Ask the AME

JOHN PATTERSON, M.D.

Hypertension

RC writes, “A friend has been diagnosed with hypertension and wants to know what medications are approved and what do they need to tell their aviation medical examiner (AME).”

This is probably the most common scenario that the AME faces since hypertension and obesity are epidemic in our nation.

Hypertension is defined by the FAA as any blood pressure reading above 155 mm mercury systolic and 95 mm diastolic. The systolic phase is the compression stroke of the heart, and the diastolic is the relaxation phase of the ventricle of the heart. Most physicians consider hypertension to be any reading above 140/90, so the FAA is lenient in this regard. It is easier to list medications that are not allowed for hypertension. Older meds such as reserpine, guanethidine, guanadrel, guanabenz, and methyldopa are not approved because they have eff ects on the brain (centrally acting). They have effects that limit the pilot’s reaction time and reasoning ability in addition to lowering blood pressure. For this reason they are not used much anymore, though I will occasionally see a patient that is on them. Suffi ce it to say that all other Food and Drug Administration (FDA) approved medications for the treatment of hypertension are FAA acceptable. Th ough not specifi cally stated, the FAA generally recognizes a two-week adjustment period while on a new blood pressure medication for the fi rst time to rule out adverse side eff ects. If none are encountered, the pilot can report the medication on the next certifi cation visit.

If this is the first time on a blood pressure medication, then several things need to be reviewed by the AME at the next medical and then sent to the FAA. A statement should be obtained from the treating physician describing any side effects or lack thereof, family history, risk factors, and representative blood pressure readings (usually three). In addition to a resting EKG, lab tests including sodium, potassium, chloride (or electrolytes), cholesterol, triglycerides (lipid profile), and glucose should be obtained. If all are within normal limits, the AME can issue the medical certificate without restriction. Subsequent visits should include a treating physician statement as to the stability of treatment. Blood work including a potassium level is required only if on a diuretic or fluid pill.

Specifi c medical certifi cation information can be obtained through the Internet at www.FAA. gov (licenses and certifi cates) and then to medical certifi cates. AOPA members have access to a medication database at www.AOPA.org/members/pic/ medical. EAA has available resources and answers to medical certifi cation issues at 1-800-564-6322.

Or e-mail me for further questions and new topics, John Patterson, M.D., at patjo@dcr.net.