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A high blood pressure doesn’t necessarily equate to the need to stop flying. However, it can certainly complicate things when it comes to certification, particularly in instances where your blood pressure remains high or where you require medications to control it.
Your readings, medications, the side effects of the medication you’re taking and your medical history will be considered by the FAA.
So, can pilots fly with high blood pressure? Most likely, yes. Depending on your situation, you may be eligible for routine issue, CACI issue, or special issuance.
FAA Blood Pressure Requirements for Medical Exams: What Every Pilot Needs to Know
The present exam guide from the FAA requires an average seated blood pressure no greater than 155/95 mm Hg (systolic/diastolic) for first-, second-, and third-class medical exams.
It is important to note that the standard of 155/95 mm Hg is an exam guide within the FAA Aviation Medical Examiner guides and not specifically codified into 14 CFR Part 67.
| Medical Certificate | Blood Pressure Guideline |
| First Class | 155/95 mmHg |
| Second Class | 155/95 mmHg |
| Third Class | 155/95 mmHg |
When booking an appointment with the FAA 1st Class Medical Examiner , the same guideline applies no matter which class you hold.
Researching high blood pressure for an FAA third-class medical? Same deal. A third-class exam doesn’t give you any extra room.
The FAA wants your blood pressure taken while you’re seated, using accepted clinical methods. Anything that could affect the accuracy of the reading should be documented too.
Does One High Blood Pressure Reading Mean You Will Fail Your FAA Medical?
Nope. One elevated reading won’t automatically get you denied or deferred. Stress, nerves, or a rushed walk into the office can push numbers up for a while.
Some pilots run into white coat hypertension FAA medical concerns, where readings spike just because they’re sitting in a medical office.
What Happens If the Reading Is Above 155/95?
If the first reading comes in over the limit, the FAA gives the AME a few ways to handle it:
- Repeat the measurement: If the second reading is within the limit, the examiner records both.
- Arrange additional readings: You might be asked to come back on three separate days over a seven-day stretch.
- Request physician reassessment: If the numbers stay high, your treatment may need a closer look.
So if you’re wondering what happens when blood pressure is too high for an FAA medical, one high reading doesn’t automatically sink your application. Uncontrolled hypertension or an unclear medical status can still lead to deferral, though.
If your medication gets adjusted, the FAA requires a seven-day no-fly period so the new treatment can be checked for problems. The exam also can’t stay open forever. It has to be submitted within the 14-day window. The FAA’s guidance on elevated blood pressure has the details.
How Does the FAA Evaluate Pilots With Diagnosed Hypertension?
The FAA looks at how well your hypertension is controlled, whether you need medication, and whether you have symptoms or treatment side effects.
H3: Pilots Who Control Blood Pressure Without Medication
If your doctor stopped your antihypertensive at least 30 days before the exam, you may qualify for routine issuance, as long as your numbers meet FAA guidelines and you’re otherwise medically qualified.
Don’t stop treatment just to get ready for an exam, though. Any medication change should be supervised by your physician.
Pilots Taking Three or Fewer Acceptable Blood Pressure Medications
The CACI pathway stands for Conditions AME Can Issue. It lets the Aviation Medical Examiner issue your certificate once you meet every requirement on the FAA’s hypertension worksheet.
The main conditions are:
- Stable blood pressure control on your current medication for at least seven days.
- Office blood pressure at or below 155/95.
- No hypertension-related symptoms.
- No bothersome medication side effects.
- No recommended treatment changes.
- No more than three acceptable medications, counting each active component.
If you check all of those boxes, the AME can issue the certificate without sending supporting documents to the FAA. You still need to meet the 155/95 limit and every other eligibility requirement.
When Does Hypertension Require FAA Review?
The AME has to defer your application if you:
- Use four or more acceptable antihypertensive medications.
- Have clinically uncontrolled hypertension.
- Take a medication that’s unacceptable under FAA guidance.
- Experience significant medication side effects.
- Have an unclear medical status.
- Fall into a category the FAA has reserved for its own review.
- Combination pills count by their individual active ingredients. Lisinopril/HCTZ, for example, counts as two.
In these cases, the FAA may consider Special Issuance after reviewing your medical records.
Which Blood Pressure Medications Are Acceptable Under FAA Guidelines?
Whether a medication is acceptable depends on its class, how well your pressure is controlled, and how your body responds to it.
The CACI worksheet lists acceptable combinations of up to three medications from these classes:
| Medication class | Examples |
| ACE inhibitors | Lisinopril |
| ARBs | Losartan |
| Beta blockers | Metoprolol |
| Calcium channel blockers | Amlodipine |
| Diuretics | Hydrochlorothiazide |
| Alpha blockers | Doxazosin |
| Direct renin inhibitors | Aliskiren |
| Direct vasodilators | Hydralazine |
Medication that acts centrally such as clonidine is considered unacceptable according to CACI worksheet, and it may also have an effect on your medical certification requirements for pilots .
Need Help with FAA Medical Certification?
If you have hypertension while still holding a valid pilot medical certificate, there may be concerns about FAA regulations and medication eligibility. At Aviation Medicine, we will assist you in understanding the possibilities for your medical certification.
Wondering how your high blood pressure impacts your FAA medical eligibility? Talk to Aviation Medicine and get advice from Dr. Weinberg.
What Happens When a Pilot Starts or Changes Blood Pressure Medication?
Adjusting medicine needs careful consideration since some medicines could cause dizziness, fatigue, light headedness or side effects.
According to the FAA, there must be a seven day no-fly time frame after you make any adjustment in your medicine.The CACI pathway also needs at least seven days of stability on your current regimen.
If you’re researching pilot blood pressure medication FAA rules, check your specific drug and formulation against the current guidance. Don’t assume every medication is fine.
FAA Disqualifying Medications for Pilots can sound like a permanent ban. In reality, a medication that isn’t accepted under CACI usually leads to deferral and further review, not automatic permanent disqualification.
What Documents Should Pilots Bring to an FAA Medical Examination With Hypertension?
Your AME needs enough information to tell whether your condition is controlled and whether your treatment fits safe flying.
The FAA generally wants a current, detailed progress note from your treating physician, dated within 90 days of the exam. The AME doesn’t need to review it if they can confirm every CACI criterion on their own.
Your AME will typically look at:
- Recent blood pressure readings.
- Medication names and dosages.
- Dates of medication changes.
- Possible side effects.
- Treatment history and stability.
- Relevant specialist reports, when applicable.
First- and second-class applicants report the required hypertension information annually. Third-class applicants report it with each required exam.
Can Other Medical Conditions Affect FAA Certification With Hypertension?
Yes. The FAA also looks at conditions that could affect your heart health or raise other certification questions.
Hypertension With Diabetes or Obstructive Sleep Apnea
Have hypertension plus diabetes or sleep apnea? You may need to document both.
The FAA may ask whether one condition is affecting your blood pressure and whether its treatment is stable.
An Air Traffic Controller Medical Exam is a separate process. FAA-employed controllers have their own medical clearance rules, and certain contract tower operators need at least a second-class airman medical certificate.
Hypertension With Kidney or Heart Complications
Long-term uncontrolled hypertension can affect organs beyond the heart and blood vessels. The FAA may ask for more information about:
- Kidney disease or renal insufficiency.
- Eye disease.
- Heart failure.
- A previous heart attack.
- Stroke or other cerebrovascular complications.
The outcome depends on how serious the complication is, how it’s being treated, and where your health stands now.
What Happens If the FAA Defers Your Medical Certificate for Hypertension?
A deferral means the AME can’t issue the certificate during the exam. They have to send the information to the FAA for review. It isn’t an automatic denial.
The FAA may ask for a current physician report covering your diagnosis, treatment plan, prognosis, how long you’ve been stable, and any related complications.
Looking for a HIMS Aviation Medical Examiner Florida? Keep in mind that routine hypertension under CACI doesn’t automatically require a HIMS evaluation. HIMS comes into play when the FAA requires specialized oversight for a separate qualifying condition.
Special Issuance may be considered under 14 CFR § 67.401 when standard certification requirements can’t be met.
How Can Pilots Maintain Medical Certification After Receiving Special Issuance?
Special Issuance comes with ongoing responsibilities. Follow the conditions in your FAA authorization letter and send whatever medical updates it asks for.
That may include:
- Regular blood pressure monitoring.
- Updated physician reports.
- Current medication and dosage information.
- Documentation of side effects or treatment changes.
- Additional testing when requested.
Booking with an FAA 2nd Class Medical Examiner? You still need to follow the monitoring conditions attached to your Special Issuance.
An evaluation by the FAA will be necessary if your blood pressure is not within acceptable levels, or if you develop another complication.
What Steps Should Pilots Take Prior to the Next FAA Pilot Medical Exam?
Good preparation will eliminate unnecessary problems, in particular when pilots take medication to manage their blood pressure.
How to Prepare 30 Days Before Your FAA Pilot Medical Exam
Firstly, read What Pilots Should Know Before Applying for an FAA Aviation Medical Certificate.
Prior to the appointment, pilots need to do the following:
- Take notes of their recent blood pressure results.
- Check their list of medications and doses.
- Get the required clinical progress note.
- Confirm how long your current treatment has been stable.
- Ask your AME whether they need any additional medical records.
Booking with an FAA 3rd Class Medical Examiner? Come along with your medical and medication details, regardless of how good they may seem!
Conclusion: Know Your FAA Certification Options
A hypertension diagnosis doesn’t automatically end a pilot’s flying career. Depending on your blood pressure control, treatment, and history, you may qualify through routine issuance, CACI, or Special Issuance.
Knowing which hypertension medications the FAA accepts can help you prepare for your exam. If you’re going for an FAA Student Pilot Medical Exam, review the medical requirements before your first solo flight.
Aviation Medicine, led by Dr. Weinberg can assist pilots to understand the requirements of the FAA medical certification process.
Having problems with your FAA medical certification? Contact Dr. Weinberg at MedAvex for guidance on hypertension and FAA medical requirements. Reach out at aweinberg@medavex.org or call (727) 648-2402 to set up a consultation.