Hypertension

Question 1

Define stage one hypertension.

Answer 1

140-159/90-99
usually asymptomatic
low risk for hypertension -related incapacitation
encourage driver to follow up with primary care doctor for therapy and education

Question 2

What criteria must be met in order to give one year certification to a driver who has stage one hypertension?

Answer 2

All the following criteria have to be met:
-this is the first exam in which driver is> found to have hypertension
-driver has no prior history of hypertension
-driver is not using any medication to control blood pressure

If all three of these criteria are met, may certify for one year.

Question 3

Under what conditions can you give a one time three-month certification to a driver with stage one hypertension?

Answer 3

There are two situations when this can happen.
Case one:
-driver was previously issued a one year certification for untreated stage one hypertension and blood pressure is > 140/90
-driver has no prescription for antihypertensive to control blood pressure, and blood pressure is > 140/90

Case 2:
-driver has a diagnosis of hypertension, is being treated with medication, and blood pressure remains > 140/90
-patient tolerates the blood pressure medication without side effects that could interfere with driving

In both of these cases you can give the one time three-month certification. During this three-month certification period, driver must seek to lower the blood pressure to less than 140/90. However, failure to decrease blood pressure to less than or equal to 140/90 will disqualify the driver from future certification after the three-month certification period expires.

Question 4

Name two situations when a patient whose current blood pressure reading is that of stage one hypertension, but the patient is not eligible for certification.

Answer 4

-Patient has already had a one time, three-month certificate but blood pressure remains greater than 140/90
-patient has a history of prior stage III hypertension, and current blood pressure is greater than 140/90

Question 5

At what blood pressure is the patient ineligible for certification, regardless of meeting all other qualifications?

Answer 5

Blood pressure greater than or equal to 180/110

Question 6

When can a driver who has been disqualified with stage one hypertension become recertified?

Answer 6

They can be recertified for up to one year once blood pressure is less than 140/90.

Question 7

How often must a driver with hypertension be re-examined?

Answer 7

Driver must have at least an annual exam

Question 8

What blood pressure range is defined as stage II hypertension?

Answer 8

160-179/100-110
-this is an absolute indication for antihypertensive drug therapy; driver should be directed to consult with primary care physician for treatment and education

Question 9

Under what circumstances can a patient with stage II hypertension receive a three-month certification?

Answer 9

There are two cases where this can happen.
Case one:
-driver has no history of hypertension
-driver is not on medications to control blood pressure

Case two:
-driver has diagnosis of hypertension and is being treated with medication
-driver is on blood pressure medication and tolerates them without side effects that could interfere with driving

Question 10

Under what circumstances is a driver who has stage II hypertension during the current examination ineligible for certification?

Answer 10

-Patient has an expired one time, three-month certificate for stage II, but their current blood pressure is still equal to or greater than 140/90
-patient has a prior history of stage II hypertension, with current blood pressure reading in the range of stage II hypertension

Question 11

If you issue the driver a one time, three-month certificate for stage II hypertension, what is the driver expected to do at that time?

Answer 11

-See primary care physician to be placed on blood pressure medication
-must follow up the medical examiner before the end of the three months
-once driver blood pressure is less than 140/90 and the treatment is being well-tolerated, driver can be certified for one year from the date of the follow-up medical exam
-inability to lower the blood pressure below 140/90 by the end of the three-month certification period will lead to disqualification

Question 12

What’s the maximum number of three-month certifications that can be issued due to blood pressure over the course of a drivers career?

Answer 12

-no maximum number

-driver can have more than one three-month certifications over the course of their career. However, if the driver fails to lower the blood pressure by the expiration date of a given three-month certificate, they are disqualified from driving until their blood pressure is less than 140/90 at a follow-up exam and their tolerating effects of their blood pressure medication

Question 13

How might the presence of comorbidities affect your decision to withhold certification if bp is in the range of stage one or worse hypertension but treatment is well-tolerated?

Answer 13

-Patient might be taking maximum doses of multiple antihypertensive medications but unable to achieve blood pressure of less than or equal to 140/90
-patient may require a more aggressive treatment plan, and will need to be monitored for effectiveness, interactions, and tolerance before you can certify driver
-driver whose three-month certification has expired cannot get recertified until they are able to get the blood pressure under 140/90

Question 14

What blood pressure range constitutes stage III hypertension? Are there any circumstances under which somebody was stage III hypertension can be certified?

Answer 14

Blood pressure greater than or equal to 180/110
-personal blood pressure in this range can never be certified, because driver is at high risk for an acute hypertensive event that can impair judgment and safe driving, including stroke, loss of consciousness, aortic dissection, aneurysm rupture, subarachnoid hemorrhage

Question 15

Under what circumstances can a driver who was disqualified due to stage 3 hypertension become recertified?

Answer 15

-Driver gets on a treatment regimen which keeps their blood pressure less than or equal to 140/90
-treatment regimen is well-tolerated
-can be recertified for a maximum six months
-must receive a medical exam every three months
-at each six-month interval, if blood pressure is found to be in the range of stage one or stage II hypertension, determined on a case-by-case basis whether or not it would be appropriate to give the patient a one time, three-month certification

Question 16

What criteria must be met in order to give one year certification to a driver who has stage one hypertension?

Answer 16

All the following criteria have to be met:
-this is the first exam in which driver is> found to have hypertension
-driver has no prior history of hypertension
-driver is not using any medication to control blood pressure

If all three of these criteria are met, may certify for one year.

Question 17

Under what circumstances can a driver who has hypertension be certified for one year?

Answer 17

Case one: driver has no prior history of hypertension and is found have stage one hypertension. This is the first exam in which the driver is found to have hypertension. Driver is not on any blood pressure medication. All three of these criteria have to be met.

Case two: driver is being treated for hypertension and blood pressure is under 140/90.

Question 18

Under what circumstances can a driver who has hypertension be given a one time three-month certification?

Answer 18

Case one: driver is being treated for hypertension, but blood pressure is in the stage one or stage II range.
Case two: driver has no history of hypertension, but is found to be in the stage II range.

In both cases, after they get certification for three months, they must work with their primary care physician to bring their pressure down. It must be below 140/90 by the end of that three-month period, or they become disqualified.

Question 19

A driver comes in for a recertification physical and his blood pressure reading is 130/80. Previously, he had a blood pressure reading of 142/92. He is not taking medication for hypertension. For how long can he be certified?

Answer 19

2 years

By DOT guidelines, this person has prehypertension; they aren’t taking bp meds, so they can have a 2 yr certification.

Question 20

What does the DOT define as normotensive?

Answer 20

< 130/80
max certification: Two years
max recertification: two years

Question 21

What does the DOT define as prehypertensive?

Answer 21

130-139/80-89

max certification: two years
max recertification: two years

Question 22

What does the DOT define as stage 1 HTN?

Answer 22

140-159/90-99

max certification: 1 year

max recertification:
One year certification if blood pressure is in the range of stage one hypertension, but this is the first exam in which driver is found to have hypertension,AND driver has no prior history of hypertension, AND driver is not using any medication to control blood pressure

-a one time certification for three months if blood pressure is in the range of 140-150/90-99, if patient was already holding a one-year certification with known stage one HTN

Question 23

What does the DOT define as stage 2 HTN?

Answer 23

160-179/100-109

max certification: One-time certificate for three months

max recertification:
-one year from date of the exam at the end of the three-month certification if blood pressure is less than or equal to 140/90

-inability to lower the blood pressure below 140/90 by the end of the three-month certification period will lead to disqualification

Question 24

What does the DOT define as stage 3 HTN?

Answer 24

Greater than or equal to 180/110

max certification: Disqualified; send to primary care physician for treatment

max recertification:
-Once driver gets on a blood pressure regiment that keeps blood pressure less than or equal to 140/90 and is tolerating blood pressure medication without concerning side effects, they can be recertified for six months from date of exam where they are found to be meeting these requirements
-can be recertified every six months as long as blood pressure remains less than or equal to 140/90