High Blood Pressure and Medical Certification of Commercial Motor Vehicle Drivers

Project Goal:

This project has four objectives, as follows:

1. To identify and review the most current literature related to high blood pressure and the measurement at which high blood pressure is likely to interfere with a driver's ability to operate a commercial motor vehicle (CMV) safely;
2. To evaluate the likelihood of individuals with high blood pressure being involved in a motor vehicle crash;
3. To evaluate whether guidance on high blood pressure that is available to medical examiners (MEs) who conduct physical qualification examinations of CMV drivers is consistent with the literature; and
4. To develop a hypertension guidance table to assist MEs in determining whether high blood pressure is likely to interfere with an individual's ability to operate a CMV safely. .

Background:

The physical qualification standard for hypertension states that a person is physically qualified to drive a CMV if that person has no current clinical diagnosis of high blood pressure likely to interfere with his/her ability to operate a CMV safely (49 CFR §391.41(b)(6)). The Medical Advisory Criteria for §391.41(b)(6) is based on the FMCSA’s Cardiovascular Advisory Guidelines for the Examination of CMV drivers, which used the 1997 Sixth Report of the Joint National Committee (JNC) on Detection, Evaluation, and Treatment of High Blood Pressure.

Since 1997, the JNC has issued the Seventh and Eighth Reports on hypertension standards. In 2003, JNC 7 was issued under the National Heart Lung and Blood Institute (NHLBI). The JNC 8 was issued in 2014. NHLBI partnered with the American College of Cardiology (ACC) and the American Heart Association (AHA) to develop recommendations on the prevention, detection, evaluation, and management of high blood pressure in adults.

Between 2003 and 2017, the hypertension standards have been updated (JNC 7 and JNC 8) either comprehensively to focus on a range of areas such as definitions of hypertension, blood pressure measurement issues, lifestyle changes, or the updates to the hypertension standards were narrowly focused.

Summary:

As the JNC 7 and JNC 8 blood pressure standards result in more individuals in the public sector falling into the category of Stage 1 hypertension, the findings of the research will inform FMCSA regarding the medical certification implications and consequences for CMV drivers, as well as primary considerations for medical examiners during the medical certification process.

Contractor:

Applied Research Associates, Inc.