High blood pressure, or hypertension as it is sometimes called, is one of the most common reasons for denial or temporary suspension of the pilot’s medical certificate.
Fortunately, it rarely leads to the permanent loss of the medical and therefore, there is little to fear from it from the medical certificate point of view.
What is High Blood Pressure?
High blood pressure is when blood is flowing at a higher than normal pressure inside blood vessels; in the sort of way when water pumped from a tap flows at very high pressure through a hose pipe, putting strain on the tap.
In the case of the human body, the pump is the heart and high blood pressure puts strain on the heart.
The acceptable blood pressure (BP) for an EASA medical certificate is 140/90mmHg or lower, when measured at the medical.
Blood pressure reading will have two figures, one 'over' the other. The higher figure (called the systolic BP) is a measure of the pressure inside the arteries when the heart is pumping blood out. The lower figure (called the diastolic BP) is a measure of the pressure inside the arteries when the heart is resting between beats. Blood pressure is measured in millimetres of mercury (mm Hg).
What causes High Blood Pressure?
9 out of 10 people with high blood pressure have no identifiable cause.
Very occasionally, kidney disease or some vary rare conditions may cause high blood pressure.
What are the Symptoms of High Blood Pressure?
The majority of people with high blood pressure do not know they have it, until it causes a complication such as stroke or a heart attack.
Occasionally, if it is very high, it can cause headaches, dizziness or blurring of vision.
How is High Blood Pressure Diagnosed?
Blood pressure varies throughout the day. It may be high for a short time if you are anxious, stressed, or have just been exercising.
Therefore a one-off blood pressure reading that is high does not mean that you have high blood pressure.
In practice, with a high BP reading, the AME would repeat the measurement up to 3 times and would suspect high blood pressure if the lowest reading was above the 140/90 maximum permitted.
In many cases, the more the AME or GP repeats the BP, the higher the readings become, usually as the pilot becomes more anxious. This is particularly true for those who have “White Coat Hypertension” i.e. their blood pressure is always high in the presence of healthcare practitioners.
Daytime blood pressure averages are typically higher than night time ones
Unless a single BP level is extremely high, a doctor will not make a diagnosis of high blood pressure without an average of several readings. These readings are usually obtained from a blood pressure monitor which the pilot is required to wear for 24 hours. This is known as Ambulatory Blood Pressure Monitoring (ABPM).
If ABPM is neither available nor possible, a standard BP monitor provided by the GP for the pilot to measure and record their own blood pressure at least twice a day for 7 days is an acceptable alternative.
How a typical 24hr BP monitor is worn. Some are more discreet.
“Hypertension should be diagnosed using a blood pressure monitor worn for 24 hours.
One-off blood high blood pressure readings should not be used for diagnosis”
High blood pressure is confirmed if the average of several readings is greater than 135/85mmHg. NB: note the lower threshold for average readings.
Why is High Blood Pressure a Problem?
High blood pressure is a risk factor for developing serious health problems sometime in the future.
In general, the higher your blood pressure, the greater the health risk.
High blood pressure is also common in people with Diabetes and those with high Cholesterol.
Potential complications of high blood pressure
What is the Treatment?
If you are diagnosed as having high blood pressure (hypertension), then you are likely to be examined by your doctor and have some routine tests which include:
A urine test to check for signs of kidney damage
A blood test to check that your kidneys are working normally, and to check your Cholesterol and sugar (Glucose) level.
An ECG (electrocardiogram) or trace of the heart to see if the heart might be affected.
Depending on the findings, your doctor may advise lifestyle changes only such as losing weight (if you are overweight); reducing the salt in your diet; and taking regular exercise.
In other cases, your doctor may advise medication.
Will I Lose My Medical?
If you are diagnosed with high blood pressure, you will temporarily lose your medical certificate.
This is to allow you to be assessed by your GP or hospital specialist to ensure you are not suffering from complications of high blood pressure.
At the revalidation or renewal medical, if your BP exceeds 160 systolic and/or 95 diastolic (i.e. 160/95), your AME will not issue a certificate.
How Do I Regain My Medical?
To be able to reinstate your medical, your AME will require a medical report confirming that your blood pressure is stable and well controlled, on acceptable treatment (if medication is required) and that you have no treatment-related side effects.
The medical report should also contain evidence that you have had tests to look for complications of high blood pressure, and that you are not suffering from any.
Your AME may need to refer your case to the CAA if you hold a class 1.
For class 1 certificate holders, the report must come from a cardiologist and for class 2 (and LAPL) certificate holders, a report from the GP is sufficient.
The length of time you are grounded for typically depends on how quickly a medical assessment and satisfactory report can be arranged. NB: If you require medication, a minimum of 2 weeks must have elapsed since starting medication before consideration can be given to reinstating your medical
In conclusion…
There is little to fear from the impact of high blood pressure on your fitness to fly. Any grounding is usually short-lived whilst ‘things’ are fixed.
There is much more to fear from the potential consequences of undiagnosed and untreated high blood pressure. Some people only discover they have high blood pressure if they are lucky enough to survive a heart attack or a stroke.
In that sense, pilots are in a very lucky position because they are unlikely to have undiagnosed high blood pressure given they examined often enough.