Original publication date: December 21, 2022
Last Updated: February 9, 2024
Author: Max Skyler
Topic: Flight Physiology
Number of Comments: 0
Hypertension, being the potentially debilitating disease that it is, garners a great deal of scrutiny, when it comes to a pilot’s physical well-being and capacity to operate an aircraft safely without posing a risk to passengers in the air, as well as to people and property on the ground. Known for its efforts at strictly enforcing and upholding the highest standards of safety, the Federal Aviation Administration (FAA) does not take the issue of pilot fitness lightly, and hypertension is among those conditions that can be called into question with respect to a pilot’s medical clearance to fly.
Being diagnosed with hypertension does not automatically disqualify anyone from becoming a pilot, nor does it automatically result in the suspension of a pilot’s license to fly. Pilots who are proactive about taking measures to keep their hypertension in check, can be cleared to fly by the FAA.
It behooves every aspiring pilot or existing pilot, to be cognizant of the risks that hypertension can pose to the safe execution of a flight, from taxi, to takeoff, to landing. Therefore, it is imperative that pilots not be complacent about their hypertension, and educate themselves to understand what are the circumstances under which the FAA can ground you. Likewise, what are the criteria which must be met, in order for the FAA to clear pilots suffering from hypertension, to ultimately remain cleared to fly?
Is hypertension a disqualifying condition according to the FAA?
Upon a cursory review of the FAA’s published list of “specifically disqualifying medical conditions”, you will find that hypertension / high-blood pressure in and of itself is not listed as one of them. There may be other diseases on the list that can lead to hypertension, or that arise as a result of complications from hypertension. But hypertension itself is categorically not on the list of disqualifying medical conditions.
Having said that, the FAA does have a lot to say about hypertension and its impact on a pilot’s potential fitness for flight. Hypertension is one of those medical conditions that are strictly regulated and monitored by the FAA.
Make no mistake, the FAA will never take a lax approach when it comes to ensuring that any potential health risks don’t go unmitigated. The FAA is not in the business of grounding pilots. The FAA Is in the business of maintaining the safety of the general public. Negligence on the part of pilots to maintain optimal health is never tolerated. If you are deemed unfit to fly, the FAA will ground you.
Left untreated, hypertension can become the precursor to a whole host of other life-threatening conditions: heart problems, kidney disease, occular diseases, strokes, cognitive degradation, just to name a few.
Having said that, the FAA can grant clearance to fly, to pilots who take health matters into their own hands and seek to live a healthier lifestyle.
What are the FAA medical certification standards for hypertension?
Where does hypertension fall on the spectrum of medical exam certification standards for pilots?
One of the prerequisites for becoming a pilot, as well as one of the ongoing requirements for maintaining your pilot license in good standing, is to obtain medical clearance to fly.
It goes without saying that your blood pressure is taken into consideration as part of the equation.
There are a number of different ways to obtain medical clearance to fly, and hypertension is fair game to play a factor in the evaluation process:
Obtaining a Medical Certificate
The most common form of medical clearance is to undergo a comprehensive medical exam, administered by an FAA-certified Aviation Medical Examiner (AME), who then signs you off to receive a medical certificate.
There are 3 classes of medical certification, each of which can be summarized by the information in the table below:
| Medical Certification Class | Required For What Type Of Pilot Certificate | Privileges | Validity |
| 1st Class Medical Certificate | Airline Transport Pilot (ATP) | An ATP license is required in order to fly for airlines, cargo jets, and jet airplanes. | Valid for 6 months if pilot is over 40 years old. Valid for 12 months if pilot is under 40 years old. |
| 2nd Class Medical Certificate | Commercial Pilot License | A Commercial Pilot license is required in order to fly for compensation or hire for any type of commercial operations, other than for any that require a 1st class medical certificate. | Valid for 12 months. |
| 3rd Class Medical Certificate | Private Pilot License | A Private Pilot license is required in order to fly for general aviation only. Commercial purposes are prohibited. | Valid for 2 years if pilot is over 40 years old. Valid for 5 years if pilot is under 40 years old. |
Flying Under BasicMed
There is a 4th classification under which pilots can be medically cleared to fly, known as BasicMed. This is not a “class” of medical certification per se. Rather, it is a fast track means for general aviation pilots to obtain medical clearance to fly. Rather than being seen by an AME, you can undergo a routine medical exam administered by a general physician who assesses your general fitness to fly. The tradeoff with obtaining BasicMed clearance to fly is that there are restrictions on the type of aircraft you can fly, the type of operations you can perform, the number of passengers you can carry, and where you are allowed to fly.
How does hypertension impact FAA medical certification?
If you are flagged as being diagnosed with hypertension, the decision to issue you a medical certificate may be deferred until the AME (or the general physician, in the case of BasicMed) is able to review evidence that your hypertension is under control and you are taking the proper, approved medications.
Based on that, the certifying doctor will either clear you to receive a medical certificate, or may grant you a medical certificate contingent upon the successful demonstration that your hypertension does not pose a threat to your ability to safely operate an aircraft.
What are the AME guidelines regarding hypertension treatment?
The FAA has published a guide for Aviation Medical Examiners concerning hypertension.
This guide provides a decision matrix that divides up the pilot’s hypertension into one of three classifications. These classes are broken down by the severity of your condition and the regimen that you are following (if at all), to treat it.
| If your hypertension is under control without the use of any medication, the AME has the green light to issue you a medical certificate. |
| If your hypertension is being kept under control with 3 or fewer FAA-approved medications, the AME must then complete a hypertension worksheet, to help evaluate whether the pilot qualifies to be issued a medical certificate. |
| If your hypertension is being kept under control with 4 or more medications, or with the use of any medications that are deemed unacceptable by the FAA, then the AME must defer the issuance of the certificate to the FAA, and provide them with a detailed report concerning the pilot’s prognosis, their treatment plan, and their current treatment regimen, including any side effects that the pilot might experience. |
What medications are approved by the FAA for hypertension?
As alluded to in the chart in the section above, the FAA has published a list of medications that are approved for the treatment of hypertension. Conversely, this chart also lists those medications that the FAA has deemed to be unacceptable for the treatment of hypertension as well.
Medications that are approved for the treatment of hypertension include the following:
- Alpha adrenergic blockers
- Angiotensin converting enzyme (ACE) inhibitors
- Angiotensin II receptor antagonists (ARBs)
- Beta-adrenergic blockers
- Calcium channel blockers
- Direct renin inhibitors
- Direct vasodilators
- Diuretics
Of course, the use of these medications does not indicate a green light for medical clearance to fly. Their use comes with a conditional caveat. If the pilot is found to be using three or fewer of the aforementioned list of medications, then this CACI Hypertension Worksheet must be completed by the AME. (CACI stands for “Conditions AMEs Can Issue”.) This worksheet will help make the final determination as to whether the pilot is a suitable candidate for receiving a medical certificate.
What are the blood pressure limitations for pilots?
The FAA has published guidelines concerning the parameters for what they deem to be acceptable limits for a pilot’s blood pressure readings.
In a nutshell, a pilot’s average systolic blood pressure (while sitting) should be 155 mm.
Their diastolic maximum blood pressure should be 95 mm, as succinctly enumerated by the FAA.
Of course this is just the baseline starting point. Further medical scrutiny is required above and beyond just the blood pressure readings, when the prevalence of hypertension is suspected.
Can you be a commercial pilot with hypertension?
Hypertension does not disqualify you from becoming a commercial pilot, as long as the necessary criteria can be demonstrated such that it is being kept in check.
Each of the items on the FAA’s list of disqualifying conditions would require pilots to obtain what is known as a Special Issuance by an AME as a prerequisite in order to receive a medical certificate and thus be cleared to fly. Examples of disqualifying conditions include diseases such as diabetes.
A Special Issuance is essentially an individualized, case-by-case review of your specific medical history with the disqualifying condition and the measures that you are taking to mitigate the risks that it poses. Once cleared with a Special Issuance, you can then proceed to obtain your medical certificate, as long as the conditions of the Special Issuance are upheld and complied with.
Since hypertension is not included on this list, a Special Issuance is not required in order to receive medical clearance to fly.
Can you be an Airline Transport Pilot with hypertension?
Whether you wish to fly for the major airlines with an Airline Transport Pilot license, or you wish to fly commercially for smaller aviation operations, or even as a Certified Flight Instructor (CFI), hypertension is categorically in and of itself not a barrier to getting your license.
Can you be a private pilot with hypertension?
Certainly, if you can become a commercial pilot whilst suffering from hypertension, then it goes without saying, that by extension, you can obtain your private pilot license for general aviation purposes as well. The same conditions apply, with respect to your ability to demonstrate that your bout with hypertension is being kept under control.
Can you fly with previously uncontrolled hypertension?
If you previously (or currently) suffer from hypertension that has not being managed properly, and the AME defers issuing you a medical certificate, then you will remain grounded until such time that you are able to demonstrate that it is back under control. A previous diagnosis with hypertension does not spell the end of your aviation career.
Conditions AMEs Can Issue (CACI)
Unlike Special Issuance certificates for other disqualifying medical conditions, the FAA maintains a separate list of what is known as a list of Conditions AMEs Can Issue (CACI).
Hypertension is listed as a CACI.
The CACI empowers AMEs to issue pilots with standard medical certificates, without subjecting them to the process of applying for a Special Issuance. This can be achieved as long as the pilot is able to satisfy the criteria of the FAA’s CACI Condition Worksheet for Hypertension.
Failure to satisfy these criteria would require the AME to defer the exam and send supporting documentation to the FAA for further review.
Is It Easier To Fly Under BasicMed With Hypertension?
General aviation pilots have the option to fly under BasicMed. This significantly reduces the complexity of the medical certification process. Under BasicMed, you need only be seen by any general physician. You do not need to be seen by an AME. The only caveat is that there are limitations on the types of aircraft you can fly.
The criteria for meeting the medical requirements for BasicMed is simply for you to undergo a standard physical exam, administered by any general physician, and then fill out a Comprehensive Medical Examination Checklist.
This checklist does not even need to be submitted to the FAA. Pilots need only to keep a copy of this checklist in their possession, either on paper or electronically, and would only need to present it upon request of the FAA. It is more of a self-managed means of medical accountability.
As long as the general physician can objectively assess that you are physically fit to fly, then you can be cleared for BasicMed.
In this case, a general aviation pilot would not be subject to the parameters as stipulated in the AME guidelines for the medical examination process for hypertension patients, which are required for issuing first, second, or third class medical certificates.
Make no mistake, however. Having said this, your general physician can decline to issue you a clean bill of health and withhold signing off on the Comprehensive Medical Examination Checklist, if they have any legitimate concerns about your health that could pose as a risk to your ability to safely operate an aircraft.
Frequently Asked Questions About Hypertension
The FAA has published a Hypertension FAQ sheet for AMEs. While this FAQ is specifically directed at AMEs, it can certainly provide pilots with some insight into what they can expect when applying for a medical certificate with a hypertension diagnosis.