Hypertension; AME versus CAA (uk)

[misterblue]

I have been diagnosed with hypertension by my GP, confirmed by 24hr ambulatory monitoring.

I have looked into all lifestyle issues and none really apply, so treatment appears to be the answer.

The UK CAA website says that a pilot should be grounded for 14 days after treatment commences, to ensure there are no side-effects.

I consulted my AME, however, and he was very dismissive of this. He said that I could start treatment in my normal days off and ignore the 14 day rule. 'Trust me, there will be no side effects', was his line.

I thought that was a bit of a thin plan for aviation, 'It'll be alright' is not normally enough for me.

So who is right, the AME or the CAA?

I did say I would ring the CAA to ask, but he was horrified by this.

Anybody had this experience? I have searched this forum, but this situation does not appear to have arisen before.

Thanks.

[Bealzebub]

Your AME (if he actually suggested this) is wrong. He works under the direction of the CAA medical division.

The CAA will want to be assured that any medication prescribed for hypertension is suitable, effective and without adverse side effects. The recommended period is as you suggest, although there may be some limited lee way on the time suggested provided that is cleared with the CAA.

Not only a new medical prescription, but any change in dosage to an existing medical prescription will also entail a similar period free from flying to ensure stability.

Your AME should be aware of this.

This all assumes (from re-reading your post, which isn't entirely clear,) that the treatment involves the use of drug therapy?

[misterblue]

Sorry, I should have made it clear that I was indeed referring to drug therapy.

The AME is well aware of the rules from the CAA, because I took a copy of them with me to my medical.

We spent at least half the medical arguing about it (which put my blood pressure up). He seemed frightened of the airline's response to grounding me for a couple of weeks.

Anyone else had any similar experience? Were you grounded for treatment or not?

[gingernut]

Interesting predicament.

Don't know the regulation, but have much experience of managing hypertension. In reality, getting your blood pressure under control may take 6-12 months of tinkering-this is par for the course.

Each titration of dosage could have potential adverse effects, although in my experience, these are few and far between.

Authorities tend to get a bit hooked up on guidelines, recommendations, policies etc. AME's tend to be good at managing risk.

[md 600 driver]

misterblue
when you say ame do you mean your doctor as a ame would already have the information from the caa

[misterblue]

I am having the dispute with my AME, not my GP. My AME indeed is aware of the CAA rules, but informs me that I do not need to follow the 14 day rule.

This is the crux of the matter - can an AME override the CAA?

[gingernut]

Is it a rule, or is it a guideline?

[homonculus]

Your AME is correct scientifically but the CAA is a government body and can say what it likes. Much of its 'evidence' is decades out of date but other diktats are just created 'to be on the safe side'.

So as with single engine IFR in helicopters, it is illegal but safe! So you fly at your risk to your license but I would be happy to be your passenger

[misterblue]

I don't know whether I'm looking at a rule or a guideline.

The CAA website says " A full report (from cardiologist or GP) should confirm that the BP has stabilised on acceptable treatment (for a minimum of 2 weeks) and that the pilot has no treatment-related side-effects. Attention to risk factors should be apparent. If satisfactory a fit assessment can be made."

I don't fancy betting my licence against what would amount to 7 days of not flying, if my usual days off are taken into account.

[gingernut]

A full report (from cardiologist or GP) should confirm that the BP has stabilised on acceptable treatment (for a minimum of 2 weeks) and that the pilot has no treatment-related side-effects.

The sentence is a little ambigous, I'm not sure if it means that you have to stay on the ground every time you're medicines are changed. If it does, then you won't see many grey haired pilots in the future.

AME's tend to ooze sensibility.

Enjoy your flying.:)

[misterblue]

Having sought various opinions and seen how other pilots have been treated, it seemed to me that there was a wide variation in how this rule/guideline is interpreted.

So I wrote to the CAA. I confirmed that this was the algorithm that should be followed-

http://www.caa.co.uk/docs/49/20080208HypertensionAlgorithm.pdf

I then asked whether adherence to the above algorithm is compulsory for Class 1 medical holder pilots, or is at the discretion of the AME. The answer is unequivocal-

Adherence to the algorithm is compulsory for Class 1 certificate holders.

That would seem to sort it.

[Old Akro]

I think the PRACTICAL answer depends on how high your blood pressure is and what drugs the doctor is suggesting. Some hypertension drugs are very benign. Others have potential side effects that are evident within a day or so. Look up the consumer information on the drugs and you can make your own assessment.

[Pace]

I would think that it is not your place to be ringing up the CAA for opinions as that area is your AMEs responsibility.

You would not expect your AME to push you out of your pilot seat and takeover flying your plane and visa versa?

As a pilot you are not qualified to make such judgements having cleared you if anything goes wrong the blame lies with the AME not you.

Pace

[misterblue]

I must respectfully disagree. A pilot should surely be able to contact his regulatory body where there is ambiguity.

MB

[lofo101]

The incidence of side-effects depends on the drug you're taking. The most common types (in Australia at least) are AII2 antagonists (eg. candesartan). ACE inhibitors are also up there. These have very few side effects in an otherwise well individual. If however you're on beta blockers (rare to start people on these these days), there are definite side effects and you would need to 'wash in' for a couple of weeks -- the side effects of these are very significantfor flying, if not extreme ie. drowsiness, fainting, light-headedness. So... what you'll experience depends on the drug. I'd hope the regulators via the AME's are up on this.