FAA Blood Pressure Limits, and What Actually Moves the Number

There is one number on the FAA medical that pilots talk about more than any other, and most of them have it slightly wrong. It is not 140/90. It is not whatever your family doctor said last year. The FAA limit for a seated blood pressure is 155 over 95, for every class of certificate, and it is written down in Item 55 of the Guide for Aviation Medical Examiners.

That number is closer than a lot of pilots think, because the reading that counts is the one taken in the AME's office after you drove across town, drank a coffee in the waiting room and started thinking about what happens if the cuff reads high.

This article covers what the rule says, what the medication rules mean in plain English, and the handful of things that move the number. I fly the Embraer 175 out of Phoenix and I am at the AME twice a year like everyone else over 40. None of this is medical advice. It is a pilot reading the FAA's own documents so you do not have to do it in the waiting room.

What Item 55 actually says

Item 55 of the AME Guide covers blood pressure. The standard is simple: the seated blood pressure must not exceed 155 systolic or 95 diastolic. That applies to first, second and third class. There is no tougher number for first class and no easier number for third.

A reading above 155/95 is not an automatic denial. It means the AME cannot simply issue and move on. What happens next depends on your history and your AME, which is why the end of this article points you back to that person.

For planning, 155/95 is a ceiling, not a target. A pilot who routinely reads 150/92 at home is one bad morning away from a problem. A pilot who reads 125/80 has a margin that absorbs a bad morning without anyone noticing.

The CACI hypertension worksheet, in plain English

CACI stands for Conditions AMEs Can Issue. It is a set of worksheets that let the AME issue your certificate in the office for certain conditions, instead of deferring you to Oklahoma City and waiting weeks for an answer. Hypertension is one of those conditions.

The hypertension worksheet comes down to a few checks:

Your in-office blood pressure is at or under 155/95. Same number as Item 55. Medication does not change the ceiling, it is the tool for staying under it.

You are on no more than three medications, and they come from the listed classes: ACE inhibitors, ARBs, calcium channel blockers, diuretics, beta blockers, alpha blockers, direct renin inhibitors and direct vasodilators. Most common blood pressure prescriptions fall in that list.

Centrally acting agents are excluded. Clonidine is the example the worksheet names. If you are on one of those, the CACI path is closed and the case goes to the FAA.

You have been stable on the regimen for at least seven days. A new prescription or a dose change the day before your exam does not count. Give it a week.

If all of that is true, the AME can issue. The point worth repeating, because pilots routinely get it wrong: being treated for high blood pressure is not disqualifying. Hiding a prescription from your AME because you think it will cost you the medical is the thing that costs you the medical. The FAA built a worksheet so that treated hypertension is routine. Use it.

The six-month clock

A first class medical is valid for 12 calendar months if you are under 40 and 6 calendar months at 40 and over. That schedule is set by 14 CFR 61.23, and it changes how you should think about blood pressure.

Under 40, the AME takes one seated reading a year. A number creeping up a couple of points a year can hide inside normal variation for most of a decade.

At 40 and over, it is two readings a year, on the record, for the rest of your career. The trend becomes visible. That is a good thing if you are paying attention and a bad thing if you are not. Twenty years of six-month exams is forty readings. If each one is a point higher than the last, you arrive at the ceiling well before mandatory retirement.

What moves the number

The levers that matter are not exotic. They are the same ones that show up in every piece of FAA guidance about fatigue and in every clinic's handout about blood pressure. The difference for a pilot is that the job pushes all of them the wrong way at once.

Weight. This is the slow lever and the big one. The Mayo Clinic estimates about 1 mmHg of blood pressure per kilogram, roughly 2.2 pounds, lost. Ten kilograms, around 22 pounds, is in the neighborhood of 10 mmHg. For a pilot who reads 150 systolic in the office, that is the difference between a margin and a problem. Nothing else on this list comes close, and nothing else takes as long. The training that gets you there is covered in the article on how airline pilots stay fit and the minimum training that works. Weight also feeds the sleep apnea screening, which is its own article: FAA weight, BMI and sleep apnea.

Sodium. The terminal sells food that keeps, and food that keeps is salted. A four-day trip eaten entirely out of airport kiosks and hotel bars is a sodium load most people never see at home. The lunch bag approach in the fitness article exists for protein, but it does as much for sodium.

Alcohol. The crew dinner drink is a small thing on its own. Three or four nights of it, every trip, is a pattern. The FAA's fatigue brochure tells you to stop alcohol three to four hours before bed for sleep reasons. The blood pressure reason runs alongside it.

Sleep. The FAA brochure says healthy adults do best on eight hours of uninterrupted sleep. A 5 a.m. show after a late arrival gives you five or six. Blood pressure taken on short sleep runs higher than blood pressure taken on a full night, and the medical appointment does not care which kind of night you had. The sleep rules article covers how to protect the eight hours on a trip.

Caffeine. The coffee you drink in the waiting room is in your system when the cuff goes on. Caffeine timing in general is in the caffeine cutoff article.

How to take a reading that means something

Most pilots who check their own blood pressure do it badly, then worry about a number that was never real or relax about one that was flattering. The clinical protocol, the same one Flight Crew Fitness walks you through when you log a reading, is not complicated. It is just specific.

Sit in a chair with your back supported and your feet flat on the floor. Rest for five minutes before the first reading. Do not talk. No caffeine, exercise or nicotine in the period right before. Bladder empty. Arm supported at heart level, on a table or an armrest, not hanging at your side. Cuff on bare skin, not over a sleeve.

Use the same arm every time. Take two or three readings a minute apart and record all of them, not just the lowest. The first reading is usually the highest. If your cuff is an upper arm model from a pharmacy, bring it to your doctor once and check it against theirs.

Do that at the same time of day for a couple of weeks and you have a baseline. A baseline is the only thing that makes a single high reading interpretable. Without one, a 152 in the AME's office is a mystery. With one, it is either a bad morning you can explain or a trend you already knew about.

If you run high the week before

Say the medical is in seven days, you have been logging properly, and the numbers are sitting at 150 over 92. That is under the ceiling, but not by much, and you do not want to find out what the waiting room adds.

The honest answer is that a week is not enough time to move weight, and the levers that do work in a week are the ones you already know. Cut the sodium hard, which on a trip means eating from the bag and not the kiosk. Skip alcohol entirely for the week. Protect sleep the way the FAA brochure describes it: no caffeine or alcohol three to four hours before bed, no hard training two to three hours before bed, and aim for the full eight. Keep your normal training but do not schedule a heavy session the day before the exam.

On the day: no coffee before the appointment. Arrive early enough to sit for ten minutes before you are called. Do not run from the parking lot. If you have a logbook of readings from the last two weeks, bring it. An AME who sees a stack of 128/82 readings next to one office reading of 148/90 has context. An AME who sees only the 148 has a number.

And if your home numbers are above 155/95 and staying there, the week before the medical is not the time to try to fix it on your own. That is the time to call your doctor, because a prescription started now will not meet the seven day stability requirement anyway, and starting treatment on a plan is what the CACI worksheet was built for.

Talk to your AME

Everything above is a pilot reading FAA documents and clinic guidance. It is not an evaluation of you, and it does not tell you whether to start, stop or change a medication. Blood pressure has causes that have nothing to do with sodium or sleep, and sorting those out is a doctor's job.

If your readings are drifting up, bring the log to your doctor first and your AME second. Both would rather see a pilot with data and a question than one with a surprise. The FAA wrote the CACI worksheet so that a treated, stable pilot walks out with a certificate. The system is on your side. Use it early, while the number is still a trend and not a problem.