DEAR DR. DONOHUE: I am 78. My last blood pressure reading was 169 over 70. The doctor had me come back two more times for two more readings, and the numbers were the same as the first reading both times. The doctor tells me to take blood pressure medicine.

I’ve gotten this far in life without taking pills. My second number is normal. Doesn’t that count for anything? Do you think medicine is needed for someone like me? – R.C.

You have what’s called systolic (siss-TOWL-ik)-only hypertension (high blood pressure). The first number is the systolic number. It’s the pressure the heart imparts to blood when pumping it into the body. A normal systolic pressure should be 139 or lower, and the ideal systolic pressure is less than 120.

Both numbers – the systolic (first) and diastolic pressures (second) – are important. If either number is higher than the norm, that constitutes high blood pressure – hypertension.

Systolic-only high blood pressure makes you two to four times more likely to have a heart attack, stroke or kidney damage than does normal blood pressure. The answer to your question is that your pressure ought to be lowered. If you want to try to do so without medicine, and if your doctor agrees to the trial, then go ahead. Don’t add any salt to your food, and don’t eat heavily salted foods. Cut down on meat. Eat lots of fruits and vegetables. If you’re overweight, lose some pounds. Exercise; walking is fine. You have to devote at least half an hour to it, and your pace should be at more than a leisurely stroll.

If you end up having to take medicine, you won’t be started on very powerful drugs that might make you feel loopy. Usually the first drug prescribed for high blood pressure is a diuretic – a water pill. And it’s given in low doses. Rarely do people on low doses of diuretics experience any unpleasant side effects.

The blood pressure booklet provides information on this most common of common disorders. Readers can obtain a copy by writing: Dr. Donohue – No. 104, Box 536475, Orlando, FL 32853-6475. 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: My boyfriend does cocaine about once a week. He says this amount won’t cause any harm. We’re supposed to get married in four months. I’d like him to stop. Can you tell me what the possible side effects of cocaine could be? – M.M.

Cocaine is highly addictive. Many believe they can limit their use to once or twice a week. Quite often, and in a relatively short time, they become daily users. Addiction is a powerful argument to stay away from it.

A second, nonmedical but compelling reason not to use it is the fact that it is illegal and its use can land him in jail.

I can give a long list of gruesome side effects, but let me limit it to one: death. Year after year, emergency doctors see cocaine users brought to the emergency department dead from cocaine. The drug can constrict heart arteries so greatly that the heart muscle doesn’t get the blood it needs. The blood-deprived part of the heart dies. That’s a heart attack, and it can be fatal.

DEAR DR. DONOHUE: Do chocolate or nuts cause cold-sore outbreaks? I get two or three outbreaks in the summer, and that’s the time I do most of my chocolate and nut eating. – D.K.

I have no information that says either chocolate or nuts lead to a cold-sore outbreak.

Ultraviolet light can. If your outbreaks are summer-related, I would blame the sun for them.

DEAR DR. DONOHUE: I have three soft growths on my upper right arm. One is the size of an egg. They don’t hurt, and they’ve been there for five years. One doctor told me to do nothing. That was easy for him to say – he doesn’t have them. What are these things, and what would you recommend? – D.P.

Soft growths that haven’t changed in five years are not likely to indicate serious problems, like cancer. I cannot see or feel yours, so I can’t be certain, but I presume they’re lipomas.

Lipomas are soft balls of fat cells. They aren’t cancer, and they rarely become cancer. If they aren’t painful, if they don’t interfere with the use of your arm and if their size isn’t changing, then they can be ignored. If they are troublesome, removal isn’t a big deal.

Take this for what it is – a guess. Since you’ve had them for so long and since they’ve remained stable, you don’t have to rush for a confirmation of the lipoma diagnosis, but, at some time, you should have your family doctor tell you what he or she thinks these masses are.

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