Stage 3 Hypertension

Stage 3 hypertension carries a high risk for the development of acute hypertension-related symptoms that could impair judgment and driving ability. Acute manifestations of elevated blood pressure (BP) can include sudden stroke, acute pulmonary edema, subarachnoid hemorrhage, aortic dissection, or aortic aneurysm rupture.

Meningismus, acute neurological deficits, abrupt onset of shortness of breath, or severe, ripping back or chest pain could signal an impending hypertensive catastrophe that requires immediate cessation of driving and emergency medical care. Symptoms of hypertensive urgency such as headache and nausea are likely to be more subtle, subacute in onset, and more amenable to treatment than a hypertensive emergency.

BP measurement greater than or equal to 180/110.

Waiting period

Not applicable.

Decision

Maximum certification period — 6 months with history of stage 3 hypertension

Recommend to certify if:

Not applicable.

Recommend not to certify if:

The driver has BP equal to stage 3 hypertension, regardless of history or treatment.

NOTE: The driver is at risk for an acute hypertensive event and should be advised to seek, or should be provided immediate medical attention and must be medically disqualified.

Monitoring/Testing

Before the driver who is disqualified for stage 3 hypertension can be considered for recertification (maximum 6 months), the driver must, at examination have:

• BP at or less than 140/90.
• Treatment that is well tolerated.

At future semi-annual examinations, if BP is equivalent to stage 1 or stage 2 hypertension, on a case-by-case basis, you should determine the appropriate use of the one-time, 3-month certificate in accordance with stage 1 or stage 2 hypertension guidelines.

If you believe BP greater than 140/90 at rest indicates an unacceptable risk for development of stage 3 hypertension and the onset of acute hypertension-related symptoms, you may temporarily disqualify the driver until BP is at or less than 140/90 and treatment is well tolerated. For example, when maximum doses of multiple antihypertensive medications are used without achieving BP at or less than 140/90, it is prudent that a more aggressive treatment plan should be monitored for effectiveness, interactions, and tolerance prior to driver certification.

Follow-up

The driver should have a medical examination at least every 6 months.

Hypertension Recommendation Table (PDF)

When determining certification for the driver with high BP or hypertension, take into consideration current driver certification status, use of antihypertensive medication, and severity of hypertension prior to treatment.