High Blood Pressure Medication and Flying for a Career

[buckrogers]

I have just started treatment for high blood pressure and although I can keep my licence and gain employment as an instructor I am wondering how far I can go. I am a CPL with a ME IR and just turned 40 with around 1000 hours total time. Am I looking at being a career instructor for the rest of my aviation career or will some airlines consider employing me?

[Shunter]

Providing your BP is under 160/95 for your medical, that's end of story in most respects. Medication to get it below said limit is perfectly ok.

[Bealzebub]

Despite the glib reply above that is not "the end of the story" nor is "medication to get it under (160/95) perfectly OK".

Hypertension is a very common systemic disorder that falls into two categories. Essential Hypertension is elevated blood pressure where no specific medical cause is evident. Secondary hypertension is elevated blood pressure caused by a recognised medical condition.

Hypertension is often very insidious, in that it goes undetected unless the patient is made aware usually by a routine check at their doctors surgery, or as part of a medical examination. Obviously sustained high BP readings should warrant further investigation as they may well be secondary to another serious underlying cause. Given the seriousness of hypertension it is important to seek treatment and guidance from your G.P.

The good news it that most cases of essential hypertension that require drug therapy, do respond well to treatment. The treatment is likely to be a lifelong requirement in most cases. Sometimes the condition can be treated by changes in the patients lifestyle and diet.

The CAA are very experienced and active in their dealings with pilots who have hypertension and controlled hypertension. They take the viewpoint that if essential hypertension is properly and adequately controlled with specific treatments they will normally maintain a class 1 medical. They do expect (sensibly) that the individual will monitor their readings and consult with their own GP on a reasonably regular basis for such things as ongoing stability and blood tests.

As far as airline employment is concerned, that is unlikely to be an issue in itself, provided the conditions for the issue and maintenance of the class 1 certificate are adhered to.

[galaxy flyer]

FAA: It requires an annual review by your attending doctor with a letter to the FAA examiner. I take Lisinopril 20mg/daily and have no problems with an FAA Class I

Gf

[buckrogers]

Thanks for this. Most useful. Treatment looks like it is working but since I am about to invest in a JAA licence conversion I wanted to see what others in the industry could tell me or had experienced. Much appreciated.

[gingernut]

Hey buckrogers, I should imagine ou starting treatment for simple hypertension, is as significant as going bald.

Anyway, at the risk of repeating me'self, here's a summary of the latest evidence.....:)

Blood Pressure / Hypertension thread.
As this seems to be a recurring worry for pilots, I thought it may be useful to summarise the current medical thinking about hypertension. (Raised blood pressure).

It's not definitive, but I'll try and be scientific by grading recommendations as follows.

(A) Strong Evidence (Clinical trials of a high standard)
(B) Fairly strong evidence (Clinical studies of less higher standard)
(C) "Expert" opinion.

I'd welcome any contribution/corrections, but to try and make the advice more "robust," I wonder if you would mind also grading your evidence ?



What is "blood pressure?"
It's simply the force exerted on the artery walls by circulating blood.

What do the figures mean?
Usually blood pressure is recorded as two figures, eg 120/70 mmHg. The top figure is the force exerted when the heart is contracted (Systolic blood pressure), the bottom figure when the heart is relaxed (diastolic).

What is hypertension?
Hypertension is diagnosed when the reading are persistently raised.

Is it Common?
Yes, about 30% of adults in the UK have hypertension. (B)

What does persistently raised mean?
Patients should usually have their bp measured again, if initially raised. They should then be asked to return on two occassions, 1 month apart.(C)

Can I help with my diagnosis by monitoring my blood pressure at home?
A popular concept, particularly amongst pilots, some of whom tend to err towards the logical (nurdy) side:8(me included).

Unfortunately, no matter how attractive the concept, the use home and ambulatory measurements are not recommended at present. Although further research is currently being performed in this area. Callibration of home machines is also an issue. (As it can be in the health service!).(C)

But doesn't this help identify the "white coat" effect.
The million dollar question. "My blood pressure is ok throughout my day to day routine, it's only ever raised when I see the quack."

There is a school of thought that suggests that even these intermittent rises can lead to long term disease- a controversial area (C)



Is hypertension a disease in itself?
Usually not, (about 95% of cases), it is a risk factor for Cardiovascular Disease- Heart attacks and strokes. (C)

How does my quack make a diagnosis of hypertension?
Usually when one or both of the readings are pesistently raised on different occasions-although if very high he may decide to commence treatment immediately.

What are these readings?
Depends on who you ask. Most authorities agree that a reading equal or over 160/100mmHg warrants treatment. If over 140/90 (some say 80), your quack should be taking into account other risk factors, (eg chloesterol, family history), prior to reaching a decision on your management.

Thresholds are lower for certain patients, eg diabetics. (C)

Who decides the targets?
Experts (C)

Is it worth doing anything about?
Yes, generally a small reduction in BP dramatically reduces the risk of illness and death from heart disease and stroke. A 2mm reduction reduces risk by about 10%) (A)

Can I do anything myself?
There are two strands to this argument, firstly can I actually reduce the blood pressure reading itself? Secondly, can I reduce my cardiovascular risk?

This is quite an important concept, often overlooked if you get too fixated on the numbers.(Pilots:)) I'd suggest number 2 is equally, if not more important than number 1.

Diet and exercise can reduce bp&risk (B)
Relaxation can reduce bp(B)
Alcohol consumption-reduce if raised-bp&risk(B)
Reduce excessive caffeine intake bp(C)
Reduce salt reduce bp(B)
Stop smoking -reduces risk (but not bp)(A)

Remember-small changes can make big differences.

Ok, I've made the changes, and my bp is still up, what next?
This will depend on two things, the actual reading itself, and your cardivascular risk. If persistently over 160/100 you will need drug treatment. If in the "grey area" eg treatment will probably depend on overall risk factors. (B)

For example, if your bp is 140/90, you smoke 20/day, you dad died of a heart attack aged 40, and your cholesterol was high, you are probably aiming for drug treatment.

If you a chap who doesn't smoke, thinks a kebab should consist of fish, tomatoes and peppers, doesn't know the pleasures of a "pie dinner", and thinks that "happy hour" is spent in the pool, then a strategy of close monitoring may be the best strategy.

(Remember pilots, don't get fixated on the numbers:))


My quack has decided I need medication, why should I take a tablet when I feel perfectly well?
Good question- once the decision is made for drug treatment, it's likely that you will need it for life, and it could potentially make you feel unwell. Drug treatment is unlikely to make you "feel" better.

However the benefits of treatment, in terms of reducing death and illness, are clear and well established (A)

Is treatment guaranteed to cut down my risk?
(Okay, for the pilots, some figures)

Definately not! If I had a roomful of 100 people who had a 20% risk of having a heart attack in the next 10 years, then 20 will have a heart attack in 10 years, and 80 will not.

If I successfully treated these people, then in 10 years, 80 will still be healthy (whether they had treatment or not), 15 will still have a heart attack, 5 will be saved.

(Ok it's a bit simple, but you never know, a surgeon could be reading this.)

I'm taking 4 tablets a day, is this a bad sign?
No, in the "old days," you would be started on one tablet, if the response was poor, the dose would be doubled, (again and again) unil control was maintained. Modern thinking suggests that patients should be given "lower" doses of drugs which act in different ways, as this reduces side effects. (B)

Is anyone drug better than another?
The differences are probably negligible, the important thing is to get the blood pressure down. Older drugs (Alpha and Beta blockers) are used less and less. Thiazide diuretics, calcium channel blockers and ACE inhibitors appear to work well, with minimal side effects. (A)

Will treatment and a diagnosis of hypertension affect my life/career?
Probably not- it's important to let your quack know if you are suffering any adverse effects- the range of treatments available is vast. Of course, your AME needs to be informed.

Who is the best person to consult about my hypertension?


Your treatment should easilly be managed by a team, but your day to day care may involve a doctor, health care assistant, nurse, or a pharmacist.

The key to successful managment is to be systematic.


Safe flying, remember if you wish to add to this thread, try and grade your evidence, don't know what you lot think, but would it be possible to keep this thread for updating current guidance, perhaps specific enquiries could be tagged on to existing threads?

cheers, ginge

[maybe!]

Before you go on medication try a spoon of apple cider vinigar and honey
once a day for two weeks, you will be suprised. rating B

[Tediek]

When I had my medical, i had a bad night sleep as my son was having bad dreams, so he woke me up:zzz:, i told them this that I was not fit due to a lack of sleep. I had a BP of 140/80 (i am 6ft6). They told me it was fine, also due to my lenght, the heart has to work a bit harder to get the blood round.:ok:

[corsair]

Thanks Gingernut for that. Most interesting. I've been on medication for some two years now. Two a day, one beta blocker one ACE inhibitor. At first I thought it was all over but the Doctors were totally relaxed about it and pointed out that it was like needing glasses. At each class 1 they check the BP and are quite happy with my progress. Now it's just routine. Interesting I was one of those people who isn't overweight never smoked, instinctively avoided salt and ate well generally and who is a moderate drinker, despite the reputation of my countrymen. So it wasn't lifestyle that brought it on.

For my flying career, it simply isn't an issue. For my life assurance it is an issue. I'm now seen as a risk despite the fact that my treatment removes much of the risk. On top of that, being a pilot already increased the premium. :ouch: You just can't win sometimes. The worst thing about it is that the drugs cost a fortune every month. :{

[gingernut]

No probs- I'm more worried about those walking about with an unknown bp, than those controlled and monitored, such as yourself;)

[Fastair345]

We have 2 measurement devices in our Household 'cos my wife got servere Pre Eclampsia Toxemia at the Birth of our firstborn so we got paranoid about fitting n stuff at the next childbirth. Fortuneatly no problem.

Issue for me now Is I have measured my BP with these two devices and one says I'm fit as a butchers dog and the other suggests I may need drugs. I hold a Class 2 and my Diastolic has been around 90 for the last 2 medicals therefore I am wondering what the hell to do?..in fact whether to even bother with a Class 1.

Is there a device that can be relied upon...?

If my BP is a bit high is this a first Class 1 failure and if so (I am a bit overweight BMI 29)could I drop my BP down with weight loss. Sorry to get technical but is there a relationship between Weight loss vs Diastolic drop?

Cheers to all

[gingernut]

Is there a device that can be relied upon...?

Try e-bay, you should be able to get a good price for both machines.

Sorry to be flippant, but home measurement is unlikely to make a difference to either the management of your blood pressure, or the long term outcomes.

Try and obtain 3 or 4 results from a calibrated device (and operator), over a period of time, get your cholesterol checked if worried, and chat with your gp.

There are only 3 things that alter (or delay?) the risk of you dying from an atherosclerotic event; long term blood pressure control, lipid management and stopping smoking.

Anything else is just fudging 'round the edges, and are subject to the law's of diminishing returns, unfortunately.

[Flyin'Dutch']

If my BP is a bit high is this a first Class 1 failure and if so (I am a bit overweight BMI 29)could I drop my BP down with weight loss. Sorry to get technical but is there a relationship between Weight loss vs Diastolic drop?

For every kg you lose your BP should come down by about 2mmHg.

Good luck

[Fastair345]

Thanks for these replies. Will look at weight reduction down to a recommended level and see what this does in combination with getting it checked properly but what I have seen (and my wife is a nurse !) was not absolutely sure all the medical profession do it correctly with Calibrated Instruments...(Can I say this??)...especially these electronic devices.

Cheers for the comments re Weight loss vs BP reduction. Guess this is based on a large sample of people. See what it does for me.

Hope some of the points raised provide some "food for thought" in terms of the original thread if you pardon the pun......;)

[Flyin'Dutch']

not absolutely sure all the medical profession do it correctly with Calibrated Instruments...(Can I say this??)...especially these electronic devices

Nah, we just do whatever we like, what the 'eck

:}



Doh, of course we get our stuff calibrated once a year with a whopping big sticker on it with dates easily visible to the patients. If your wife's isn't calibrated she should get that done pronto!

[greywings]

Dear All,

Many thanks for the interesting posts. I have never had a BP lower than 120/75, and, in over 40 years of flying, it has remained in what the doc tells me is the 'higher range'. ie; it has been around 130/80 for the last fifteen to twenty years. My cholesterol is slightly high, though I excercise, eat well, have never smoked and drink in moderation. The doc tells me that I should be concerned about the 'elevated bp' and may well suggest some treatment - possibly for the cholesterol level - at my next medical.

Does that seem reasonable or should I be pushing for a non-medical solution, such as losing weight, etc?

GW

[gingernut]

Always go for the non medical option if it's available:)

Once on medication, your usually on it for life.

Treatment at such a borderline level usually depends on risk assessment-your quack mmay use a tool to work out the chances of you having an "event" over the next 10yrs.

[greywings]

Many thanks for the comment.

I would always prefer a non-medical approach if possible.

I will bear it in mind when I go for my medical in ten days time.

GW

[bullshot]

Anyone had any experience of the relaxation methods (music & rhythm breathing I think) as advertised at great expense in the UK newspapers?

Does it work?

BS

[HZ123]

Having been on the single tablet a day I complained to the doctor about erection (lack of) and going to bed everynight at 21;00 hours. He said the best way of dealing with this was to take me off medication and monitor the situation. Two years later i am still off the tablets and I do feel much better, i have changed a number of lifestyles, less alcohol stoped smoking although I was only a social smoker and more exercise.

My point do not assume that because the Doc says you are on it for life that you cannot change things. Also a warning to all those forty somethings that may smile reading this it will effect you all to soon so make changes now not after the event. It is easy just to make a record of everything you eat / drink over a week or so. Then make an appraisel of it and see how easy it is to change things.

[CEJM]

Very interesting thread this is. Thanks to everybody who contributed to it.

Personally I (29) have a raised BP myself, 150/90. However with this BP I have had no problems with getting my Class 1 medical.

Needed to go to my normal GP a few days ago and their alarmbells started ringing. Their immediate reaction was to put me on medication and monitor the situation. Just managed to avoid all this and had a chat with my AME and he is convinced that I have no high BP and that medication at this stage is not required. However to make everybody happy, he recommended a 24 hour BP monitor to get an average reading of my BP.

Raised BP has run in the family for a long time. My father has been on medication since he was 24 (actively playing sports, ideal weight but smoking). He has been taken off medication roughly 8 years ago (50) and the situation is back to normal now.

Anybody got any experience with this BP monitor? As it seems that the general idea in this thread is to have your BP monitored over a longer time period.

Thanks, CEJM

[Water_methanol]

I had an ambulatory monitor fitted for 24 hours at non-urgent CAA request. Quite painless if a little bulky, the only discomfort is the cuff self-inflating at regular intervals (20 minutes) through the night when you are trying to get some sleep. The advice from the nurse was to turn it off if you find it annoying. My BP averaged over 18 hours was 132/82. The lowest diastolic was 66 during sleep. The doc asked me what I was doing at 2.30 pm during the day I was wearing the monitor. Immediate flashbacks; Guilt; I couldn't have been doing IT, could I? Oh, God. No! The embarrassment.

In fact I was in the checkout at Morrison's. That's when my BP hit the highest reading, 155/95. I never had any BP queries after that and never needed any medication.

The monitor I used was from my GP's surgery and it cost me nothing for the day. He took the paper till-roll out of it and sent it off to Gatwick for me. Nice man.

Good luck

Water