DEAR DR. DONOHUE: Will you please discuss refractory hypertension? My doctor has tried everything, but nothing seems to work for me. – C.R.

ANSWER: Refractory hypertension is blood pressure that can’t be controlled even when the patient has done all in his or her power to make life changes (such as reducing salt intake) and even when the doctor has prescribed two or three medicines in their full doses.

Take an inventory of the things that you can do to lower your blood pressure. One is weight reduction if it applies to you. Another is a drastic cutback in salt and salty food. Hiking the amount of potassium in your diet lowers blood pressure. Foods with lots of potassium include: baked potato with skin, spinach, bananas, oranges and orange juice, cantaloupe, prunes, lima beans and sweet potatoes. A diet consisting mostly of fruit, vegetables and low-fat dairy products can also bring down pressure. Thirty minutes of exercise (walking) reduces blood pressure.

There are 56 blood pressure medicines. You and your doctor have to work together to find the ones that are best for you. A water pill is almost always part of the medicine regimen. A second and even a third medicine might be necessary.

About 5 percent to 10 percent of people with high blood pressure have what’s called secondary hypertension – high blood pressure that comes about because of another process going on. For instance, a narrowed kidney artery, sleep apnea, adrenal gland tumors and some kidney conditions elevate blood pressure. Secondary hypertension often does not respond to medicines. Correcting the underlying problem does lower the pressure.

The blood pressure booklet deals with the causes and treatment of high blood pressure. Readers can order a copy by writing: Dr. Donohue – No. 104, Box 536475, Orlando, FL 38253-6475. Enclose a check or money order (no cash) for $4.75 U.S./$6.75 Can. with the recipient’s printed name and address. Please allow four weeks for delivery.

DEAR DR. DONOHUE: I take allopurinol (Zyloprim) for gout, and it helps me very much. Since I’m on this medicine, can I eat more of the food that has purine in it? How about shellfish? – J.D.

ANSWER: Elevated blood uric acid precipitates gout attacks. Uric acid rises when the body makes too much of it, when the kidneys get rid of too little of it or when a person eats food that contains too much of it. Actually it’s not uric acid in food that’s to blame; it’s food high in purines. Purines are the precursors of uric acid in the body.

In the days before there were effective gout medicines, diet was the only treatment available. Today the diet most gout patients have to put up with is one that previous generations would have found a cakewalk.

People with gout are advised not to eat large quantities of meat. Organ meats – such as liver – are forbidden. All types of seafood are high in purines, so their use has to be minimized. No fruit or vegetable is banned. Low-fat dairy products prevent gout attacks. Drinking two or more glasses of skim milk a day lessens your chances of having an attack.

You want an exact quantity of the forbidden food that you can eat. No one can give you such an estimate. It’s a matter of experimenting. If you are willing to endure a possible gout attack, then you can increase your intake of these foods, but you’d better have a heart-to-heart talk with your doctor first. Your blood uric acid is another way to tell if you are eating too many high-purine foods.

DEAR DR. DONOHUE: I have had GERD for years. If I eat part of a raw apple before retiring, I am never bothered by heartburn. Please print this. – I.J.

ANSWER: OK, I’ll have it printed. I thank you for the information, but I’m not sure all of humankind will benefit from it. I don’t doubt it works for you, but I have serious doubts that it will work for others.

Dr. Donohue regrets that he is unable to answer individual letters, but he will incorporate them in his column whenever possible. Readers may write him or request an order form of available health newsletters at P.O. Box 536475, Orlando, FL 32853-6475. Readers may also order health newsletters from www.rbmamall.com