Measure Blood Pressure and Check Pulse

Because of the prevalence of hypertension in the commercial driving population, this routine test is an essential tool as part of the physical examination to determine the medical fitness for duty of the driver. Blood pressure (BP) should be measured in a standardized fashion using equipment that meets certification criteria.

BP levels aid in evaluating the risk of an acute hypertensive event while driving and assist you as you make certification decisions that allow a driver who does not present an immediate safety risk to continue working while obtaining primary care provider evaluation and implementing a primary care provider treatment plan.

Remember, you are the medical examiner and not the treating provider. The purpose of the examination is medical fitness for duty, not diagnosis and treatment of the underlying disease.

Note: Under the supervision of the medical examiner, trained assistive personnel may measure and record BP; however, it is prudent for the medical examiner to confirm disqualifying BP personally.

Pulse

Check the pulse and note rate, strength, and rhythm.

Confirm Elevated BP

Confirm BP higher than or equal to 140/90 with a second measurement taken later during the examination. BP, especially systolic pressure, will fluctuate in a short time from normal to elevated and back to normal as a response to many factors, including:

• Circadian cycle.
• Emotional and physical states.
• Transient hypertension (e.g., "white coat syndrome").
• Use of left versus right arm during BP measurement.
• Problems with technique, such as:
  • Placing the BP cuff over clothing instead of on the skin.
  • Using an inappropriately-sized BP cuff.
  • Positioning the arm incorrectly.