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Hypertension -- Follow Up

High Blood Pressure - Subsequent Evaluations

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FAA Disease Protocols-Hypertension

Subsequent and Follow Up Evaluations

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FlightPhysical.com discusses Hypertension in 4 sections. This parallels the FAA's Instruction to AMEs concerning this common and serious problem. This page deals with follow up evaluations (renewals for pilots already found to have hypertension).

The FAA requires that followup evaluations include a current status report describing at least the medications used and their dosages, the adequacy of blood pressure control, the presence or absence of side effects, the presence or absence of end-organ complications and the results of any appropriate tests or studies. A potassium level is required if the airman is taking a diuretic. This evaluation can be performed by the AME if the AME can attest to the accuracy of the above information. Hypertension followups are required annually for first- and second-class medical certificate applicants and at the time of renewal for third-class certificate applicants.

An individual who has already reported the hypertension and received an initial clearance will require hypertension followups annually for first- and second-class medical certificate applicants and at the time of renewal for third-class certificate applicants. The specific information required at each hypertension follow-up is as follows:
  1. A statement (current status report) from the treating physician describing at a minimum the medication(s) used and the dosage(s); the adequacy of blood pressure control; the presence or absence of medication side effects; and, the presence or absence of any "end organ" hypertension complications (that is, in the heart, blood vessels, brain, eyes and kidneys). A one-sentence, "no problems" report will not suffice and will delay certification
  2. The results of any appropriate tests or studies deemed necessary by the treating physician
  3. A serum potassium level if the airman is taking a diuretic

The above evaluation may also be performed by the AME if the AME can attest to the accuracy of the above information.

 

Duration of Certificate

The duration of an Aeromedical certificate granted to a pilot with hypertension will be valid until the time of normal expiration, unless otherwise specified by the FAA.

Hypertension has its worst effects on the heart, kidneys, eyes, and brain. High blood pressure is a risk factor for heart attack, stroke, kidney failure, hemorrhages of the retina of the eye, and generalized atherosclerosis (hardening of the arteries all over the body).

It is easy to understand, then, why we are concerned about pilots who have high blood pressure. We donít like to see aviators flying when they are at increased risk for these conditions. Fortunately, hypertension is easy to treat. For many people, simply achieving an appropriate weight, exercising regularly, and watching dietary salt will control their mild hypertension. Other individuals may be required to take medications to reduce their blood pressure. Either way, hypertension and its treatment should have little effect on oneís ability to be medically certified to fly.

Measuring Blood Pressure
Blood pressure can be measured with the individual lying down, sitting, or standing. Regardless of the position, the blood pressure recording will always consist of two numbers written like a fraction with the top number called the systolic pressure and the bottom number called the diastolic pressure. In the example 120/80, the systolic pressure is 120 and the diastolic pressure is 80. These numbers are in units of "millimeters of mercury". (That means that a pressure of 120 is enough to support a column of mercury 120 millimeters high.) One can think about the systolic pressure as representing the peak pressure during the heartís contraction and the diastolic pressure as representing the resting or baseline pressure within the blood stream between contractions.

Most doctors today believe that people who consistently run blood pressures higher than 140/90 are at increased risk for the complications noted above and should be considered for treatment. Remember, however, that blood pressure is variable and occasional readings above this level are to be expected. It is a preponderance of readings above 140/90 that defines hypertension.

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