FAR's & blood pressure

[zero.one.victor]

After discussing high blood pressure problems (with regards to medical certificates) with some fellow pilots the other day, I looked it up in my (1995) FAR book.
In Part 67, under Class 1 medicals,there was a listing of age groups & blood pressure limits. But nothing under class 2 or 3. I have a class 3-- is there no specific blood-pressure redline applicable?
I know a lot of pilots who worry about their high blood pressure knocking them out of flying. Is that in fact not really a problem?

Eric

[FredM]

Their worrying is why they have high blood pressure.

[n4517c]

When I went on blood pressure medication my Medical Examiner showed me in his handbook the blood pressure limits for all classes. As I remember for second class it was 155/95. He said from his experience, that many pilots who depend on their medical for a living have a hard time with those limits during the physical. However, since he is a small town doc and regularly treats the same people as a personal physician, he sees lower numbers at other times. He had me begin to monitor my pressure several times a day on an automatic machine at work and at home. Many times, in those settings, my numbers were marginally low instead of the opposite. The standard reading assumes 15 minutes of rest before the test. The ME went on to say that he feels many pilots are needlessly medicated because of the tension during the exam. So why did I decide to go on medication. At the time I was working as floatplane pilot flying in challenging situations, and I reasoned that the inherent tension of that job probably elevated my pressure, at times, just as much as the doctor. One very important thing to realize is that if you choose an FAA approved medication the paperwork is a non event. Also, once you are on medication there are no BP limits. You simply need a statement from your personal physician that your BP is being treated and is under control. If you begin treatment before your medical runs out and have the statement from your doctor in advance only a ECG is required on exam day, as I remember. AOPA has a complete guide for this process.

[170C]

Many years ago I began taking BP medication. Mine was not really high, but my Dr. felt I needed to take the medication to lower it. I made (in my opinion) a mistake by putting this on my medical data for my 3rd class medical and also I take Lipitor for cholesterol. Once OKC has this information you are from then on a marked person! Every two yrs they require blood work, statements from your Dr. and in some cases require an EKG. If your not on a PPO or other medical plan this can run into mucho $$$. They will always require this as long as you are taking the medication. I know its "the law" that you must provide all the medical data, but so many times I have wished I would have kept my mouth shut and gone on. Without that hanging over my head I could go to my AME, gotten his exam and all would have been OK (if not legal). There are some good reasons not to take mediction and fly, but any medication causes the FAA to go into orbit! No one ever considers the millions on the road daily passing within 20 feet of another oncoming vehicle at a closure rate of 100 to 150 mph and no problem if the drivers are taking multiple medications. Something isn't right with this picture.

IMHO!

[mrpibb]

While were on the subject let me tell you my story. Two years ago when I applied for my third class i decided to go to a local AME, my first impression was to leave when they slide the k-mart scale out from under the desk, but i figured I was there and stayed.. BIG mistake!!!! He takes my blood pressure and says that I am 180/110 now I know I am a little high but not that high, I argue that some thing is not right and he say yea you got problems you need to see a doctor " who am I talking to?". Now not to brag but I got big arms, and I know that you need to use the right cuff for takeing blood pressure, I mention that and this so called doctor said " no, your sick, you need help" . and to top it off he said my kiddneys are shot as per the urine sample!!!. So he failed the medical, I knew that they can hold the results for one month from the faa so you can retest, he said "no I'm sending the results in". So I was at a loss, here I was thinking that I was 40 and dead, I called the aopa and was told go to another AME and see what happens, I asked about the failed medical and was told well you can't do anything about it now, try to pass and if you do worry about it then, at least you will have a AME that will help with the FAA. Well on my own I went to my doctor ( remember I was told I was dying ) and got a check out, well my bp was 135/87 but to be on the safe side cause I wanted a letter from my doctor to sent to the faa incase they wanted proof, I was put on a BP monitor for 2 days. and at the end of 2 day they connected the unit to a computer and got pages of info like pulse rates, pressures and the such taken every hour. With this info I scheduled a exam with a recomended AME, told him what was going on, he gave me a complete exam and said that I qualify for a first class Medical. So he gave me my third class, Ahh now the FAA, I started geting letters wanting to know why after I failed that I went somewhere else, who did what when and were. then they pulled my cert for a week then reinstateded it to pull it again untill they got more info, now Im on a " conditional grant" I can exercise the privilage but they can pull it at any time. The second AME was great he started a investigation with the Faa on the first AME and got my situation rectified because a few months back I got a letter from the Faa tha they pulled the first AME's certification.
Now it's that time of they year for my medical, be interesting to see what happens.

[170C]

I wish you good luck on your upcoming medical. It can be a challenge sometimes when you accidently find a Quack like the one you did. I bet you pass OK this go round. I just had my regular physical this am so my Dr. can forward the data to my AME who I see in the morning. Based on my regular Dr.'s comments, I should have no problem, but of course I haven't seen the results of the blood work & EKG.

Keep Em Flying!

[GAHorn]

And, ...just for balance....there's the case of my friend who flew for United, and got off the plane one day with a stomach ache.
By the time he got home he felt fine, but since his medical was soon due he went to his regular AME (A GOOD GUY, named Bud Dryden who is also a pilot) who issued him a fine First Class physical.
Two days later John's stomach ache was back and he went to his regular doctor. Short version of this story is that John was dead in 4 months from cancer. He was 37.
Moral: Don't assume a freshly passed FAA physical is a "bill of good health' cause it aint. It only checks the bare necessitites and if you really want to know about your personal health you should get a full work-up from a family doctor you trust.

[russfarris]

In over thirty years of flying I have noticed that AMEs and A&Ps fall roughly in to two very different camps; I'm being somewhat general here.

The first group seems to feel that they have done their job by grounding you or your airplane. In 1979, I took a first class physical with a jerk in Miami, who made me feel like he was doing me a favor passing me at 25 years old. Somehow I've made it to 49, flying for a major airline for many years now.

When I owned my Stinson 108, an IA refused to sign off an annual, because I had an auto-gas STC. Never mind the legality, he just didn't like the idea of burning car gas.

The second group are people who genuinely want to keep you in the air, AND safe. My AME of the last 17 years just retired (at 84!!!) and sold his practice to a 40ish doctor/pilot, who carries on Dr. Long's tradition of working with the pilot group. My IA, a true pro that has built two RV-6s, also has the knowledge and judgement to keep 'em flying and safe.

Just a personal observation...Russ Farris

[zero.one.victor]

Nobody's came up with an answer to my question, which is whether there is an official specific blood-pressure limit for 2nd & 3rd class medicals. Like I said, all my (old) FAR-AIM shows is a list of max BP's for different age groups for a 1st class medical,BP doesn't seem to be addressed in the sections on 2nd & 3rd class.
I seem to recall my AME telling me there was a limit, but it mighta been a case like Russ's IA not liking cargas use.
Maybe one of you more up-to-date guys or CFI's out there have a current FAR-AIM that you could check?

Eric

[JJH55]

From AOPA's web page:

Medical Certification Standards as of September 16, 1996
Medical Certificate Class I Class II Class III
Type Pilot Airline Transport Commercial Private
Duration 6 months 1 year 2 years; 3 years if less than 40 at exam
Distant Vision 20/20 in each eye, with or without correction 20/40 in each eye w/wo correction
Intermediate Vision
32 inches - panel 50 years and older 20/40 w/wo lenses 50 years and older 20/40 w/wo lenses N/A
Near Vision 16 inches 20/40 in each eye, with or without corrective lenses
Color Vision Colors necessary for safe performance of airman duties
Hearing Conversational voice at 6 feet with both ears, or audiometry
Blood Pressure No standard. If medication required, will need cardiovascular workupEKGElectrocardiogram At age 35, and yearly after 40 N/A N/A
ENT No disease causing vertigo or disturbance of equilibrium
Disqualifying
Conditions Diabetes Mellitus requiring Insulin or oral medication, Angina Pectoris, Coronary Heart Disease, Myocardial Infarction, Cardiac Valve, Pacemaker, Cardiac Transplant, Epilepsy, Substance* Dependence or Abuse, Failed DOT Drug Test, Disturbance of Consciousness or Transient Loss of Nervous System Function without Satisfactory Explanation, Personality Disorder, Psychosis, Bipolar Disorder (Manic-Depressive Psychosis)
*Substances Alcohol; Sedatives and Hypnotics (sleeping pills); Tranquilizers (Valium, Xanax, Librium); Opioids (narcotics); Central nervous system stimulants such as Cocaine, Amphetamines (speed); Hallucinogens (LSD); Phencyclidine (PCP), Cannabis (marihuana); Inhalants (glue); other Psychoactive drugs and chemicals. Not Caffeine and Nicotine
The FAA has issued an extensive revision to FAR Part 67-Medical Standards and Certification, affecting all pilots required to hold a medical certificate. The revision is effective September 16. 1996. Concurrent with the effective date, the FAA is amending FAR Part 61 to extend the duration of a third-class medical certificate to three years for pilots under age 40. For pilots age 40 and older, a third-class medical will remain for two years.
The revised FAR Part 67: • Deletes the uncorrected visual acuity standards for first- and second-class medical certification. However, each eye must be corrected to 20/20 or better as in the current standard.
• Changes the current 20/50 uncorrected, or 20/30 corrected. distant vision visual acuity standard for third-class certification to 20/40 or better, in each eye with or without correction.
• Specifies, for first- and second-class certification, near vision requirements of 20/40 or better. Snellen equivalent, at 16 inches in each eye separately, with or without corrective lenses. For age 50 or older, near vision of 20/40 or better, Snellen equivalent, at both 16 and 32 inches in each eye separately, with or without corrective lenses is required. For third-class medical certification, a visual acuity standard of 20/40 or better. Snellen equivalent, corrected or uncorrected, each eye, is required.
• Changes color vision requirements for all classes to read: "ability to perceive those colors necessary for safe performance of airman duties." Current standards require "normal color vision" for first-class and the ability to distinguish aviation signal colors for second- and third-class applicants.
• Replaces the "whispered voice test. for hearing with a conversational voice test using both ears at six feet: an audiometric word (speech) discrimination test to a score of at least 70 percent obtained in one ear or in a sound field environment: or pure tone audiometry according to a table of acceptable thresholds.
• Defines substance dependence and substance abuse and specifies these as disqualifying medical conditions. Alcohol dependence and alcohol abuse are included in the terms "substance dependence" and "substance abuse.- respectively. As before. a verified positive drug test result conducted under an anti-drug rule or internal program of the U.S. Department of Transportation (DOT) will result in disqualification.
• Adds "cardiac valve replacement," "permanent cardiac pacemaker implementation," and "heart replacement" as specifically disqualifying cardiovascular conditions for all classes.
• Includes "bipolar disorder" as a specifically disqualifying condition; "transient loss of control of nervous system function(s) without satisfactory medical explanation of the cause" is also disqualifying.
• Reduces the time period for which an electrocardiogram may be used to satisfy the requirements of the first-class medical certificate from the current 90 days to 60 days.
• Deletes the current table of age-related maximum blood pressure readings for applicants for first-class medical certificates and the reference to "circulatory efficiency.- Blood pressure will continue to be assessed for all three classes but will be evaluated under the appropriate general medical guidelines. • Provides for special issuance of medical certificates at the discretion of the Federal Air surgeon; i.e:.. "Authorization for Special Issuance of a Medical Certificate. (Authorization) or a "Statement of Demonstrated of Ability. (SODA). Authorizations differ from SODAs in that Authorizations are time limited while SODAs may remain valid indefinitely.

[zero.one.victor]

..........................
• Deletes the current table of age-related maximum blood pressure readings for applicants for first-class medical certificates and the reference to "circulatory efficiency.- Blood pressure will continue to be assessed for all three classes but will be evaluated under the appropriate general medical guidelines. •....................

The way I read this,the AME can arbitrarily decide that your blood pressure is "too high" and refuse to issue a medical certificate. It seems like there should & would be definitive limit(s), like there is with the vision requirements, and like my old FAR's show for a class 1. I guess I'll have to try to remember to check out a current FAR-AIM book for the official wording in part 67,next time I'm at a bookstore or something.

Eric

[JJH55]

The way I read this,the AME can arbitrarily decide that your blood pressure is "too high" and refuse to issue a medical certificate.

Eric

Yep, I concur. Scary aint it?
JJH55

[JJH55]

The way I read this,the AME can arbitrarily decide that your blood pressure is "too high" and refuse to issue a medical certificate.

Eric

Yep, I concur. Scary aint it?
JJH55

[eichenberger]

The basic standard now is 155/95 for all classes, treated or untreated.

[zero.one.victor]

The basic standard now is 155/95 for all classes, treated or untreated.

Thanks for the info. Is that limit actually spelled out in the FAR's, or is it one of those unwritten rules of thumb?

Eric