When a fat guy presents to me with a pulse of 46 and a BP of 100/60, I’m pretty sure what’s going on, and it’s not uncommon...
Hypertension in the US is a CACI, as long as the airman is controlled on less than 3 drugs, so all I need as an AME is a note from his doctor saying he’s asymptomatic on his current med regimen, and we’re good to go for any class medical. Why lie?