Essential Hypertension

The Sixth Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure established three stages of hypertension that define the severity of hypertension and guide therapy.

49 CFR 391.43(f) Blood Pressure (BP) was amended to include the use of BP readings equivalent to the stages of hypertension to determine driver certification status. The complete text of the amendment may be accessed at Federal Register/Vol. 68, No. 189/Tuesday, September 30, 2003/Rules and Regulations, 56199.

When you determine certification for the driver with high BP in the ranges of stage 1 or stage 2 hypertension (BP greater than 140/90 but less than 180/100), consider these additional factors:

• Type of examination (certification or recertification).
• Current certification interval (1-2 years or 3 months).
• Treatment (lifestyle changes, use of medication).
• Severity of hypertension prior to treatment (particularly if history of stage 3 hypertension).

The purpose of the one-time, 3-month certificate is to allow the driver with high BP that is an absolute indication for antihypertensive drug therapy to continue to drive while taking steps to lower the elevated BP. It is not intended as a means to indefinitely extend driving privileges for a driver with a condition that is associated with long-term risks.

For the driver with high BP or hypertension to maintain continuous certification, the driver must demonstrate at examination BP at or less than 140/90.

NOTE: "One-time" means you cannot issue consecutive 3-month certificates for BP greater than 140/90. It does not mean once in a lifetime.

Hypertension Recommendation Table (PDF)