Hypertension Reprise (Part Two)

Missed the first portion of this article? Read it here

Last time, we reviewed high blood pressure from both a clinical and a regulatory standpoint.  Issuance of a medical certificate while taking blood pressure medications is one of the simplest processes one can experience in dealing with the FAA.  So don’t fret about it!  If your doctor suggests that you be on medications, go ahead and start medication sooner rather than later.  Untreated high blood pressure carries with it some nasty and undesirable complications, including stroke, heart attack and heart failure, and kidney disease. 

If you are on no more than three blood pressure medications and are well controlled, the FAA utilizes a program called CACI (Conditions AMEs Can Issue) that allows the aviation medical examiner to issue a medical certificate without FAA review provided the pilot has adequate documentation to support the issuance.  The CACI worksheet that can be completed by your treating doctor that verifies your hypertension is stable, that there are no symptoms, that you are on an allowed medication or combination of meds, and that your blood pressure at the time of the exam is no higher than 155/95.  Your own doctor can also just write a status report that references the information on the worksheet.  Either way is fine, provided the aviation medical examiner gets what is needed to issue the medical in the office.  The worksheet is not sent to the FAA; it is just for the medical examiner’s use at the time of the exam.  Just be aware that if the AME doesn’t issue the certificate to you in the office, there will be a delay before the medical certificate is issued, so having paperwork in order is important!

Many people have what is referred to as “white coat hypertension.”  They have normal blood pressures except when in the doctor’s exam room.  In this case, the AME will usually continue the exam or let you sit or lay quietly for a few minutes to give you a chance to settle down.  Often, your pressure will come down low enough to allow office certification.

If you keep home blood pressure logs, bring them with you to verify what your readings normally run.  In situations where your pressure just doesn’t come down, the FAA will ask you to return to your treating doctor for three separate days over a seven-day period for serial checks.  You may need to start medications if not already treated, or a change in your medications may be needed.  You will need to be on new meds for at least 7 days to get the pressures down.  If all this can be done within 14 days after the initial physical exam, the AME can still issue in the office. 

Now, if your hypertension is “intractable,” that is, it requires more than three different medications to control, the FAA can still qualify you medically but under a special issuance.  The AME will defer your application, so you will need a good status report from your doctor with a summary of any secondary cause for the hypertension, a treatment plan, and a listing of all the medications, dosages, and frequency of use.  If your blood pressure is controlled and there are no other significant medical issues, you can expect a special issuance authorization.  

Portrait of Gary Crump, AOPA's director of medical certification with a Cessna 182 Skylane at the National Aviation Community Center.
Frederick, MD USA

Gary Crump

Gary is the Director of AOPA’s Pilot Information Center Medical Certification Section and has spent the last 32 years assisting AOPA members. He is also a former Operating Room Technician, Professional Firefighter/Emergency Medical Technician, and has been a pilot since 1973.
Topics: Pilot Health and Medical Certification

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