Flying with High Blood Pressure: A CACI Condition

Back in March of 2013, the FAA started defining “Conditions AMEs Can Issue (CACI).” They realized that many uncomplicated illnesses that had required a decision by the FAA in Oklahoma City could be monitored by a local Aviation Medical Examiner (AME).

It’s been nearly five years since the FAA started granting this discretion to AMEs and it seems to have worked out well. There has been no increase in accidents attributed to this delegation of oversight and life has become a lot easier for pilots with a number of well-controlled medical conditions. Since these “CACI Qualified Conditions” are all pretty common medical problems, I thought it would be helpful to spend the next few months looking at them.

The most common problem covered by a CACI is high blood pressure or hypertension. Hypertension affects about 30 percent of adults in the United States. Alarmingly enough some 20 percent of folks with high blood pressure are unaware of it. Bottom line—if your local doc hasn’t checked your BP lately, have her or him do it. Alternately, a lot of pharmacies or minute clinics can oblige.

As a rule of thumb, you want your readings to be below 140/90 mmHg. The top figure, or systolic pressure, is the peak pressure when your heart is pumping blood into the circulation. The bottom, or diastolic pressure, is when the heart is refilling for the next squirt.

Recent reports have indicated even further lowering of pressure may be advantageous. In other words, as long as you don’t pass out when you stand up, the lower, the better!

Why, you might ask, all the fuss about lowering your blood pressure? Twenty percent of pilots with high blood pressure cruse around and don’t know they have it, right? That is why it is called “The Silent Killer.” It’s not the elevated blood pressure that causes problems. It’s what it does to all the organs that get pumped up under pressure for years and years.

Hypertension leads to thickening and weakening of blood vessels. Among other things, this can cause damage to the kidneys, enlargement of the heart, stroke, or hemorrhage in the eyes. None of these things are very helpful when you’re trying to land an aircraft. That’s why the FAA wants to make sure your high blood pressure is well controlled without side effects before you get your medical certificate.

So what are the conditions that have to be met for your AME to give you your ticket without deferring you to Oklahoma City? First of all, your treating physician or your AME must feel that your condition is stable on your current medications for at least seven days and that no changes are recommended.

Second, you must be free from symptoms attributable to your hypertension, such as headache, dizziness, light-headedness when getting up due to your blood pressure medicines being too strong.

Third, your blood pressure in the AME’s office must be less than or equal to 155 systolic and 95 diastolic. Now, as we’ve said, these figures are higher than desirable for good blood pressure control, but the FAA is allowing for a little bit of “White Coat Hypertension.” Everybody’s pressure goes up in a flight physical!

Fourth, you have to be on no more than three anti-hypertensive medications, and they must be ones that are acceptable to the FAA—ones that rarely have side-effects that interfere with flight. Fortunately most of the currently used blood pressure pills fall into the OK category. Check with your AME if you have and questions.

Fifth, and finally, you should not be having any side-effects from the medications. If all five of these criteria are met, your AME can issue your Medical Certificate on the spot since you have “CACI qualified hypertension.”

If not, you’ll have to go through the Special Issuance process where the FAA reviews your medical records. The good news is that the large majority of pilots with high blood pressure do qualify for a CACI.

Fly wisely. See you next month.