The DOT physical is a mandatory medical examination required by the Federal Motor Carrier Safety Administration (FMCSA) to ensure commercial drivers are medically fit to operate vehicles safely. The examination focuses on conditions that could lead to sudden incapacitation or impaired judgment while driving. High blood pressure, or hypertension, is a significant focus because uncontrolled readings greatly increase the risk of stroke, heart attack, and other acute cardiovascular events. The results of the blood pressure check directly determine the maximum length of time a driver can be medically certified.
Understanding the FMCSA Blood Pressure Requirements
The FMCSA sets specific numerical thresholds for blood pressure to determine a driver’s medical certification period. A driver with a reading below 140/90 mmHg is considered to have controlled blood pressure, which qualifies them for the maximum two-year medical certificate. This full certification is granted when the driver is not taking medication for hypertension and has no other conditions requiring more frequent monitoring.
If a driver’s blood pressure is in the Stage 1 hypertension range (140–159 mmHg systolic or 90–99 mmHg diastolic), they may receive a one-year conditional certification. This certification allows time for the driver to be evaluated and begin treatment to lower their blood pressure. Drivers already on medication to control their blood pressure, even if the reading is below 140/90 mmHg, are typically limited to a one-year certification period to ensure their condition remains stable and treatment is well tolerated.
A reading in the Stage 2 hypertension range (160–179 mmHg systolic or 100–109 mmHg diastolic) results in a one-time, three-month temporary certification. This shorter window is provided so the driver can immediately initiate or adjust antihypertensive drug therapy. The driver must reduce their blood pressure to 140/90 mmHg or less before the three months expire. If successfully controlled by the follow-up exam, the driver may then be granted a one-year medical certificate, dated from the original examination.
What Happens After an Elevated Reading
When a Certified Medical Examiner (CME) records an elevated blood pressure reading that does not lead to immediate disqualification, a specific follow-up procedure is initiated. For drivers receiving the one-year conditional certificate for Stage 1 hypertension, the CME notes that the driver must return for an annual re-examination. If the driver is beginning treatment, they are advised to work with their primary care physician to establish a treatment plan.
For drivers issued the three-month temporary certificate for Stage 2 hypertension, the medical examiner documents that treatment must be started or adjusted. The driver is expected to return for a re-check to confirm their blood pressure is at or below 140/90 mmHg. The driver is responsible for bringing documentation from their treating physician detailing the medication type and dosage, and confirming that the treatment is well tolerated without side effects that could impair driving ability.
If the driver returns for the re-check and the blood pressure is controlled to the required 140/90 mmHg or less, the CME will issue a full one-year certificate. However, if the blood pressure remains elevated above the acceptable limit after the three-month window, the driver will be temporarily disqualified from operating a commercial motor vehicle.
Addressing Severe Hypertension and Disqualification
Severe, or Stage 3, hypertension is defined by a blood pressure reading at or greater than 180 mmHg systolic or 110 mmHg diastolic. A reading in this range leads to immediate medical disqualification from commercial driving. This rule is enforced because Stage 3 hypertension carries a high risk for an acute cardiovascular event, posing an unacceptable safety risk on the road.
A driver cannot be certified until their blood pressure is reduced to 140/90 mmHg or less, and the treatment is confirmed to be well tolerated. Once the driver’s blood pressure is successfully controlled, they may be certified, but only for a six-month period. Following this initial clearance, the driver will be required to undergo recertification examinations every six months to ensure the blood pressure remains consistently managed and below the critical threshold. This frequent monitoring is a long-term requirement for drivers who have been disqualified due to a prior severe hypertensive episode.