Be Aware of New Blood Pressure Recommendations Developed by Medical Advisory Panel

Source: J. J. Keller & Associates, Inc.

Recently the FMCSA published results from a Cardiovascular Medical Advisory Panel it convened to develop new guidelines for cardiovascular related conditions based on medical advances over the last 15 years. One cardiovascular related condition in which the panel developed new guidelines is high blood pressure (hypertension).

The medical standard regarding blood pressure (49 CFR 391.41(b)(6)) has not changed. It states that a person must have "...no current clinical diagnosis of high blood pressure likely to interfere with his/her ability to operate a commercial motor vehicle safely." The standard must be followed.

The guidelines are recommendations that the medical examiner should follow. While not law, the guidelines are intended as standards of practice for medical examiners. Although the medical examiner is responsible for determining if the commercial driver is medically qualified under the Federal Motor Carrier Safety Regulations, the guidelines issued by FMCSA are based on the medical literature. If the medical examiner chooses not to follow the guidelines, the reason(s) for the variation should be documented.

The following table gives the new recommendations for hypertension.

RECOMMENDATION TABLE
HYPERTENSION

Diagnosis	Physiologic/Functional	Certification	Re-certification
Essential Hypertension	Evaluate for other clinical CVD including TOD†; Presence of TOD, CVD or diabetes may affect therapy selected.
Stage 1 (140-159/90-99 mmHg)	Usually asymptomatic; Low risk for near-term incapacitating event.	Yes Rarely disqualifying alone.	Annual BP <140/90 at annual exam; If not, but <160/100, certification extended 1 time for 3 months.
Stage 2 (160–179/100–109 mmHg)	Low risk for incapacitating event; risk increased in presence of TOD; Indication for pharmacologic therapy.	Yes One time certification for 3 months. Yes, at recheck if: BP ≤140/90mm Hg Certify for 1 year from date of initial exam.	Annual BP ≤140/90.
Stage 3 (≥180/110 mmHg)	High risk for acute hypertension-related event.	No Immediately disqualifying; Yes, at recheck if: BP ≤140/90 mmHg., and treatment is well tolerated. Certify for 6 months from date of initial exam.	Every 6 months; BP ≤140/90.
Secondary Hypertension	Evaluation warranted if persistently hypertensive on maximal or nearmaximal doses of 2-3 pharmacologic agents; May be amenable to surgical/specific therapy.	Based on above stages. Yes if: Stage 1 or nonhypertensive. At least 3 months after surgical correction.	Annual BP ≤140/90

† TOD – Target Organ Damage – Heart Failure, Stroke or Transient Ischemic Attack,
Peripheral Artery Disease, Retinopathy, Left Ventricular Hypertrophy, Nephropathy.
Examiner may disqualify a driver if TOD significantly impairs driver's work capacity.
Driver should have no excess sedation or orthostatic change in BP.

For the complete "Cardiovascular Advisory Panel Guidelines for the Medical Examination of Commercial Motor Vehicle Drivers," visit FMCSA's website at www.fmcsa.dot.gov.

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