New blood pressure guidelines in effect Sept. 30 for truckers

| Tuesday, August 10, 2004

Truckers with high blood pressure could lose their certification under new guidelines that will appear on medical forms starting Sept. 30.

A DOT official previously told Land Line that the new blood pressure levels were regulations. However, in an e-mail sent to the magazine recently, that official said that the new levels are guidelines, not regulations.

Although they do not have the full force of regulation, the guidelines are contained on the Federal Motor Carrier Safety Administration’s official examination form that will be used to medically certify all drivers.

Physicians do have some latitude regarding drivers and blood pressure, FMCSA officials said. The panel that developed the guidelines does acknowledge “blood pressure's physiologic variations and measurement errors.”

However, the FMCSA indicated that if doctors do not use the new guidelines, they must document that they used a medically accepted standard to show that the driver’s blood pressure reading does not constitute a “current clinical diagnosis of high blood pressure.”

“The guidelines are to help the medical examiner make that determination,” Bill MacLeod, director of communications at the FMCSA, said in a written statement. “We strongly encourage medical examiners to use them. They were developed, published and distributed for that purpose.

“If medical examiners choose not to use the guidelines, it is reasonable to expect them to document some other best practice guidance or data to support their decision.”

Here’s how the new guidelines stack up:

  • Truckers with a blood pressure less than 140/90 can be medically certified.
  • Truckers whose blood pressure runs between 140/90 and 159/99 – called Stage 1 – can get a one-year certification, but they must have a DOT certification exam each year thereafter, and should have a blood pressure of less than 140/90. If their blood pressure is more than 140/90 but less than 160/100, their certification may be extended one time for three months.
  • Truckers with blood pressure readings between 160/100 and 179/109 – defined as Stage 2 – will be certified for only three months, and must seek help from their doctors to lower the reading. If drivers seek treatment and bring their blood pressure reading back below 140/90, they can get a one-year certification, but again must be re-certified every year thereafter.
  • Truck drivers whose blood pressure is above 180/110 will be medically disqualified. At that level, called Stage 3, drivers must seek treatment and bring their blood pressure down to 140/90 or less to receive a six-month certification, but then must seek re-certification every six months.

The new guidelines, which were spelled out in a report by the FMCSA’s Cardiovascular Medical Advisory Panel, were adopted in October 2002. The final rule that placed them on the medical examination form was not published until Sept. 30, 2003. Doctors can still use the old forms – which are still posted on the agency’s Web site – until Sept. 30, 2004.

After that date, the agency will require use of the new forms.

The actual regulations are unchanged. That rule allows a driver to be certified if “the driver has no current clinical diagnosis of high blood pressure likely to interfere with his/her ability to operate a motor vehicle safely.”

However, according to Donna Ryun with OOIDA’s Communications Department, even before the new guidelines were published, the agency’s blood pressure rule was backed up by a specific set of guidelines.

The previous guidelines, which were contained in a listing of Medical Advisory Criteria in an addendum to the regulations, said any driver with blood pressure of 160/90 or less would be certified.

Those with blood pressure between 160/90 and 180/104 were given a three-month certification and were required to be certified annually. Those above 180/104 were not certified – not even temporarily – until they lowered their blood pressure to that level or less.

FMCSA officials said the new guidelines were based on the most recent blood pressure guidelines produced by the Joint National Committee on Prevention, Detection, Evaluation and Treatment of High Blood Pressure.

MacLeod said those figures “are recommended by the accepted leaders in cardiovascular disease, including the National Institutes of Health, the American Heart Association and the American College of Cardiology.

“The term guidelines obviously represents the best meeting of the minds of the experts, but with the recognition that there may be other solutions,” he said.

According to the American Heart Association, a blood pressure of less than 120/80 is considered normal for adults. Any reading that is above 140/90 is considered high.

The heart association literature says that even a blood pressure reading between 120/80 and 139/89 is considered “prehypertension.” The heart association recommends that people who have a reading in that range should make changes in their lifestyle to bring the reading down.

--by Mark H. Reddig, associate editor

Mark Reddig can be reached at mark_reddig@landlinemag.com.