High Blood Pressure a Daily Issue for Drivers and Medical Examiners
New Criteria May Change Blood Pressure Requirements For CDL Medical Cards if Adopted By FMCSA
Hypertension continues to be a driver roadblock to obtaining a two year medical card. One of the issues is whether the newer (and more strict) hypertension guideline issued by the American College of Cardiology and American Heart Association (ACC/AHA) have been, or will be adopted by the FMCSA Medical Division. The current FMCSA Advisory Criteria for high blood pressure is based in part on the previous published value of 140/90 mm/Hg. These values represented the point when cardiovascular disease begins to occur. These are the values that are contained in the FMCSA Advisory Criteria and represents the blood pressure values that triggers a medical card being issued for less than 2 years.
Current Values for Cardiovascular Disease are 140/90, But That Could Change in the Future
The recent ACC/AHA values lowered the value when cardiovascular disease begins from 140/90 to 130/80. If these new values were adopted by FMCSA, it would mean that drivers with blood pressure values beginning at 130/80 could receive a medical examiner’s certificate for less than two years. Obviously, this would be a more stringent requirement. But, lets not jump to any conclusions yet.
The high blood pressure values that are contained in the FMCSA Advisory Criteria have not changed. The Advisory Criteria is “codified”. This means that the rule making process would need to be used to change the content of the Advisory Criteria. This gives the public ample opportunity for input and for the new values to be challenged. This process typically requires a year or more to complete. But, lets still not get too excited.
FMCSA’s own administrative regulations require them to review and if needed update components of the Advisory Criteria. At the very least, the stages of hypertension values must be updated to reflect the ACC/AHA changes. However, completely separate from the issue of Stages and their assigned values, FMCSA may change the values that MEs use to determine driving status and medical certificate duration or leave them the same as they are currently. From the discussion at the recent FMCSA Medical Review Board meeting, an expectation that the hypertension guidance will be more restrictive would not be supported, in fact, the discussion leaned more toward less restrictive guidance. However the next MRB meeting’s discussion may differ and once a MRB recommendation is made, the FMCSA makes the final decision.
To begin the process, the MRB will be tasked to recommend changes which will then be reviewed by FMCSA. Then the rulemaking process will begin. The rulemaking process usually takes a year to complete. Given the conflicting concerns of safety organizations versus driver associations, this rulemaking process will likely be longer than most.
Medical Examiners Discretion Determines the Impact of Hypertension On CDL Medical Cards
For now, the hypertension advisory criteria for commercial drivers has not changed and MEs continue to have discretion if they have a valid medical reason for doing so. That would include the ability to return a driver to receiving a 2 year medical certificate even if they have a history of high blood pressure. To do that, most MEs would likely require the driver to be removed from medication by their treating physician, to maintain current blood pressure values less than 140/90 and then the ME would consider the age of the driver.
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Michael Megehee, DC, NRCME, President
TeamCME National Network of Certified Medical Examiners