A healthy 35-year-old man, who is also a pilot, was found to have high blood pressure at a recent physical. He has no symptoms, and his blood pressure is now controlled with medication. How does the Federal Aviation Administration (FAA) deal with this issue?
Your blood pressure measurement consists of two numbers – systolic and diastolic – expressed as a fraction e.g., 130/70. The higher number (systolic) represents the pressure in the artery as the heart contracts and the lower number (diastolic) is the pressure as the heart relaxes. Over the last few years, the guidelines for what constitutes a normal blood pressure have changed. The current guidelines from the American Heart Association and American Stroke Association are shown in Figure 1 (below).
The FAA has a remarkably liberal standard for blood pressure. Anything <155/95 is acceptable for all classes of medical certificates. So even though you may be significantly hypertensive by medical standards, your pressure may still be acceptable to the FAA.
If your blood pressure during the FAA exam is above 155/95, the AME may ask you to return on at least three days during a one-week period to recheck the pressure. If all those pressures are <155/<95 the AME may issue your certificate with no further testing. If they are not, the AME can send you back to your regular doctor for initiation or change of anti-hypertension medications. After seven days on the new medications, if there are no side effects and the pressure comes down to acceptable levels, the AME can issue the certificate. It is important to note that any deferral by the AME to see if the pressures come down must be completed within 14 days of the AME’s initial examination.
The vast majority of medications used to treat hypertension are acceptable to the FAA; a pilot can be taking up to three antihypertensive medications and still meet the FAA requirements.
For renewal of your certificate, it is a good idea to have your primary physician prepare a note within 90 days of your aviation medical exam stating that 1) your pressures are stable, 2) you have no complications related to hypertension and 3) you have no side effects from any antihypertensive medications you are taking. With that information, the AME should be able to issue your certificate without any problem.
One final note: Hypertension is a serious condition. It is sometimes called the silent killer because it usually causes no symptoms, yet it is a significant risk factor for stroke, heart failure, myocardial infarction and kidney disease. The FAA is quite liberal in its blood pressure standard. If your blood pressure is high, get treated either with lifestyle changes (exercise and weight loss are often quite effective in returning blood pressure to normal levels) or medication. Don’t worry about the FAA. Worry about your heart.