HYPERTENSION & THE AVIATOR

High Blood Pressure is a common condition in the general population, and no less so in pilots. According to the United States Preventive Services Task Force, hypertension contributes to adverse health outcomes, including premature death, heart attack, renal insufficiency, and stroke. Appropriate diagnosis and treatment for elevated blood pressure can have a major impact on these consequences. My usual goal for control of blood pressure is 130/80.

FAA regulation is fairly lenient when it comes to blood pressure. For any class of medical,

“The average blood pressure while sitting should not exceed 155 mm mercury systolic and 95 mm mercury diastolic maximum pressure for all classes.”

Pilots who present with blood pressures in these limits and have not taken blood pressure medication within 30 days may be issued certificates if they are otherwise qualified. For those with blood pressures slightly above the stated limits, repeated blood pressures may be documented over the next seven days to confirm that the average is within FAA guidelines.

When pilots with elevated blood pressure have not had prior evaluation, medical certification cannot be provided until the problem has been adequately evaluated and treated. On the initial medical exam after diagnosis of high blood pressure, the airman with any class medical must submit an evaluation that includes:

• Personal and family medical history, including risk factors for heart disease.Physical exam including at least three separate BP readings on different days.Electrocardiogram.Basic chemistry labs including cholesterol panel.Review of medication and effectiveness/ adverse effects.
• Depending on the above, occasionally an ECG may be required.

This data may be compiled by one’s primary care provider- and often has been done already- or by the AME. If you bring this information at the time of your medical, your certificate may be issued without delay if no other concerns are encountered.

Pilots of any class with an established history of hypertension may be issued medical certificates by their AME, as long as the required documentation is available.  This includes a current status report:

“describing at least the medications used and their dosages, the adequacy of blood pressure control, the presence or absence of side effects, the presence or absence of end-organ complications and the results of any appropriate tests or studies. A potassium level is required if the airman is taking a diuretic.”

Again, the AME may conduct this evaluation if he or she can attest to the accuracy of the information. Pilots treated for high blood pressure will require annual reports if they carry first or second class medical certificates, and at the time of their next medical for third class medical certificates.

Deferral of the certification to FAA is required if unacceptable medications are used, if the medical status is unclear, if blood pressure is not controlled, or if there are significant adverse effects to blood pressure or medication. Any change in BP medication should prompt a two-week transition period before flying is resumed.

In general, with a little advance planning, I have found the blood pressure reporting requirements to be fairly manageable for the pilots I serve.

Steve Wahls is a Senior Aviation Medical Examiner and Family Physician who practices at OHSU Family Medicine in Scappoose. He holds a private pilot certificate and is available for aviation medical consultation or pilot medical exams.

February 1, 2011