blood pressure meds correct procedure?

[Unregistered]

Here's the FL300 view - I'm a 44 year old male with otherwise excellent health, no meds, PPSEL and 3rd class medical, no interest in commercial ops. My BP has been borderline for several years now (140's/80's) and my primary doc wants to put me on low-dose Lisinopril to control it. I'm up for my 3rd class renewal in a few months, I would like to sail through that with a minimum of fuss and paperwork with this BP med.

My question is this - what is the "proper" way to handle this to avoid pain and angst with the AME? Should I go on the Lisinopril and document effects for some period of time (30/60/90 days? longer?) and then go for my 3rd class? Or should I go to the AME and tell him I just started the BP med and we are monitoring? Will that likely get a referral and second visit? What's the easiest way to handle this med transition?

 

[gprellwitz]

Get on the med now, get stable, and get a letter from your MD to that effect saying that you've been stable since xx/yy on such a dose with no side effects. It's a yawn.

 

[azure]

Seconding what Grant said. My BP was even farther from the "edge", i.e. 125-130/85 and I insisted on medication for it. The standard letter just says that the doctor is satisfied with your BP control, that your blood pressure is stable, and that you have no side effects and doc has no immediate plans to change your regimen. Easy peasy.

 

[ronnieh]

Yep what they said. One thing, I am not familiar with Lisinopril but, most BP meds are approved. Just make sure.

 

[azure]

Yep what they said. One thing, I am not familiar with Lisinopril but, most BP meds are approved. Just make sure.

Yes, make sure, but I can't see why it wouldn't be. Pretty common ACE inhibitor.

 

[Clark1961]

Yep what they said. One thing, I am not familiar with Lisinopril but, most BP meds are approved. Just make sure.

Lisinopril is approved.

Other question, I had to get an EKG for the first 3rd class after starting the blood pressure meds. What's the trigger on that? One thing Doc Bruce mentioned about EKGs was to get it sooner rather than later so stuff that shows up as you age isn't there 'cause there may be some FAA hurdles associated with "stuff" which may show up. I think the "stuff" was bundle branch blocking or something along those lines.

 

[another unreg]

Like the OP, I am a PPASEL with a 3rd class. I am in my late 30s, in otherwise good health, BMI <25, but my bp wanders from 130/80 to 140/90. I have been with my primary care doc for about a decade but he has not treated my prehypertension. At what point should medication be prescribed?

 

[azure]

Lisinopril is approved.

Other question, I had to get an EKG for the first 3rd class after starting the blood pressure meds. What's the trigger on that? One thing Doc Bruce mentioned about EKGs was to get it sooner rather than later so stuff that shows up as you age isn't there 'cause there may be some FAA hurdles associated with "stuff" which may show up. I think the "stuff" was bundle branch blocking or something along those lines.

Check with Doc Bruce on that, but HTN is now a CACI. I think the EKG requirement was from the days when it was a full SI or AASI. The current worksheet (attached) doesn't mention it.

 

[AggieMike88]

Yep what they said. One thing, I am not familiar with Lisinopril but, most BP meds are approved. Just make sure.

IIRC nearly all are okay if that's the only condition. But if you also are a diabetic, there are some "yellow alert" combinations of BP meds and DM meds. Check the AME guide and the various medication lists (like what AOPA maintains) for more details.

 

[azure]

My dad was on Catapres (clonidine), a centrally acting alpha-2 agonist, for blood pressure. Pretty sure that one is not allowed by the FAA. So it's a good idea to check and not assume that since it's for HTN, it's good.

 

[Paul Hamilton]

According to my AME, Lisinopril is approved.

 

[timwinters]

According to my AME, Lisinopril is approved.

Yes, that's what I'm on and it's not an issue at all. I forgot about having to get an EKG and note from my PCP when I went in for my next FAA exam but, indeed, That's what I went thru...now that someone above jogged my memory.

It was a yawn...and less than $100 addl cost for me (my insurance covered the EKG).

 

[Unregistered]

Yes, that's what I'm on and it's not an issue at all. I forgot about having to get an EKG and note from my PCP when I went in for my next FAA exam but, indeed, That's what I went thru...now that someone above jogged my memory.

It was a yawn...and less than $100 addl cost for me (my insurance covered the EKG).

OP here - my PCP has run an annual EKG on me for the last 4 years (no cost, good insurance) so I've got the historical records on that too. So far nothing has shown up worth noting, but copies of those would be helpful for the AME, I'm sure.

 

[gprellwitz]

OP here - my PCP has run an annual EKG on me for the last 4 years (no cost, good insurance) so I've got the historical records on that too. So far nothing has shown up worth noting, but copies of those would be helpful for the AME, I'm sure.

Don't provide more than s/he asks for. Their role is to certify you, not provide your health care.

 

[Doggtyred]

Like the OP, I am a PPASEL with a 3rd class. I am in my late 30s, in otherwise good health, BMI <25, but my bp wanders from 130/80 to 140/90. I have been with my primary care doc for about a decade but he has not treated my prehypertension. At what point should medication be prescribed?

Joint National Committee (JNC8) guidelines call for your age cohort to have a blood pressure (or be treated to a blood pressure) of less than 140 systolic/less than 90 diastolic. You are right on the cusp. If you are already doing maximal behavior modifications (diet, exercise, etc) then it might be time to have that conversation with your physician.

There is some internal controversy over the JNC8 guidelines over the previous JNC7 guidelines, but that controversy does not include the recommendations for your age group.

 

[Doggtyred]

OP here - my PCP has run an annual EKG on me for the last 4 years (no cost, good insurance) so I've got the historical records on that too. So far nothing has shown up worth noting, but copies of those would be helpful for the AME, I'm sure.

Only submit if asked. Keep prior EKG's in your back pocket until needed or asked for. If there is a "problem" with a new EKG, and the problem is present on old EKG's it may lend evidence to your "problem" being a normal variant rather than pathologic. My dad had a "glitch" when he got a 1st class back in the 80's (and was grounded in the interim).. It took getting his old files from the Army in the 70's to prove that he was airworthy and a normal variant, rather than having pathology.

 

[Doggtyred]

According to my AME, Lisinopril is approved.

Lisinopril is a great drug, and cheap (generic).... The only thing I caution people about is if you develop a dry, persistent, unrelenting cough the drug may be the culprit. Even though it has its effect in the kidneys, the pharmacodynamics of the medication involve lung tissue. In a significant number of patients they eventually develop such a cough. I did. After a couple years of medicating. Changing to an ARB got rid of the cough. Estimates are that up to 1/3rd of patients develop that side effect.

If you develop a persistent cough on lisinopril, your chest X-ray is clear, and you don't have a fever or "viral syndrome" you might want to talk to your prescriber about a different class of medication.

 

[gprellwitz]

Lisinopril is a great drug, and cheap (generic).... The only thing I caution people about is if you develop a dry, persistent, unrelenting cough the drug may be the culprit. Even though it has its effect in the kidneys, the pharmacodynamics of the medication involve lung tissue. In a significant number of patients they eventually develop such a cough. I did. After a couple years of medicating. Changing to an ARB got rid of the cough. Estimates are that up to 1/3rd of patients develop that side effect.

If you develop a persistent cough on lisinopril, your chest X-ray is clear, and you don't have a fever or "viral syndrome" you might want to talk to your prescriber about a different class of medication.

Yes, I had that cough, so we went to a different Rx. Leslie had a much rarer reaction, and ended up going through abdominal surgery before we tied her symptoms to Lisinopril.

 

[Stingray Don]

I started taking Lisinopril last year and the AME didn't even bat an eye. It was not an issue.

 

[mattaxelrod]

I believe the letter from your treating doc should mention the dosage, lack of any side effects, the BP is well controlled, and something that I think has not been mentioned here yet, but is very important: Patient is not being treated for any cardiac issues or conditions.