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Pressure Regulators

One of the advantages of working in a busy call center as we have here in the Pilot Information Center is that we have a pulse on what members are concerned and calling about.

In the medical certification section, we run the full spectrum of medical conditions from allergies to heart disease to strokes, questions about how to report a particular situation on the medXpress medical application, how to contact the FAA, and one of the most frequently asked about topics, “Why does it take the FAA so long to respond?”

We have covered these areas before, but we always have a new audience tapping into our PPS communications, so we will eventually get back to writing about those areas of interest. This month, blood pressure has been a popular topic of concern so we will hit the highlights for dealing with this common medical condition. Two pilots I recently spoke with were both really concerned, and maybe “terrified” wouldn’t be too strong a descriptor, that they were advised to start medications to get their blood pressure under control, and that they would be grounded as a result.

I talked them off the ledge and assured them that 99.9% of blood pressure medications are allowed, and that once on the meds and the BP was under control, their AMEs could issue them an unrestricted medical certificate at the time of their regular flight physicals. I could feel and hear their sense of relief on hearing that news, and I reminded myself that there is a lot of junk information out there in the universe being spewed by people who don’t know what they’re talking about. 

If you’re one of “those” pilots in that situation, just take a deep breath and relax! The first step in dealing with the FAA is to get your medical condition under control. In the case of hypertension, it can often creep up on you without letting you know it, so regular visits to your health care provider is always a good thing. Checking blood pressure is easy progressive maintenance. Your local retail pharmacies such as Rite Aid, CVS or Walgreens may have blood pressure kiosks in the stores. You can also purchase an automated home blood pressure cuff and keep a diary of your readings a few times a week. Health fairs at your place of employment or through local community events will do BP checks as well, so “keeping an eye on your numbers” takes little effort. (Speaking of numbers, you should also know your blood lipids – cholesterol and triglycerides – and your fasting glucose and A1c hemoglobin, too!)

Here’s the quick summary for blood pressure as explained the FAA’s Guide for Aviation Medical Examiners “Decision Considerations.” The upper limit for office certification for an applicant who is not on antihypertensive meds is 155 systolic over 95 diastolic. That is a “regulatory” limit and is a bit higher than what most physicians would consider acceptable in a clinical setting. The “magic number” for blood pressure is often considered to be about 120/80, but the number keeps going down, so some literature now suggests that the target should be 115/75. If your BP is high at the beginning of the flight physical, the AME can recheck it later in the exam, and if the recheck is less than 155/95, the examiner can issue the medical.

If the pressure is consistently higher than acceptable, your AME will send you back to your family physician for rechecks, and if medications are prescribed, after 7 days on meds and a BP that is within the limits, the AME can issue a medical if you return within 14 days of the initial exam. You can be on up to three blood pressure medications and still qualify for a medical under the CACI Hypertension policy. Alpha blockers, beta blockers, calcium channel blockers, diuretics, ACE-inhibitors, Angiotensin Receptor Blockers (ARB), direct renin inhibitors, and/or direct vasodilators are all allowed. In fact, the only drugs not allowed by FAA are centrally acting antihypertensives such as clonidine (Catapres), and I can’t remember the last time I talked to someone who was prescribed that drug. It is an old medication that has aeromedically undesirable side effects. You can also look at our medications database to search the blood pressure meds by name.

If you require more than three meds for control, the AME will defer your application to the FAA for a decision under a special issuance. Regular readers of this column probably know that a deferral means a lengthy delay in getting your medical to you, so plan accordingly and do your homework so you know the numbers when you go in.

Life often gets in the way of living. If you are on the edge with your blood pressure, hopefully this will assure you that the flying part of your life won’t be adversely impacted by the need for meds to keep the pressure regulated!

Keep on truckin’!

Portrait of Gary Crump, AOPA's director of medical certification with a Cessna 182 Skylane at the National Aviation Community Center.
AOPA NACC (FDK)
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.

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