DEAR DR. DONOHUE: About a year ago, I was told I had high blood pressure, and ever since, I have taken medicine for it. At first it was one drug; then two; now I am on three. These medicines are making me groggy. Still my blood pressure is high.

I am only 32. No one else in my family has high blood pressure. I am on a low-salt diet. I exercise regularly and am on the thin side. I have never smoked. What’s going on with me? — R.B.

ANSWER: Thirty-two is a young age for high blood pressure. Furthermore, you’re doing all the right things, but your pressure stays elevated. Three medicines don’t bring your pressure down. You could have secondary hypertension (high blood pressure).

Most high blood pressure is essential hypertension. “Essential” here doesn’t mean necessary. It means that the high pressure is unexplainable. Much is known about what’s happening, but the basic cause is still in the dark. Secondary hypertension indicates that the rise in pressure is due to a definite and separate disorder that’s causing the pressure rise. Examples are tumors of the adrenal gland, all sorts of kidney diseases, narrowing of one kidney’s artery, Cushing’s disease (an endocrine hormone disorder) and a kink of the aorta (coarctation). If the secondary cause can be eliminated, as it often can, then the blood pressure returns to normal, and medicines are no longer needed. Your profile suggests secondary hypertension.

Discuss this with your doctor. If the doctor believes a search is justified, then looking for secondary causes could explain many of the peculiarities in your story — young age of onset and blood pressure that’s resistant to drugs.

The booklet on high blood pressure explains this common malady and its treatments. Readers can order a copy by writing to: Dr. Donohue — No. 104, Box 536475, Orlando, FL 32853-6475. Enclose a check or money order (no cash) for $4.75 U.S./$6 Can. with the recipient’s printed name and address. Please allow four weeks for delivery.

DEAR DR. DONOHUE: Last month I delivered my third and last child. During this pregnancy, I developed diabetes. The doctor thought I would have to take insulin, but I didn’t. I closely followed the diet given to me.

What are my chances of coming down with permanent diabetes? — S.M.

ANSWER: Gestational diabetes — diabetes that occurs during pregnancy and leaves after delivery — happens to as many as 5 percent of pregnant women. The hormones of pregnancy upset sugar balance. Most women can cope with this, but some cannot adjust their insulin production, and their blood sugar stays elevated.

A constantly elevated blood sugar leads to very large babies. Often, a Cesarean section has to be performed to deliver the baby. An untreated mother can come down with high blood pressure and protein loss in the urine. Insulin is prescribed for gestational diabetes if diet doesn’t bring sugar down to the normal range.

Your chances for developing diabetes can be greatly lessened if you stay on the slim side. An obese woman who has had gestational diabetes has a 50 percent to 75 percent chance of coming down with diabetes. A woman of normal weight has less than a 25 percent chance.

DEAR DR. DONOHUE: I don’t know why you mention Flomax and not Cardura. I’ve been taking it for years.

Your mention of Avodart made me decide to try it. My doctor prescribed it, but I was afraid of the possible side effects. — C.B.

ANSWER: I mentioned only one drug to save space. Flomax and Cardura are two drugs that are familiar to men with a large prostate gland. They both work in the same way. They relax the muscles at the lowermost part of the urinary bladder. That allows the bladder to completely empty. Uroxatral is another medicine in this same class. I hurt its feelings, too. These medicines work within a matter of days to a week.

Avodart (dutasteride) is a different medicine. It, too, is used for enlarged prostate glands. It actually shrinks the gland, but it can take months for the shrinkage to take place. Often, it’s used along with one of the drugs in the first paragraph. Proscar (finasteride) is a similar drug.

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.

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