Today's Economist: Casey B. Mulligan: The Health Care Law and Retirement Savings

Casey B. Mulligan is an economics professor at the University of Chicago. He is the author of “The Redistribution Recession: How Labor Market Distortions Contracted the Economy.”

Because of its definition of affordability, beginning next year the Affordable Care Act may affect retirement savings.

Employer contributions to employee pension plans are exempt from payroll and personal income taxes at the time that they are made, because the employer contributions are not officially considered part of the employee’s wages or salary (employer health insurance contributions are treated much the same way). The contributions are taxed when withdrawn (typically when the worker has retired), at a rate determined by the retiree’s personal income tax situation.

Employees are sometimes advised to save for retirement in this way in part because the interest, dividends and capital gains accrue without repeated taxation. In addition, people sometimes expect their tax brackets to be lower when retired than they are when they are working.

These well-understood tax benefits of pension plans will change a year from now if the act is implemented as planned. Under the act, wages and salaries of people receiving health insurance in the law’s new “insurance exchanges” will be subject to an additional implicit tax, because wages and salaries will determine how much a person has to pay for health insurance.

While much about the Affordable Care Act is still being digested by economists, they have long recognized that high marginal tax rates lead to fringe benefit creation. And the Congressional Budget Office has concluded that the act will raise marginal tax rates.

Were an employer to reduce wages and salaries (or fail to increase them) and compensate employees by introducing an employer-matching pension plan, the employee is likely to benefit by receiving additional government assistance with his health-insurance costs. The pension contributions will add to the worker’s income during retirement, except that the income of elderly people does not determine health-insurance eligibility to the same degree, because the elderly participate in Medicare, most of which is not means-tested.

Take, for example, a person whose four-member household would earn $95,000 a year if his employer were not making contributions to a pension plan or did not offer one. He would be ineligible for any premium assistance under the Affordable Care Act because his family income would be considered to be about 400 percent of the poverty line.

If instead the employer made a $4,000 contribution to a pension plan and reduced the employee’s salary so that household income was $91,000, the employee would save the personal income and payroll tax on the $4,000 and would become eligible for about $2,600 worth of health-insurance premium assistance under the act. (The employer would come out ahead here, too, by reducing its payroll tax obligations).

Even though the Affordable Care Act is known as a health-insurance law, in effect it could be paying for a large portion of employer contributions to pension plans. This has the potential of changing retirement savings and the relative living standards of older and working-age people.

Read More..

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





Read More..

Google's Plan to Snatch Shopping From Amazon Is Working



Of all the great match-ups among tech’s Fantastic Four — Google, Apple, Facebook, Amazon — it’s Google versus Amazon that’s becoming the most fascinating, and not because of who has the better tablet.


Quietly, Google has been retooling in a bid to beat Amazon as the place to shop — and some early evidence suggests the search giant isn’t crazy to try.


In a survey released today, Google’s transition last fall to all-paid product listing display ads in search results is paying off. (These are the product photos that show up next to price and seller info at the top of “organic” Google search results for products, such as at the top of this search for “iPhone 5.”) Digital ad management provider Marin Software found that advertisers managing $4 billion annually in online ad campaigns through its platform spent 600 percent more on Google product listing ads after the change in October than before. That result alone doesn’t necessarily surprise: If Google says pay to play, advertisers have little choice.


But they may be paying gladly. Marin found that the paid product listings were turning up more in Google search results, especially around the holidays, which means advertisers’ products are getting seen more by potential buyers. And that visibility is translating into action: Marin says click-throughs on product listing ads have increased 210 percent since last year.


(Marin also is releasing a new product today to help advertisers manage Google paid product listing campaigns, though the company says it has no strong reason to show bias toward Google, since advertisers also use its software to manage campaigns on competing sites such as Yahoo, Bing and Facebook.)


When Google announced its plans to require companies to pay to be listed in product searches, critics and competitors complained the change would hurt consumers by tainting the objectivity of the search results. While the results may now be plainly biased, Marin vice president of marketing Matt Lawson says users are responding to the paid listings more because Google is putting more effort into them.


And so are advertisers, who had less incentive to care about the quality of listings they got for free. “As soon as it became clear they were going to be paying for them and contributing a significant amount of their budget to them, then they became interested in managing it,” Lawson says.


What does any of this have to do with Amazon? Lawson and Marin Software CEO Chris Lien say that online shoppers today tend to start in one of two places for product information: Google or Amazon. In effect, Amazon has become a “commerce search engine,” which cuts into Google’s core function. To compete, Google wants to give shoppers every reason not to go straight to Amazon by becoming as reliable a destination not just to learn about products, but to buy them.


“What you’re going to see them do is do everything they can to enable marketers to sell through their platform,” Lawson says.


Not that Google likely plans to set up its own warehouses, he says. But he adds that the days when merchants see Google as a conduit for clicks to their own sites is fading. If Google can package the sale from search to checkout, merchants can handle the inventory and shipping themselves. If Google and retailers — especially brick-and-mortar Amazon competitors — can come together in that way, suddenly online shoppers have another broad, deep Amazon alternative.


At the same time, Lien says, the competition between Google and Amazon isn’t all-or-nothing. Shoppers are too smart for that.


“Consumers are looking on Amazon and they’re looking on Google,” Lien says. “I think most thoughtful consumers are to take the best deal.”



Homepage photo: Halilgokdal/Flickr


Read More..

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.


Entertainment News Headlines – Yahoo! News





Title Post: Dior: Jennifer Lawrence dress had no malfunction
Url Post: http://www.news.fluser.com/dior-jennifer-lawrence-dress-had-no-malfunction/
Link To Post : Dior: Jennifer Lawrence dress had no malfunction
Rating:
100%

based on 99998 ratings.
5 user reviews.
Author: Fluser SeoLink
Thanks for visiting the blog, If any criticism and suggestions please leave a comment




Read More..

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.

Read More..

DealBook: Gleacher to Leave His Investment Bank

9:32 a.m. | Updated with interview with Mr. Gleacher

Eric J. Gleacher, a veteran deal maker who participated in the fight over RJR Nabisco, said on Tuesday that he would leave the investment bank he founded about 23 years ago.

The departure of Mr. Gleacher as chairman comes months after his struggling firm hired Credit Suisse to explore a sale.

Gleacher & Company disclosed last month that the Nasdaq stock market had initiated a move to delist the investment bank, after its stock price lingered below $1 for months. The firm is appealing the decision.

Mr. Gleacher, 72, told DealBook in an interview on Tuesday that his decision was prompted in part by finishing work on the sale of Archstone, a massive real estate company once owned by Lehman Brothers. Since the deal was announced in late November, he has been approached by a number of companies seeking advice, and he is weighing opportunities to essentially become a freelance adviser.

“As the business model on Wall Street changes, I’m looking forward to working with C.E.O.’s and investors in helping them realize their goals,” he said. “I’m looking forward to doing so in an independent manner.”

(He has been contemplating a move for some time, having put up his Manhattan town house for sale earlier this month.)

Mr. Gleacher, a former Marine and long one of Wall Street’s top golfers, founded his company after having become one of the top deals bankers on Wall Street during the 1980s. He founded the mergers department at Lehman Brothers in 1978, and then led Morgan Stanley‘s deal team from 1985 to 1990.

He then founded his firm, maintaining it for years as an independent merger advisory shop. He sold it to the British bank Natwest in 1995, but bought it back four years later.

Mr. Gleacher and his partners decided in 2009 to sell their business to Broadpoint Securities, a small brokerage, giving rise to the current Gleacher & Company. But the firm struggled, burdened with rising regulatory constraints and tepid deal activity.

Under Thomas Hughes, Gleacher & Company’s chief executive, the investment bank has sold off businesses in an attempt to revive its flagging fortunes. In the fall, the firm explored a potential sale to a larger concern, Stifel Financial, but the talks fell apart over price, according to people briefed on the matter.

It is unclear whether the investment bank is still pursuing a sale. Mr. Hughes suggested in a statement that the firm continued to weigh its options.

“We will continue to grow our M.&A. and capital-raising capabilities in line with the vision we have described previously, a vision that Eric helped author,” Mr. Hughes said. “On behalf of the company, I want to wish Eric the best in his future endeavors.”

While striking off on his own will allow him more personal time, Mr. Gleacher added that he intended to keep busy.

“To me, retirement is just time allocation,” he said. “I’ve always just enjoyed what I’ve done.”

Read More..

'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."





Read More..

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 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.


Read More..

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.”


Entertainment News Headlines – Yahoo! News





Title Post: Barbara Walters hospitalized with chickenpox
Url Post: http://www.news.fluser.com/barbara-walters-hospitalized-with-chickenpox/
Link To Post : Barbara Walters hospitalized with chickenpox
Rating:
100%

based on 99998 ratings.
5 user reviews.
Author: Fluser SeoLink
Thanks for visiting the blog, If any criticism and suggestions please leave a comment




Read More..

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.

Read More..