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Blood Pressure/Pulse Rate

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Blood Pressure/Pulse Rate — Medical Examiner Instructions

  Regulations — You must measure:

Blood Pressure (BP)

  • Only BP readings taken during the driver physical or follow-up examinations may be used for certification decisions.
  • BP greater than 139/89 must be confirmed with a second measurement taken later during the examination.
  • Record additional BP measurement in your comments on the Medical Examination Report form.


  • Document pulse rhythm by marking the “Regular” or “Irregular” box.
  • Record pulse rate.
  • Record additional pulse characteristics in your comments on the Medical Examination Report form.

NOTE: Trained assistive personnel may take and record the BP and pulse. When BP, pulse rate, or both are significant factors in your decision not to certify a driver, it is prudent for you to measure the readings yourself. However, the Medical Examiner must sign the Medical Examination Report form. By signing the Medical Examination Report form, you are taking responsibility for and attesting to the validity of all documented test results.

Blood Pressure/Pulse Rate — Stages of Hypertension Guidelines Table

The instructions for medical examiners found in 49 CFR 391.43 Blood pressure (BP) stipulate that more frequent monitoring is appropriate when a driver has hypertension at examination time or is being medicated for hypertension. The Blood Pressure/Pulse Rate section of the Medical Examination Report form has a table that summarizes the medical guidelines for BP measurements and is equivalent to three stages of hypertension.

A one-time, three-month medical certificate is granted in two cases: where the driver has a BP that is equivalent to Stage 2 hypertension, or a driver that was certified with Stage 1 hypertension has not achieved a BP less than or equal to 140/90 at recertification. This three-month certificate is a one-time issuance for the recertification period and is not intended to mean once in the driver’s lifetime.

NOTE: These are recommendations. The medical examiner may use his/her clinical expertise and results of the individual driver examination to determine the length of time between recertification examinations.

The following table corresponds to the first two columns of the recommendation table in the Medical Examination Report form. Column one has the blood pressure readings, and column two has the category classification.




Stage 1 hypertension


Stage 2 hypertension

greater than or equal to 180/110

Stage 3 hypertension

When a BP reading is a value where the individual systolic and diastolic readings are in different stages, you should classify the reading by the higher stage. For example, 168/94 and 148/104 are both examples of Stage 2 hypertension.

The next table corresponds to columns three and four of the recommendation table in the Medical Examination Report form. Use the Expiration Date and Recertification columns to assist you in determining driver certification decisions.

Expiration Date


1 year

1 year if less than or equal to 140/90

One-time certificate for 3 months

1 year from date of examination if less than or equal to 140/90

6 months from date of examination if less than or equal to 140/90

6 months if less than or equal to 140/90

A driver with Stage 3 hypertension (greater than or equal to 180/110) is at an unacceptable risk for an acute hypertensive event and should be disqualified. You may reconsider the driver for certification following effective treatment for hypertension evidenced by BP stabilized at less than or equal to 140/90.

The 6-month expiration and recertification dates apply to the driver with a known history of Stage 3 hypertension, who has an acceptable BP at examination time, and who tolerates treatment with no side effects affecting safe operation of a commercial motor vehicle (CMV).

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