Hypertension is another name for high blood pressure.  It occurs when the pressure within the arteries is too high.  This causes strain on the arteries, which can result in them becoming clogged or weakened.  This is turn can lead to damage to the heart and other organs in the body.

People who have untreated or poorly controlled hypertension, are more likely to suffer from complications such as stroke, heart attack, heart failure, heart rhythm irregularities and kidney failure, than those who have normal blood pressure.

High blood pressure can affect anyone, and it does tend to increase with age.  Often no cause is found, but you are more likely to develop hypertension if:

• You have a family history of hypertension, stroke or heart attack;
• You are overweight, eat too much salt and not enough fruit and vegetables, take little exercise or drink too much alcohol;
• You have certain conditions such as diabetes, kidney disease or heart disease;
• How is hypertension assessed?

Hypertension usually has no signs or symptoms.  The only way to determine if you have hypertension is to have your blood pressure measured, and this will always be done at your medical examinations.  Although this is a simple process, it is important that it is done correctly.  If the reading is made while you are agitated, frightened, excited or angry, it may be high due to your emotional state.

If your blood pressure is recorded as high when taken by a doctor, but is normal when you are at home, it is called “white coat hypertension”.  To check if you have this, you may be asked to wear a blood pressure monitor for 24 hours.  This will provide a record of blood pressure away from the medical environment, and will determine whether you genuinely have high blood pressure or not.

Your blood pressure is represented as two numbers.  The first is called the systolic pressure and indicates the peak pressure in your arteries generated when your heart beats.  The second is the diastolic pressure and indicates the residual pressure in your arteries when your heart is relaxed between heartbeats.

The British Hypertension Society recommends that anyone with a blood pressure of 140/90 or over should be diagnosed as hypertensive.  The Joint Aviation Requirements (JAR) state that any pilot with a blood pressure consistently over 160/95 requires grounding for assessment and treatment.  For ATCOs the European Class 3 requirements also state that when the blood pressure exceeds 160/95 consistently the applicant shall be assessed as unfit.  Your doctor may recommend that you commence medication even if your pressures are lower than these, according to best clinical practice.

Once you have been diagnosed as having hypertension, your medical certificate will be temporarily suspended until you have undergone assessment and been commenced on effective treatment.  This assessment will be done by a cardiologist or your GP.  Your risk of complications such as coronary heart disease and stroke will be assessed, blood tests will be taken, and an ultrasound scan (echocardiogram) may be required to check the structure and function of your heart.   

How your blood pressure is treated will depend upon how high it is and how many “risk factors” you have for heart disease and stroke.  the following medication is acceptable for pilots/ATCOs:

• ACE inhibitors
• Angiotensin-II receptor antagonists
• Calcium channel blockers
• Beta-blickers (atenolol or bisoprolol. Not propanolol)
• Thiazide diuretics
• Potassium-sparing diuretics

Unacceptable medications:

• Centrally acting agents
• Adrenergic blocking drugs
• Alpha-blocking drugs
• Loop diuretics 

Your treating doctor will determine the best drug or combination of drugs for you, start you on treatment and monitor your progress.  Antihypertensive medication can cause side effects and this is the reason you are grounded for at least the first two weeks of your treatment.  Once your blood pressure is under control, and you have no side-effects from any medication, you can return to flying/controlling.  If you have developed any complications of hypertension or have multiple risk factors (if you are a pilot), a multi-crew or safety pilot limitation (OML or OSL) may be required.

Continuing to take antihypertensive medication is important.  As soon as you stop, your blood pressure will go rise, as will your risk of a heart attack or stroke.  If you experience any unusual symptoms, which you think may be caused by your medication, you should discuss a change of medication with your GP.  If your medication is changed or the dose increased, you should not fly/control for at least two weeks until your blood pressure is well controlled and you are free of side-effects.  You should keep your Aeromedical Examiner (AME) informed of any changes and he or she will always be able to give advice about the most appropriate type of treatment.

The protocols for hypertension are given below.

Aircrew
Hypertension 

ATCOs
Hypertension