The Department of Transportation (DOT) physical examination is a mandatory screening tool to ensure commercial driver’s license (CDL) holders are medically fit to operate heavy vehicles safely. Required by the Federal Motor Carrier Safety Administration (FMCSA), the exam focuses on health conditions, such as hypertension, that could lead to sudden incapacitation or impaired judgment. While an elevated reading will not automatically fail the physical, it triggers specific guidelines determining the length of certification. The medical examiner’s goal is to confirm that existing hypertension is managed and stable, preventing a health risk from becoming a public safety hazard.
The Specific Blood Pressure Standards
The answer to passing a DOT physical with high blood pressure depends entirely on the measured reading, as the FMCSA has established clear thresholds linked to certification timelines. Drivers with a blood pressure reading below 140/90 mmHg generally receive the maximum medical certification period of two years, provided they have no other disqualifying conditions.
Readings that fall into Stage 1 hypertension (systolic pressure 140–159 mmHg or diastolic pressure 90–99 mmHg) result in a shorter, one-year certification. This period allows the driver to continue working while requiring annual monitoring to ensure the condition does not worsen. The medical examiner must confirm the driver is actively managing the condition, often through lifestyle changes or medication, to maintain the pressure below 140/90 mmHg by the next exam.
A more elevated reading, categorized as Stage 2 hypertension (systolic pressure 160–179 mmHg or diastolic pressure 100–109 mmHg), grants a one-time, temporary three-month certification. This brief period allows the driver time to seek treatment and lower their blood pressure to a safer level.
Any blood pressure reading at or above 180/110 mmHg is classified as Stage 3 hypertension and results in an immediate temporary disqualification. The driver cannot be certified, even temporarily, until their blood pressure is reduced to 140/90 mmHg or less. This strict limit is in place because Stage 3 hypertension carries a substantially higher risk of acute complications.
Conditional Certification and Re-testing
A driver who receives the one-time, three-month conditional certification due to Stage 2 hypertension must immediately initiate treatment to stabilize their blood pressure. This short-term card provides a window for the driver to work with their healthcare provider to reach a controlled state. Before the three months expire, the driver is required to undergo a mandatory re-examination.
During this follow-up visit, the medical examiner will re-measure the blood pressure, expecting a reading of 140/90 mmHg or lower. If the driver successfully lowers their pressure to the acceptable range, they will be issued a one-year medical certification. Importantly, this one-year period is dated from the day of the initial examination, not the date of the successful follow-up.
For a driver temporarily disqualified due to Stage 3 hypertension, the process to return to work is similar, but the subsequent certification is shorter. Once their blood pressure is lowered to 140/90 mmHg or less and the treatment is well-tolerated, they may receive a six-month certification. The driver must then be re-examined every six months thereafter to maintain sustained blood pressure control.
Failing to meet the required blood pressure standard of 140/90 mmHg by the end of the conditional three-month period results in a full medical disqualification. The driver must cease commercial driving activities until they can present a controlled blood pressure reading in a subsequent examination. This rigorous re-testing schedule ensures that only drivers who can demonstrate sustained management of their hypertension are permitted to operate commercial motor vehicles.
Documentation Requirements for Controlled Hypertension
For drivers with a pre-existing diagnosis of hypertension managed with medication, the requirements shift toward documentation and demonstrated stability. If the driver’s blood pressure is consistently below 140/90 mmHg at the time of the physical exam while on treatment, they are certified for one year. This annual recertification is necessary to monitor the ongoing efficacy of the treatment plan.
The medical examiner requires specific documentation to confirm the stability of the condition and compliance with treatment. This includes a complete and accurate list of all current blood pressure medications, their dosages, and the contact information for the prescribing physician. A note from the treating physician confirming that the condition is stable and the treatment is well-tolerated is also expected.
The examiner must evaluate the medication regimen to ensure it does not produce any side effects that could impair the driver’s ability to operate a vehicle safely. Certain side effects, such as dizziness, excessive fatigue, or sudden drops in blood pressure, must be ruled out before certification is granted. Providing this thorough medical history and documentation streamlines the examination process and facilitates the one-year medical certification.