Blood pressure checks

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Blood pressure checks

Post by DOTexaminer » Tue Jun 03, 2014 3:03 pm

I have young man up for initial certification and he is very anxious about blood pressure checks. The first reading in the office was 174/100. The second reading taken 10 minutes later was 162/90. The last reading, at the end of the exam, was 144/90. Taking the higher of the latter two reading, I gave him 3 months for repeat BP check at my office with goal blood pressure <=140/90. If the initial BP is elevated, should I givee him more than one try to get the right number at follow-up? If yes, where should one draw the line? Thanks ahead of time for any of your inputs.

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Re: Blood pressure checks

Post by Robert Swotinsky MD » Tue Jun 03, 2014 9:39 pm

The blood pressure guidelines are not physical qualification standards. Unlike vision 20/40 in each eye, or hearing threshold at 500/1000/2000 Hz of no greater than 40 dB in the better ear, the blood pressure guidelines are not regulations. That is, the examiner is not required by law to follow them.

The blood pressure guidelines do hold the distinction of being the only guidelines pre-printed on the long form. In this respect, many employers, third party administrators, and even medical examiners treat them as if they're regulations. I think it's seeing them in print on the government form that throws people off.

Where it is a guideline and not a standard, the medical examiner does have discretion to qualify even if the BP appears not to meet the guideline.

The intent of the guideline is for a 1-time, 3-month certification to allow the driver to get his/her BP under control. The guideline is not intended for serial 3-month periods.

It is a common practice for clinics to recheck the blood pressure if it's high. It's also common for clinics to only write in the lower blood pressure reading, rather than writing all of the blood pressure readings. By writing in only the lower blood pressure reading, the clinic hopes the form will more clearly pass muster by those who review it, e.g., employers. As a physician, I would prefer to see all the blood pressure readings on the form. But, those who take the blood pressures and record them on the forms often just enter the lower, acceptable blood pressure.

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