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on maximal or near-maximal doses of 2-3 pharmacologic

accompanied by" is designed to include a clinical diagnosi s of

a cardiovascular disease (1) which is accompanied by

(See Conference on Pulmonary/Respiratory Disorder s and

agents. Some causes of secondary hypertension m ay be

symptoms of syncope, dyspnea, collaps e or congestiv e

Commercial Drivers at :

amenable to surgical intervention or specific pharmacologic

cardiac failure; and/ or (2) which i s likel y to cause syncope,

disease.

(See Cardiovascular Advisory Panel Guidelines f or the

dyspnea, collapse or congestive cardiac failure.

It is the int ent of t he FMCSRs t o render unqualified, a

Medical Examination of Commercial Motor Vehicle Drivers at :

Hypertension

driver who has a current cardiovascular disease which is

)

§391.41(b)(6)

accompanied by and/ or likely to cause symptoms of syncope,

A pers on i s physicall y qualified to drive a commercial mot or

dyspnea, collapse, or congestive cardiac failure.

vehicle if that pers on:

Rheumatic, Arthritic, Orthopedic, Muscular,

However, the subjective decisi on of whether the natur e and

Has no current clinical diagnosis of high blood pressur e likely

Neuromuscular or Vascul ar Disease §391.41(b)(7)

severity of an individual's condition will likely caus e

A pers on i s physicall y qualified to drive a commercial mot or

to interfere with ability to operate a commercial mot or vehicle

symptoms of cardiovascular insufficienc y is on an individual

vehicle if that pers on:

safely.

basi s and qualification rests with the medical exami ner and

Hypertension alone is unlikely to cause sudden

Has no established medical history or clinical diagnosis of

the mot or carrier. In those cases where there is an

collapse; however, the likelihood increases when target or gan

rheumatic, arthritic , orthopedic, muscular, neuromuscular or

occurrenc e of cardiovascular insufficiency (myocardial

damage, particularl y cerebral vascular disease, is present.

vascular diseas e which interferes with the ability to control

infarction, thrombosis, etc.), it is suggested before a driv er is

This regulatory criteria is based on FMCSA' s Cardiovascular

and operate a commercial motor vehicle safely .

certified that he or she have a normal resting and stress

Advisory Guidelines for the Examination of CMV Drivers ,

Certain diseases are known to have acute episodes of

electrocardiogram (ECG), no residual complications and no

which used the Sixth Report of the Joint National Committee

transient muscle weakness , poor muscular coordination

physical limitations, and is taking no medication likely t o

on Detecti on, Evaluation, and Treatment of High Blood

(ataxia), abnormal sensati ons (paresthesia), decreas ed

interfere with safe drivi ng.

Pressure (1997).

muscular tone (hypotonia), visual disturbances and pain

Coronary artery bypass surger y and pacemaker

Stage 1 hypertension corresponds to a systolic BP of

which may be suddenl y incapacitating. With each recurring

implantation are remedial procedures and thus, not

140-159 mmHg and/ or a diastolic B P of 90-99 mmHg. T he

episode, thes e symptoms m ay become more pronounced

unqualifying. Implantable cardiovert er defibrillator s are

driver with a BP in this range is at l ow risk f or hypertension-

and remain for l onger periods of time. Ot her diseases have

disqualifying due t o risk of syncope. Coumadin is a medic al

related acute incapacitation and may be medically certified t o

more insidious onsets and displ ay symptoms of muscl e

treatment which can improve the healt h and safe ty of the

drive for a one-y ear period. Certificati on examinations should

wasting (atrophy), swelling and paresthesia which m ay not

driver and should not, by its us e, medically disqualif y the

be done annua lly thereafter and should be at or less than

suddenl y incapacitate a person but may restrict his/ her

commercial driver. The emphasi s should be on t he underlying

140/90. If less than 160/100, certification m ay be extended

movements and eventuall y interfere with the abilit y to safel y

medical condition(s) which require treatment and the general

one time for 3 months .

operate a motor vehicle. I n many instances these diseases

health of the driver . The FMCSA shoul d be contacted at ( 202)

A blood pressure of 160-179 systolic and/or 100-109

are degenerative in natur e or m ay result in deteriorati on of

366-1790 for additional recommendations regarding the

diastolic i s considered Stage 2 hypertension, and t he driv er i s

the involved ar ea.

physical qualificati on of drivers on coumadin.

not necessarily unqualified during evaluation and institution of

Once the individual has been diagnosed as having a

(See Cardiovasul ar Advisory Panel Guidelines for t he

treatment. The driver is given a one tim e certification of three

rheumatic, arthritic , orthopedic, muscular, neuromuscular or

Medical examination of Commercial Motor Vehicle Driver s

mont hs to reduce his or her bl ood pressure to less than or

vascular disease, then he/she has an established histor y of

at:

)

equal to 140/90. A blood pressur e in this range is an absolute

that disease. The physician, when examining an individual,

indication for anti-hypertensive drug therapy. Provided

should consider the following: (1) the nature and severity of

treatment is well tolerat ed and t he driver demonstrates a BP

the individual's conditi on (such as sensory loss or loss of

Respiratory Dysfuncti on

value of 140/ 90 or less, he or s he may be certified for one

strength); (2) the degree of limitation present (suc h as range

§391.41(b)(5)

A pers on i s physicall y qualified to drive a commercial mot or

y ear from date of the initial exam . The driver is certifi ed

of motion); (3) the likelihood of progressive limitati on (not

vehicle if that pers on:

annually thereafter .

always present initially but m ay manifest itself ov er time); and

A blood pressure at or great er than 180 (systolic) and

(4) the likelihood of sudden incapacitati on. If severe

Has no established medical history or clinical diagnosis of a

110 (diastolic ) is considered Stage 3, hi gh risk for an acut e

functional impairm ent exists, the driver does not qualify. In

respiratory dysfunction likely to interfere with ability t o control

BP-related event. The driv er m ay not be qualifi ed, ev en

cases where more fr equent monitoring is required, a

and drive a commercial mot or vehicle safely .

Since a driv er must be alert at all times, any change i n

temporarily, until reduced to 140/90 or less and treatment i s

certificate for a shorter period of tim e may be issued. (See

his or her ment al state is in direct conflict with highw ay safety .

well tolerated. The driv er m ay be certified f or 6 months and

Conference on Neurological Disorders and Commerci al

Even the slightest impairment in respiratory functi on under

biannually (every 6 months ) thereafter if at recheck BP i s

Drivers at :

emergenc y conditi ons (when greater oxygen suppl y i s

140/ 90 or less .

)

necessary f or performanc e) may be detrimental to saf e

Annual recertification is recommended if the medic al

driving.

examiner does not know the severity of hypertension pri or to

There are many conditions that interfere with oxygen

treatment.

exchange and may result in incapacitation, includi ng

An elevated blood pressure finding should be confirm ed

emphysema, chronic asthma, carcinoma, tuberculosis ,

by at least two subsequent measurements on differ ent days .

chronic bronchitis and sleep apnea. If the medic al exami ner

Treatment incl udes nonpharmacologic and

detects a respiratory dysfunction, that in any w ay is likely t o

pharmacologi c modalities as well as counseling to reduc e

interfere with the driver's abilit y to safel y contr ol and drive a

ot her risk factors. Most antihypertensive medications als o

commercial mot or vehicle, the driver must be referred t o a

have side effects, the importance of which must be j udged on

specialist for further evaluation and therapy. Anticoagulati on

an individual basis. Individual s mus t be alerted to t he hazar ds

therapy for deep vein thrombosi s and/ or pulmonar y

of these medications while driving. Si de effects of

thromboembolism is not unqualifying onc e optimum dose is

somnolenc e or syncope are particulary undesirable i n

achieved, provided lower extremity venous examinations

commercial drivers .

remain normal and the treating physici an gives a favorabl e

Secondary hypertension is bas ed on the above stages.

recommendation.

Evaluation is warranted if patient is persistently hypertensive

Form 649-F - Medical Examination Report - Federal Motor Carrier Safety Administration Page 6

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