A pilot’s blood pressure, hypertension and the FAA Form 8500-9
Vas•cu•lar [adjective] Latin: Hollow container; a vessel or vessels, especially those that carry blood.
Time Bomb: [noun] A potentially detrimental, dangerous or catastrophic delayed reaction.
They say many people don’t realize that they have high blood pressure. This isn’t true for us pilots because we get it checked all the time. We should know ours. What we may not know, however, is what BP reading is “too” high. After a half-century of uneventful civilian and military flight physicals, about a year ago my blood pressure inexplicably started to climb.
But why fret? High BP is simply caused by stress and we can control stress, right? After all, we’re Twin & Turbine pilots: steely eyed, cool, calm and collected. Poised and unflappable. Fighter pilots, astronauts, airline pilots, physicians, attorneys, business moguls, authors, artists, stock brokers and engineers. We eat stress for breakfast. And we don’t notice the strain because we tactfully handle stress like a dog: if we can’t eat it, play with it, or fix it, we pee on it and walk away.
Blood pressure was never an issue in past flight physicals, so my first “recheck” at 153/91 was a wake-up call. It turns out that BP is influenced by different things for different folks. And for any one individual, the things that had no influence in the past may have an influence as we age. BP is something that we must actively monitor and if necessary, modify any contributory behaviors. There’s no peeing on this one and walking away. You’ve written me asking for pearls of wisdom from my 23,000-plus hours of flying. This pearl is about getting our BP where it belongs. Because if we lose control of it, we could die. Or worse, we could lose our medical and ability to act as PIC.
I’m not a physician, I don’t play one on TV and I didn’t stay at a Holiday Inn Express last night. But I did learn interesting things about blood pressure and how easy it can be for most of us to lower it. I had some time away from flying due to rotator cuff surgery, so I took the time to read all about hypertension. I started reading food labels and dropped my sodium intake to near zero. I even stopped drinking softened (salty) tap water. Hold your nose if you must, as you swallow the following, unsalted, need-to-know medicine.
The first number, systolic blood pressure, measures the pressure in your blood vessels when your heart beats (contracts). The second number, diastolic blood pressure, measures the pressure when your heart rests between beats. The maximum systolic pressure (the first, bigger number) for a first, second and third-class physical are all approximately 155. It’s an approximate number because the physician has some clinical discretion including checking it twice during the same visit. The recheck is to help with white-coat syndrome, BP cuff placement and to facilitate a perhaps more meticulous overall procedure and interpretation.
If a pilot with no known history of hypertension is found to have blood pressure consistently higher than 155/95, then further investigation is required. Initially, this should consist of recording the blood pressure twice a day (morning and evening) for three consecutive days. If at least four of these six readings are 155/95 or less and the pilot is otherwise qualified, then no further action is required, and the certificate can be issued.
If the three-day blood pressure checks confirm the presence of hypertension, then treatment of some kind will be required for certification. Once a person is on a stable treatment plan and their blood pressure is adequately controlled without significant adverse effects, certification can be considered.
For an individual who has already reported the hypertension and received an initial clearance, the follow-up requirements are simple. All that’s required is a statement from the treating physician that the individual is in good health and is having no blood pressure-related problems. Some sample blood pressure readings should be included in the report. There are some things to know and do in order to avoid this “what if” scenario.
Worth His Salt
According to scientists at Weill Cornell Medicine in New York City, a high-salt diet can lead to significant mental decline. Researchers fed mice 8 to 16 times their normal salt intake and observed a dramatic drop in blood flow to the cortex and hippocampus. After three months, the mice were suffering from cognitive decline and struggled to navigate a maze. They believe their findings likely apply to people as well.
Other than losing our medical, it’s easy to understand why we should be concerned about sodium and high blood pressure: it’s all of that other heart attack, stroke, dementia, impotence and death stuff that it can cause. And getting lost in a maze would be terrifying. Hypertension affects the heart, kidneys, eyes and brain. High blood pressure is a risk factor for kidney failure and atherosclerosis (hardening of the arteries). Strokes can also come from damaged and weakened blood vessels in the brain, high BP having caused them to narrow, rupture or leak. High blood pressure can also cause blood clots to form in the arteries leading to your brain, blocking blood flow and also causing a stroke.
If we have high blood pressure, is our life as a pilot over? Not at all. The brain function of the mice was restored to normal when they resumed a normal diet. And the blood pressure of most pilots can be lowered with a few changes in lifestyle and diet.
Fortunately, hypertension is easy to treat. For many people, simply achieving an appropriate weight (BMI), exercising regularly and restricting dietary salt (sodium) will control mild hypertension. Severely restricting salt intake worked great for me and lowered my BP from 150 to below 120 in just a few days. And therein lies this month’s humbly offered pearl of wisdom. I have never needed to, or tried to, control my diet. You name it and I’ve eaten it: spicy food, salty food, canned soup and canned “meats,” all manner of chips, candy and condiments. I’ve even eaten things that aren’t actually a food, like bugs, tree sap, glue, paper and airline crew-meals (no Tide Pods). But after 60-plus years of carefree and careless dining, my BMI is 24.0, A1C blood glucose is 5.3, HDL cholesterol is 35 and LDL is 83. And up until last year, my BP was below 140. When it climbed over 150 and started to threaten my FAA medical, sodium and I parted ways.
Here are three blood pressure myths and some final pearls of wisdom to consider before your next flight physical.
Myth No. 1: High blood pressure runs in my family so there’s nothing I can do to prevent it. Yes and no. While hereditary, lifestyle and dietary choices have allowed many people with a family history to avoid it themselves.
Myth No. 2: I don’t use table salt so I’m in control of sodium intake. Not good enough. About 75 percent of the sodium we consume is in processed foods. The worst are vegetable juice, canned soups, canned meats, canned vegetables, most
condiments, beets, lunch meats, spag-hetti sauce and ready-to-eat cereals.
Myth No. 3: I don’t use any regular table salt, only kosher, red or sea salt. Wrong answer. Table salt, red salt and sea salt contain comparable amounts of sodium by weight. All are about 97 percent NaCl (40 percent sodium, 60 percent chloride).
Once we’ve licked our salt addiction, we can also consider some precautionary, pre-physical preparations to avoid other problematic peculiarities as well. And although most minor abnormalities are shown to be not clinically significant, the time, expense and anxiety associated with obtaining the required re-evaluation tests and exams can be avoided by simple preparation.
Before the medical exam you should be well rested and should avoid high-sugar meals, caffeine, tobacco, ibuprofen, decongestants and stimulant type medications. Also, meals high in sugar may cause an erroneous result in the urinalysis. Complex carbohydrates (green vegetables, whole grains and beans) and proteins before the exam will stabilize blood sugars. These recommendations will also help in achieving normal and consistent EKG results.
With any luck, these pearls of wisdom have convinced you to monitor your BP and to keep it in the normal (<120) range; maybe even buy a blood pressure monitor. They range from $30 to $90 for an automatic, electronic version. I’d get one with an arm cuff instead of for the wrist; they’re more accurate.
Read food labels, stop eating salt, get your BMI where it belongs and have a few delicious green salads with sunflower seeds, chicken and beans before your next physical. Similar to running your engines at redline, with high BP, eventually something is going to blow. Remember, even if you stop eating bugs, tree sap and stress for breakfast, and even if you don’t add salt to your crew meal, high blood pressure is something you can’t just pee on and walk away.