Physical Qualification Standards and Advisory Criteria - Hypertension

Question 1

____ and ____ are the mainstays of antihypertensive treatment regimens.

Answer 1

Lifestyle modification

Pharmacotherapy

Question 2

An individual diagnosed with Stage 1 HTN (BP is _____) may be certified for _____

Answer 2

BP 140/90 - 159/99

One year

Question 3

At recertification, an individual with stage 1 HTN with a BP =/<140/90 may be certified for _____.

Answer 3

One year

Question 4

At recertification, an individual with stage 1 HTN whose BP is > 140/90 but <160/100 may…

Answer 4

Be issued a one-time certificate for 3 months

Question 5

An individual diagnosed with Stage 2 HTN (BP is ______) should be…

Answer 5

BP 160/100 - 179/109

Treated and a one-time certificate for 3-month certification can be issued.

Once driver has reduced his/her BP to =/< 140/90, he/she may be recertified annually thereafter.

Question 6

An individual diagnosed with Stage 3 HTN (BP ____) should….

Answer 6

BP >/= 180/110

Should not be certified until his/her BP is reduced to 140/90 or less

May be recertified q6mo thereafter

Question 7

During history taking, a current diagnosis of HTN exists when…

Answer 7

One or more antihypertensive agents are used to control high BP.

When antihypertensive medication is being used to treat an underlying condition other than high BP, certification is based on the underlying condition and tolerance to the medication.

Question 8

If initial BP reading is > 139/89, you should…

Answer 8

Confirm BP with a second measurement taken later during the examination

Also check pulse rate, strength, and rhythm

Question 9

Factors that can cause fluctuations in BP (esp systolic)

Answer 9

Circadian cycle

Emotional and physical states

Transient HTN (“white coat syndrome)

Use of left vs right arm during measurement

Problems with technique

Question 10

When discussing BP, you must document discussion with the driver about…

Answer 10

Any affirmative history (ie onset date, diagnosis, meds, any current limitations)

Potential neg effects of meds used while driving (incl OTC meds)

Any abnormal findings

Any additional tests and evaluation

Question 11

The purpose of the one-time, 3 month certificate is …

Answer 11

To allow the driver with high BP that is an absolute indication for antihypertensive drug therapy to continue to drive while taking steps to lower the elevated BP

Question 12

Is there a waiting period before certification for drivers with Stage 1 HTN?

Answer 12

No recommended time frame.

Question 13

Maximum certification period for drivers with Stage 1 HTN

Answer 13

1 year (if no history of HTN and not using antihypertensive meds)
OR
One-time for 3 months (if previous 1 year certificate for untreated HTN with no prescribed meds)

Question 14

What does “one-time” mean?

Answer 14

You cannot issue consecutive 3-month certifiates for BP greater than 140/90. It does not mean once in a lifetime.

Question 15

The driver with elevated BP or hypertension should have at least _____ medical examinations.

Answer 15

Annual

Question 16

What stage of HTN is considered an absolute indication for antihypertensive drug therapy

Answer 16

Stage 2 (BP 160/100 - 179/109)

Question 17

Maximum certification period for Stage 2 HTN

Answer 17

One time for 3 months

To qualify at f/u, BP should be at or less than 140/90

Question 18

If a driver with stage 2 HTN qualifies at 3 mo follow up…

Answer 18

A one year certificate will be issued from the date of the initial examination (not the expiration date of the one-time 3-mo certificate)

Question 19

Recommend not to certify driver with Stage 2 HTN who …

Answer 19

At 3mo f/u BP is still >140/90

A history of stage 3 HTN and BP >140/90

BP >180/110 regardless of any other considerations

Question 20

What is the maximum certification period for a driver with a history of Stage 3 HTN?

Answer 20

6 months

MUST have lowered BP to <140/90 and treatment that is well tolerated

Question 21

Waiting period for Secondary HTN?

Answer 21

3 months post-surgical correction

Question 22

Once waiting period for secondary htn is satisfied, what is the maximum certification period?

Answer 22

1 year post-surgical correction provided BP is <140/90

Recertify annually