Hypertension & Blood Pressure Meds

High blood pressure is one of the conditions the FAA handles most routinely. Your blood pressure at the exam must not exceed 155 systolic and 95 diastolic, for all classes. If you are not on medication, or your treating physician stopped your blood pressure medication 30 days ago or longer, your AME can issue as long as you meet that limit and are otherwise qualified. If you take blood pressure medication, most pilots are certified by their AME at the exam under the FAA's CACI (Conditions AMEs Can Issue) Hypertension Worksheet, with no Special Issuance and no documents sent to the FAA.

Most classes of blood pressure medication are acceptable: alpha blockers, beta blockers, calcium channel blockers, ACE inhibitors, ARBs, direct renin inhibitors, direct vasodilators, and diuretics. Beta blockers are allowed even if you also take insulin, a sulfonylurea, or a meglitinide for diabetes. Some medications are unacceptable alone or in any combination product, and your AME cannot issue if you take them: clonidine (Catapres), guanabenz, guanfacine (Tenex), methyldopa, reserpine, and nitrates such as nitroglycerin, isosorbide dinitrate, and isosorbide mononitrate. When you start a new blood pressure medication, you must not fly for 7 days so you can confirm you have no side effects.

Under the CACI worksheet, your AME can issue if you take 3 or fewer acceptable medications, have been stable on your current regimen for at least 7 days with no changes recommended, have no symptoms, have no medication side effects, and your office reading is 155/95 or lower. The FAA counts each ingredient of a combination pill separately, so lisinopril/HCTZ counts as 2 medications. Your AME needs a detailed clinical progress note from a visit with your treating physician within 90 days before the exam, unless the AME can otherwise confirm you have been stable on your current medication for at least 7 days without symptoms, side effects, or recommended changes. First- and second-class pilots must provide this information every year; third-class pilots provide it at each required exam. Your AME records the CACI result in Block 60.

If your reading is high on exam day, your AME doesn't have to defer. The AME can recheck it during the visit, have you return to the clinic on 3 separate days over a 7-day period, or send you back to your treating physician. If your medication is adjusted, the 7-day no-fly period applies. All of this must happen within the 14 days the AME has to transmit the exam; the AME cannot hold it open longer. Your AME must defer to the FAA, for a possible Special Issuance, if you take 4 or more medications, your blood pressure is uncontrolled, you take an unacceptable medication, you have side effects, your medical status is unclear, or your certification has been specifically reserved to the FAA.