Hypertension (High blood pressure) General discussion

Author: Dr Philip Ranger

Although pilots are often, understandably, anxious about their pilot’s medical, they do serve a very useful function as well as being part of the safety regulations. It must also be said that it is very rare for a condition to be found at medicals which is totally and permanently disabling.

One of the most important problems picked up during a pilot’s medical is high blood pressure or “Hypertension”. There are two important facts to remember. Firstly, it is a misconception that high blood pressure is associated with symptoms, a fact established from many studies. Secondly, 60% of all cases of blood pressure have an hereditary basis. (A study once suggested that high blood pressure could be predicted by looking at the fingerprints of developing babes before birth.)

Following all the well known recommendations to lower blood pressure (losing weight, avoiding excess salt, doing more exercise and avoiding stress) can help mild to moderate blood pressure to a certain degree but may not prevent its onset or development.

Few people have their pressure checked as often as pilots during their medicals and the early detection of high levels is, in fact, a very worthwhile discovery. In my 42 years of medicine l have seen huge changes in the recommended levels and treatment programmes. In the 1970’s what would now be considered moderate to high levels were simply advised and followed up on an infrequent basis. Indeed treatment was generally only given for levels where there was a real risk of stroke. Around that time a number of researchers performed the, so called. ‘Thirty Year Trials’. These were studies following the long-term progress of people with moderate elevations of pressure and studying the effect of this on the end organs. These are the parts of the body which might be affected such as the heart, kidneys, eyes and so on. The results showed clearly that, while incidences of strokes and heart attacks did not say, quadruple, there was a significant increase in these events.

As a result of this, treatment was recommended for even moderate elevations and fortunately this coincided with improvements in the drugs used for treatment. Early drugs often had very profound side effects making their use difficult to justify at these moderately raised blood pressure levels.

The levels concerned and their application to pilots’ medicals will be considered separately.


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