Why are the diagnosis and treatment of hypertension important?

These criteria are important because there is strong prospective, randomized clinical-trial evidence that hypertension markedly increases the risk of cardiovascular disease and that effective treatment reduces cardiovascular morbidity and mortality. To be certified to drive, the driver should have ongoing hypertension management and be free of side effects that may impair safe driving.

49 CFR 391.43(f) Blood Pressure (BP)

“If a driver has hypertension and/or is being medicated for hypertension, he or she should be recertified more frequently. An individual diagnosed with Stage 1 hypertension (BP is 140/90-159/99) may be certified for one year. At recertification, an individual with a BP equal to or less than 140/90 may be certified for one year; however, if his or her BP is greater than 140/90 but less than 160/100, a one-time certificate for 3 months can be issued. “

According to the Third National Health and Nutrition Examination Survey, 29% of all U.S. adults 18 years and older have BP greater than or equal to 140/90 or are taking medication for hypertension. The prevalence of hypertension is nearly equal for men and women. Among adults with hypertension, 78% are aware of their condition, 68% are treated with antihypertensive medication, and 64% achieve BP less than 140/90 with treatment.

Risks Associated With Hypertension

Hypertension alone is unlikely to cause sudden collapse; however, hypertension is a potent risk factor for the development of more serious cardiovascular disease (CVD), peripheral vascular disease, and chronic renal insufficiency. BP greater than or equal to 140/90 is deemed high for most individuals without other significant cardiovascular risk factors.

In individuals ranging from 40 to 89 years of age, for every 20 mm Hg systolic or 10 mm Hg diastolic increase in BP, there is a doubling of mortality from both ischemic heart disease and stroke. The relationship between BP and risk of a CVD event is continuous, consistent, and independent of other risk factors. Both elevated systolic and diastolic BP are risk factors for coronary heart disease (CHD).

Commercial Drivers at Greater Risk for Developing Hypertension

Once in the profession, commercial motor vehicle (CMV) drivers have a greater propensity to develop hypertension than their peers in other professions. The Cardiovascular Advisory Panel Guidelines for the Medical Examination of Commercial Motor Vehicle Drivers includes data from Ragland, et al., demonstrating that the percentage of drivers with hypertension increased from 29% in drivers with fewer than 10 years of driving experience, to 32% in drivers with 10-20 years of experience, and to 39% in drivers with more than 20 years of driving experience. As the years of experience rise, part of the increase in hypertension may relate to accompanying aging, increase in body mass, or decline in physical activity.

Effective Treatment Reduces Risk

High BP can be a modifiable CVD risk factor. Lifestyle modification and pharmacotherapy are the mainstays of antihypertensive treatment regimens. Effective hypertension management reduces cardiovascular morbidity and mortality. The Chicago Heart Association Detection Project in Industry found that antihypertensive therapy reduces the incidence of stroke, myocardial infarction, and heart failure.

Contemporary medical therapies are effective in lowering BP, reducing complications, and are generally regarded as safe.

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