China and India jumped 17 percent, to $2.65 billion, while sales of cancer drugs, a newer focus for Pfizer, rose 9 percent to $370 million.

The animal health business saw revenue increase 6 percent, to $1.17 billion. Pfizer is set to sell about a 20 percent share in the business, called Zoetis, in an initial public offering on Friday.

The consumer health business saw revenue jump 16 percent, to $936 million, due to strong growth of Advil pain reliever and Centrum vitamins.

He said Pfizer will soon launch two new medicines, rheumatoid arthritis treatment Xeljanz and — with partner Bristol-Myers Squibb Co. — potential blockbuster Eliquis, for preventing heart attacks and dangerous clots in patients with the irregular heartbeat atrial fibrillation. CEO Ian Read said Pfizer's mid- to late-stage drug pipeline "continues to strengthen with key potential opportunities," including drugs for advanced breast cancer and three other types of cancer, one for high cholesterol and a meningococcal B vaccine for adolescents and young adults.

For the full year, net income was $14.57 billion, or $1.94 per share. That was down from $10.01 billion, or $1.27 per share, in 2011. Revenue totaled $58.99 billion, down 10 percent from $65.26 billion in 2011, before generic competition slashed sales of Lipitor and schizophrenia drug Geodon.

___

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Senators Agree on Blueprint for Immigration

J. Scott Applewhite/Associated Press

Senators Lindsey Graham, left, and Charles E. Schumer, shown in 2011, are two of the eight lawmakers behind the proposal.

A bipartisan group of senators has agreed on a set of principles for a sweeping overhaul of the immigration system, including a pathway to American citizenship for 11 million illegal immigrants that would hinge on progress in securing the borders and ensuring that foreigners leave the country when their visas expire.

The senators were able to reach a deal by incorporating the Democrats’ insistence on a single comprehensive bill that would not deny eventual citizenship to illegal immigrants, with Republican demands that strong border and interior enforcement had to be clearly in place before Congress could consider legal status for illegal immigrants.

Their blueprint, set to be unveiled on Monday, will allow them to stake out their position one day before President Obama outlines his immigration proposals in a speech on Tuesday in Las Vegas, in the opening moves of what lawmakers expect will be a protracted and contentious debate in Congress this year.

Lawmakers said they were optimistic that the political mood had changed since a similar effort collapsed in acrimony in 2010. Senator John McCain, Republican of Arizona and one of the negotiators, said he saw “a new appreciation” among Republicans of the need for an overhaul.

“Look at the last election,” Mr. McCain said Sunday morning on ABC’s “This Week With George Stephanopoulos.” “We are losing dramatically the Hispanic vote, which we think should be ours.” The senator also said he had seen “significant improvements” in border enforcement, although “we’ve still got a ways to go.”

He added, “We can’t go on forever with 11 million people living in this country in the shadows in an illegal status.”

According to a five-page draft of the plan obtained by The New York Times on Sunday, the eight senators — including Mr. McCain; Charles E. Schumer, Democrat of New York; and Lindsey Graham, Republican of South Carolina — have agreed to address the failings of the immigration system in one comprehensive measure, rather than in smaller pieces, and to offer a “tough, fair and practical road map” that would eventually lead to a chance at citizenship for nearly all of the immigrants here illegally.

“We on the Democratic side have said that we are flexible and we want to get a bill,” Mr. Schumer told reporters in New York on Sunday. “But there’s a bottom line, and that’s a path to citizenship for the 11 or so million people who qualify. We’ve made great, great progress with our Republican colleagues.”

Under the senators’ plan, most illegal immigrants would be able to apply to become permanent residents — a crucial first step toward citizenship — but only after certain border enforcement measures had been accomplished.

Among the plan’s new proposals is the creation of a commission of governors, law enforcement officials and community leaders from border states that would assess when border security measures had been completed. A proposal would also require that an exit system be in place for tracking departures of foreigners who entered the country through airports or seaports, before any illegal immigrants could start on a path to citizenship.

The lawmakers intend for their proposals to frame the debate in the Senate, which is expected to take up immigration this spring, ahead of the House of Representatives. Compared with an immigration blueprint from 2011 that White House officials have said is the basis for the president’s position, the senators’ proposals appear to include tougher enforcement and a less direct path for illegal immigrants than Mr. Obama is considering.

In a parallel effort, a separate group of four senators will introduce a bill this week dealing with another thorny issue that is likely to be addressed in a comprehensive measure: visas for legal immigrants with advanced skills in technology and science. The bill, written primarily by Senator Orrin G. Hatch of Utah, a Republican, and Senator Amy Klobuchar of Minnesota, a Democrat, would nearly double the number of temporary visas, known as an H-1B, available each year to highly skilled immigrants. It would also free up more permanent resident visas, known as green cards, so those immigrants could eventually settle in the United States and go on to become citizens.

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 misidentified the journalist who interviewed Senators Robert Menendez and John McCain on “This Week With George Stephanopoulos” on ABC. It was Martha Raddatz, not Mr. Stephanopoulos.

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Apple reportedly prepping new 128GB fourth-gen iPad

It isn’t the “next big thing” Apple (AAPL) investors are said to be waiting for as the company’s share price continues to plummet, but Apple is reportedly prepping a new iPad that will be its first iOS device to pack more than 64GB of storage. 9to5Mac reports that Apple has a new fourth-generation iPad SKU that will soon hit the shelves at one of its retail partners’ stores. Details are slim but the site says its source noted the presence of the word “ultimate” next to the new iPad’s description in the retailer’s system, leading 9to5Mac to speculate that the new model will feature 128GB of internal memory, adding a fourth storage option to Apple’s full-size iPad arsenal. The 128GB iPad listed in the retailer’s system reportedly features both Wi-Fi and cellular connectivity options. A purported image from the “high-profile” retailer’s inventory system follows below.

[More from BGR: Driverless cars could be the big thing that vaults Google over Apple]

This article was originally published on BGR.com

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'Argo' on a roll with big win at SAG Awards

LOS ANGELES (AP) — A few weeks ago, the Oscar race looked wide open. The stately, historical "Lincoln" seemed like the safe and likely choice, with the provocative "Zero Dark Thirty" and the quirky and inspiring "Silver Linings Playbook" very much in the mix for the Academy Award for best picture.

But now, an "Argo" juggernaut — an "Argo"-naut, if you will — seems to be rolling along and gathering momentum as we head toward Hollywood's top prize.

The international thriller from director Ben Affleck, who also stars as a CIA operative orchestrating a daring rescue during the 1979 Iranian hostage crisis, received the top honor of best ensemble cast in a movie at Sunday night's Screen Actors Guild Awards, their equivalent of the best-picture Oscar. It's a decent indicator of eventual Academy Awards success, with the two matching up about half the time.

The film, which also stars John Goodman and Alan Arkin as Hollywood veterans who help stage a fake movie as a cover, has received nearly unanimous critical raves and has proven to be a box-office favorite, as well, grossing nearly $190 million worldwide.

But "Argo" also won the Producers Guild of America Award on Saturday night, which is an excellent Oscar predictor, and it earned best picture and director statues from the Golden Globes two weeks earlier. The Directors Guild of America Awards next Saturday will help crystallize the situation even further.

The one tricky thing at work here: Affleck surprisingly didn't receive an Academy Award nomination in the director category, which most often goes hand in hand with best picture. (There are nine best-picture nominees but only five slots for directors.) Only once in modern times has a film won best picture without a directing nomination: 1989's "Driving Miss Daisy." The other two times came in the show's early years, at the first Oscars in 1929 with "Wings" and for 1932's "Grand Hotel."

Asked backstage at the SAG Awards what might happen when the Oscar winners are announced Feb. 24, Affleck said: "I don't do handicapping or try to divine what's going to happen down the road with movies.

"I didn't get nominated as a director and I thought, 'OK, that's that.' Then I remembered that I was nominated as a producer," said Affleck, who already has an original screenplay Oscar for writing 1997's "Good Will Hunting" with longtime friend Matt Damon. "Nothing may happen but it's a wonderful opportunity to be on the ride and I'm really honored."

Many of the usual suspects throughout the lengthy awards season heard their names called again Sunday night, including Daniel Day-Lewis as best actor for his intense, deeply immersed portrayal of the 16th U.S. president in "Lincoln." Accepting the prize on stage, he gave thanks to several of his colleagues including "The Master" star Joaquin Phoenix (who did not receive a SAG nomination), Leonardo DiCaprio and Liam Neeson.

Backstage, Day-Lewis elaborated for reporters that DiCaprio urged him to stick with Steven Spielberg's project, which was in the works for many years.

"He said, 'Don't give up, he's the greatest man of the 19th century,'" Day-Lewis said. "So this is all Leo's fault."

His co-star, Tommy Lee Jones, also won again in the supporting-actor category for his lacerating portrayal of abolitionist Thaddeus Stevens in Spielberg's Civil War epic.

Anne Hathaway, the front-runner for best supporting actress at the Oscars and a winner already at the Golden Globes, won at the SAGs for her performance as the doomed prostitute Fantine in the gritty musical "Les Miserables."

"I'm just thrilled I have dental," Hathaway joked on stage.

But in the already-tight best actress race, Jennifer Lawrence made things a little more interesting in winning for the drama "Silver Linings Playbook." The 22-year-old plays a damaged young widow opposite Bradley Cooper, whose character is fresh out of a mental institution. Jessica Chastain, the winner at the Golden Globes, has been her main competition as a driven CIA operative searching for Osama bin Laden in "Zero Dark Thirty."

Lawrence said on stage that she got her SAG card at 14 — which was only eight short years ago — for a promo for the MTV reality series "My Super Sweet 16," which she said felt like the best day of her life.

"And now I have this naked statue which means that some of you even voted for me, and that is an indescribable feeling," she said.

On the television side, the popular PBS series "Downton Abbey" bested more established shows like "Mad Men" to win the TV drama cast award in just its first nomination. "Modern Family" won the comedy cast prize for the third straight year.

And Dick Van Dyke received the guild's life-achievement award, an honor he presented last year to his "The Dick Van Dyke Show" co-star, Mary Tyler Moore.

After receiving a lengthy standing ovation from the audience, he asked his fellow actors, "Aren't we lucky that we found a line of work that doesn't require growing up?"

____

Contact AP Movie Writer Christy Lemire through Twitter: http://twitter.com/christylemire

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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.

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Little Change on Wall Street

Wall Street stocks opened flat on Monday despite strong economic data and earnings results from Caterpillar, after a rally last week that took the Standard & Poor’s 500-stock index above 1,500 for the first time in more than five years.

The S.&P. 500 was off about a point in early trading, the Dow Jones industrial average gained 4 points, and the Nasdaq composite index added 0.1 percent.

Caterpillar, a Dow component, rose 2.5 percent after it reported adjusted fourth-quarter earnings that beat expectations, though revenue was slightly below forecasts. The heavy machinery maker also said it remained cautious on the economy despite recent improvements.

“You can’t find more of a global bellwhether than Cat, and people are pleased with the number, which suggests there could be less concern about slowing growth in China after this,” said Wayne Kaufman, chief market analyst at John Thomas Financial in New York.

Thomson Reuters data through Friday showed that of the 147 S.&P. 500 companies that have reported earnings so far, 68 percent exceeded expectations. Since 1994, an average of 62 percent of companies have topped expectations, while the average over the past four quarters stands at 65 percent.

A strong start to the earnings season has bolstered equities, with major averages rising for four straight weeks. The S.&P. has gained for eight straight days, its longest winning streak in eight years, and closed at its highest since Dec. 10, 2007. The Dow ended at its highest since Oct. 31, 2007.

The S.&P. 500 is about 4.1 percent away from its all-time closing high of 1,565.15 on Oct. 9, 2007.

The Commerce Department said Monday that orders for durable goods jumped 4.6 percent in December, a pace that far outstripped expectations for a rise of 1.8 percent.

“We continue to have a parade of better-than-expected economic reports. All in all, it’s a good picture. I think there’s a good chance we’ve reached a point of recognition where people don’t think the economy will crater,” Mr. Kaufman said.

In addition to a push from earnings, equities have also risen on an agreement in Washington to extend the government’s borrowing power. On Monday, Fitch Ratings said that agreement removed the near-term risk to the country’s AAA rating. Previously, the agency said the lack of an agreement would prompt a review of the sovereign rating.

Keryx Biopharmaceuticals said a late-stage trial of its experimental kidney disease drug met the main study goal of reducing phosphate levels in blood, sending shares up 41 percent.

In Europe, stocks were generally ahead in afternoon trading.

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