Hypertension is one of the most common conditions AMEs encounter. The FAA has a well-defined, manageable pathway for most pilots — including those on medication — but medication choice and the number of drugs you take matter significantly.
Informational Use Only. The information on this page reflects our understanding of current FAA medical certification requirements and is provided for general educational purposes only. FAA policies and the AME Guide are updated frequently. The FAA AME Guide is the authoritative source in all cases. Always verify with your AME and at faa.gov/ame_guide.
The FAA Blood Pressure Standard: ≤ 155/95
The FAA's guideline maximum is 155 mm Hg systolic and 95 mm Hg diastolic for all classes of medical certificate. This is more permissive than the clinical standard of 140/90 used by most physicians. Pilots who consistently meet this limit — with or without medication — can generally be certified. The challenge arises when medication count, medication type, or end organ damage complicates the picture.
HTN certification complexity ranges from straightforward issuance to full Special Issuance depending on BP control, medications, and comorbidities.
BP at exam ≤ 155/95, not on any antihypertensive medications
BP controlled on 1–3 acceptable medications, CACI worksheet criteria met
BP elevated at exam — AME re-checks and second reading ≤ 155/95
On 4 or more medications, or on unacceptable medications
HTN clinically uncontrolled or significant medication side effects present
Evidence of end organ damage (kidney, heart, eyes, stroke) from HTN
HTN + OSA or diabetes as comorbidities — each condition must independently meet standards
The FAA uses a three-scenario disposition table to determine certification action for hypertension.
Scenario A
If the pilot's BP meets the FAA standard (≤155/95) and no antihypertensives have been used for 30+ days, the AME can issue directly. AME documents in Block 60.
Scenario B
Follow the CACI Hypertension Worksheet. AME can issue if all worksheet criteria are met. Annotate Block 60. Each medication component counts separately — lisinopril/HCTZ = 2 medications.
Scenario C
AME must defer. Required submission: status report from treating physician (treatment plan, prognosis, stability); mention of secondary causes or comorbidities; list of all medications, dates, and side effects.
HTN certification goes beyond just the BP reading at your exam. The FAA reviews the full clinical picture.
The AME takes a seated BP reading. If elevated, the AME can re-check later in the same visit, have the pilot return on 3 separate days over 7 days, or refer back to the treating physician. Readings are documented in Block 60.
Each antihypertensive component counts separately. The CACI pathway is available for 1–3 acceptable medications. At 4+ components, the case must go to the FAA. All medications are cross-referenced against the FAA's acceptable antihypertensives list.
The FAA specifically looks for evidence of HTN-related damage: renal disease, left ventricular hypertrophy, prior MI or stroke, retinopathy, and peripheral arterial disease. Any documented end organ damage requires a Special Issuance.
Assessment should address secondary causes such as OSA, renal artery stenosis or endocrine disorders. When a treating-provider report is required, it should address these findings; the CACI stable-control exception may allow the AME to establish eligibility without a separate note. Identified secondary causes may need separate evaluation.
Hypertension frequently co-occurs with OSA, diabetes, obesity, and dyslipidemia. Each comorbid condition must independently meet FAA certification standards. A combined submission addressing all conditions is preferred.
Recent medication changes require a 7-day no-fly period to verify no adverse effects from the new medication. The AME must establish stability; a separate treating-provider note is not mandatory when the worksheet's stable-control exception is met.
Not counting combination pill components separately — lisinopril/HCTZ is 2 medications, putting you at the CACI limit sooner than expected
Starting a new antihypertensive and flying within 7 days — any medication adjustment requires a 7-day no-fly observation period
Assuming a drug class is prohibited — alpha blockers are permitted when criteria are met; check the exact drug against the FAA table
Undisclosed end organ damage — the AME may discover renal insufficiency or LVH that was not addressed in the physician's note, triggering deferral
White coat hypertension repeatedly exceeding 155/95 at the exam — consistent readings above limits require treatment before certification
Failing to address OSA as a potential secondary cause of HTN — if OSA is undiagnosed, the FAA may flag this as incomplete evaluation
Official FAA sources used in developing this guide.