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Medical Stuff: The AME’s
Definition of Hypertension
By Donato Borillo, MD,
JD
Reprinted with permission from FAA Aviation News
This article originally
appeared in the Federal Air Surgeon’s Medical Bulletin
High blood
pressure is a risk factor or a cause of more than 210,000 deaths in
the U.S. each year and is often called the silent killer.
There is a saying among aviators,
“Being legal does not mean you’re safe or proficient.” The same axiom
holds true regarding high blood pressure, since recent changes in this
disease’s definition seemingly conflict with FAA regulations.
Aviation medical examiners (AMEs)
understand the measurement of blood pressure as an essential part of
the FAA medical certification examination. A pilot is disqualified for
all classes if she, or he, has a sitting systolic blood pressure above
155 mm mercury at the time of the exam.
However, on May 14, 2003, the National
Heart, Lung, and Blood Institute (NHLBI), a division of the Department
of Health and Human Services and National Institutes of Health, issued
new blood pressure standards. [Note: The Seventh Report of the Joint
National Committee on Prevention, Detection, Evaluation, and Treatment
of High Blood Pressure (JNC 7).]
As defined by the NHLBI, a blood
pressure of 120/80 mmHG (or higher) is now considered
pre-hypertension; a precursor condition to hypertension, which serves
as a warning signal that risk is increased for high blood pressure.
The new report also changes the former blood pressure definitions.
The new guidelines also recommend a
change in medication use. [Note: Simplified and strengthened drug
treatment recommendations. The guidelines recommend use of a diuretic,
either alone or in combination with another drug class, as part of the
treatment plan in most patients. The report notes that even though
many studies have found diuretics to be effective in preventing
hypertension’s cardiovascular complications, they are currently not
being sufficiently used. The guidelines also list other drug classes
that have been shown to be effective in reducing hypertension’s
cardiovascular complications and that may be considered to begin
therapy; angiotensin converting enzyme (ACE) inhibitors angiotensin
receptor blockers, beta-blockers, and calcium channel blockers. The
report also gives the “compelling indications”—or high-risk
conditions—for which such drugs are recommended as initial therapy.
Use of additional drugs for severe hypertension or to lower blood
pressure to the desired level. According to the new report, most
persons will need two, and at times three or more, medications to
lower blood pressure to the desired level.]
An aviator could therefore, have
untreated stage 1 hypertension (and possibly stage 2 hypertension) and
still be within the medical standards—to fly.
We know that pilots with a diagnosis
of hypertension or those on medication to control blood pressure must
provide a detailed cardiovascular evaluation for FAA consideration.
So, what’s an AME to do? And, does this “new definition” imply an
increased risk for sudden incapacitation (the underlying factor for
medical disqualifications)?
The simple answer is, no. The AME
should identify the elevated, but legal, blood pressure, inform the
airman applicant of its health impact, and make recommendations for
life style changes and medical follow-up. The AME should refer the
patient back to his, or her, primary care physician and may issue the
certification. If the AME happens to be the primary care provider for
the aviator, a work-up for essential hypertension should be conducted.
If a diagnosis of high blood pressure
is subsequently made, or anti-hypertensive medication is initiated,
these actions effectively suspend the medical certificate, since this
would be consider a significant change in medical condition or
history. Pilots with a diagnosis of hypertension or those on
medication to control blood pressure must provide a detailed
cardiovascular evaluation for FAA consideration.
The consequences of high blood
pressure, if left untreated, should be stressed to the aviator, since
damage to major organs, including the heart, brain, and kidney may
occur. It is a major risk factor in heart failure, heart attack,
stroke, kidney failure, and certain kinds of blindness. High blood
pressure is a risk factor or a cause of more than 210,000 deaths in
the U.S. each year, and is often called the silent killer.
Although it is legal to fly with
pre-hypertensive condition, it may not be healthy in the long run.
Dr. Borillo is the Medical Director
of Occupational and Hyperbaric Medicine, The Toledo Hospital,
ProMedica Health System. He is also a senior aviation medical
examiner, an attorney, and a pilot with a Commercial rating. |
