FMCSA Blood Pressure Thresholds for DOT Physical Certification

The Federal Motor Carrier Safety Administration (FMCSA) establishes specific blood pressure thresholds under 49 CFR 391.41(b)(6) that determine whether a commercial driver can be certified, and for how long. These standards exist because uncontrolled hypertension significantly increases the risk of heart attack, stroke, and sudden incapacitation while driving—all of which pose serious safety risks on the road.

Blood pressure is measured as systolic (top number) over diastolic (bottom number). The systolic reading indicates pressure when your heart beats, while diastolic measures pressure between beats. For DOT certification purposes, BOTH numbers matter—whichever reading places you in a higher category determines your certification outcome.

Understanding the Four Blood Pressure Categories

FMCSA recognizes four distinct blood pressure categories, each with different certification implications:

Normal Blood Pressure (Below 140/90): This is the target range for all commercial drivers. Readings consistently below 140/90 indicate well-controlled blood pressure that poses minimal cardiovascular risk during commercial vehicle operation. Drivers in this category qualify for the maximum 2-year medical certificate.

Stage 1 Hypertension (140-159 systolic OR 90-99 diastolic): Moderately elevated blood pressure requires annual monitoring. Drivers can still obtain certification but are limited to 1-year certificates. This ensures regular medical oversight while allowing continued commercial driving.

Stage 2 Hypertension (160-179 systolic OR 100-109 diastolic): Significantly elevated readings require immediate attention. The medical examiner may issue a one-time certificate valid for up to 1 year to allow time for the driver to receive treatment and achieve better control. Upon recertification, the driver must demonstrate improvement to readings below 140/90.

Stage 3 Hypertension (180+ systolic OR 110+ diastolic): Severely elevated blood pressure is immediately disqualifying. No certificate can be issued until blood pressure is brought under control through medical treatment. Drivers in this category should see their primary care physician promptly to begin or adjust treatment.

DOT Medical Certification Periods by Blood Pressure Level

The following table summarizes certification outcomes based on your blood pressure reading at the time of examination:

Important Note: If your systolic and diastolic readings fall into different categories, the higher category determines your certification. For example, a reading of 155/105 would be classified as Stage 2 (due to the diastolic reading) even though the systolic is only Stage 1.

What to Expect During Your DOT Physical Blood Pressure Check

Understanding the blood pressure measurement process can help you prepare mentally and physically for your examination. Here’s what happens at Charlotte DOT Exam Center:

The Measurement Process

When you arrive for your DOT physical, the medical examiner or staff member will take your blood pressure using a manual or automated sphygmomanometer (blood pressure cuff). You’ll be seated with your arm supported at heart level. The cuff is placed around your upper arm and inflated to temporarily stop blood flow, then slowly released while the examiner listens for pulse sounds or the machine records the readings.

At Charlotte DOT Exam Center, we follow American Heart Association guidelines for accurate measurement, which include:

• Allowing you to sit quietly for 5 minutes before measurement
• Using an appropriately sized cuff for your arm circumference
• Supporting your arm at heart level during measurement
• Taking multiple readings if the initial reading is elevated

If Your First Reading Is High

Many drivers experience “white coat hypertension”—elevated readings caused by the stress of a medical examination. If your initial reading is elevated, our examiners typically allow you to rest for several minutes before taking additional readings. The lowest of multiple readings is generally used for certification purposes.

According to FMCSA Medical Examiner Handbook guidelines, examiners should consider the driver’s overall cardiovascular health, not just a single blood pressure reading. If you have documentation of well-controlled blood pressure from your regular physician, bring it to your appointment.

What Happens If Your Blood Pressure Is Too High?

If your blood pressure exceeds the certifiable limits during your DOT physical, several options exist depending on how elevated your readings are:

Readings Between 160-179/100-109 (Stage 2)

The medical examiner may issue a one-time medical certificate valid for up to one year. This allows you to continue driving while seeking treatment to lower your blood pressure. However, when you return for recertification, you must demonstrate readings below 140/90 to receive another certificate. If your readings remain in Stage 2 territory at recertification, you will not be certified until achieving better control.

Readings at 180/110 or Higher (Stage 3)

You cannot be certified at this blood pressure level. The examiner will provide documentation explaining the disqualification and recommend that you see your primary care physician promptly. Once your blood pressure is controlled through medication, lifestyle changes, or both, you can return for recertification. There is no waiting period—you can return as soon as your readings are within certifiable range.

Returning After Treatment

Many drivers who are initially disqualified due to high blood pressure return within 2-4 weeks after starting or adjusting medication. We recommend bringing documentation from your treating physician showing your recent blood pressure readings and current medications. This helps demonstrate a pattern of control, not just a single good reading.

Tips to Lower Blood Pressure Before Your DOT Physical

If you know you have borderline or elevated blood pressure, these strategies may help you achieve better readings on exam day:

24-48 Hours Before Your Exam

• Avoid caffeine — No coffee, energy drinks, or caffeinated tea for at least 24 hours before your exam. Caffeine can temporarily raise blood pressure by 5-10 points.
• Limit sodium intake — High-sodium foods cause water retention, increasing blood pressure. Avoid fast food, processed foods, and adding salt to meals.
• Get adequate sleep — Sleep deprivation raises blood pressure. Aim for 7-8 hours the night before your exam.
• Avoid alcohol — While moderate alcohol may temporarily lower blood pressure, the rebound effect the next day can elevate it significantly.

The Morning of Your Exam

• Take your medications — If you’re prescribed blood pressure medication, take it as usual. Never skip doses before a DOT physical.
• Eat a light breakfast — Avoid heavy meals, but don’t skip eating entirely, as low blood sugar can cause stress responses.
• Allow extra time — Rushing to your appointment raises stress hormones and blood pressure. Arrive 10-15 minutes early.
• Empty your bladder — A full bladder can raise systolic pressure by 10-15 points.
• Use the restroom — The urinalysis portion of the DOT physical requires a urine sample anyway, so you’ll need some fluid, but don’t overhydrate.

At the Examination

• Sit quietly — When the examiner is ready to take your blood pressure, sit calmly with both feet flat on the floor. Avoid talking during the measurement.
• Practice deep breathing — Slow, deep breaths can lower blood pressure by several points within minutes.
• Request a second reading — If your first reading is high, ask if you can rest for 5 minutes and try again. Most examiners will accommodate this request.

For more information on managing blood pressure, visit our guide on borderline blood pressure and DOT physicals.

Blood Pressure Medications and DOT Physical Certification

Taking blood pressure medication does NOT disqualify you from obtaining a DOT medical certificate. In fact, FMCSA encourages treatment of hypertension. The regulations focus on whether your blood pressure is controlled, not whether you take medication.

Commonly Prescribed Blood Pressure Medications

The following medication classes are commonly used to treat hypertension in commercial drivers and are generally acceptable for DOT certification:

• ACE Inhibitors (Lisinopril, Enalapril, Benazepril) — Generally well-tolerated with minimal side effects affecting driving ability
• ARBs (Losartan, Valsartan, Olmesartan) — Similar to ACE inhibitors, rarely cause drowsiness or impairment
• Calcium Channel Blockers (Amlodipine, Diltiazem, Nifedipine) — Effective for hypertension, usually well-tolerated
• Diuretics (Hydrochlorothiazide, Chlorthalidone, Furosemide) — May cause more frequent urination, plan accordingly for long hauls
• Beta Blockers (Metoprolol, Atenolol, Carvedilol) — Effective but may cause fatigue in some drivers; discuss with your physician if you experience drowsiness

Medications That May Require Additional Evaluation

Some blood pressure medications can cause side effects that may affect driving ability. If you take any of the following, ensure your condition is stable and you don’t experience impairing side effects:

• Clonidine — Can cause drowsiness, especially when starting treatment
• Alpha blockers (Prazosin, Doxazosin) — May cause dizziness, especially when standing quickly
• Central-acting agents — May cause sedation in some patients

If you experience side effects from your blood pressure medication, work with your physician to find an alternative that provides good blood pressure control without impairing your ability to drive safely.

For drivers taking multiple cardiovascular medications, see our related guides on heart disease and DOT physicals and blood thinners and DOT certification.

Why Choose Charlotte DOT Exam Center for Your Blood Pressure Evaluation

At Charlotte DOT Exam Center, we understand that high blood pressure is a manageable condition that shouldn’t end your commercial driving career. Our FMCSA-certified medical examiners have over 84 years of combined experience helping drivers with hypertension achieve certification.

Our Medical Examiners

What Sets Us Apart

• $70 flat rate — same price regardless of blood pressure complexity
• Multiple blood pressure readings if initial reading is elevated
• Same-day certification for drivers who meet standards
• Walk-ins welcome Monday-Friday 8:30am-5:00pm, Saturday 8:30am-12:00pm
• FMCSA National Registry electronic submission within 1 hour
• Clear guidance on next steps if certification is delayed
• 4.8/5 rating from 426+ reviews

Frequently Asked Questions: High Blood Pressure and DOT Physicals

Q: What blood pressure is too high to pass a DOT physical?

Blood pressure at or above 180/110 mmHg is immediately disqualifying. You cannot receive a DOT medical certificate until your blood pressure is brought under control through treatment. Readings between 160-179/100-109 may receive a one-time certificate, but readings at 180/110+ require treatment before any certificate can be issued.

Q: Can I pass a DOT physical if I take blood pressure medication?

Yes. Taking blood pressure medication does not disqualify you from DOT certification. FMCSA standards focus on whether your blood pressure is controlled, not whether you take medication. In fact, treated and controlled hypertension is preferred over untreated elevated blood pressure.

Q: What if my blood pressure is high because I’m nervous?

“White coat hypertension” is common. If your first reading is elevated, our examiners will typically allow you to rest for several minutes before taking additional readings. The lowest reading is generally used for certification purposes. Bringing documentation of normal readings from your regular doctor can also help.

Q: How long do I have to wait to retake the DOT physical after failing for high blood pressure?

There is no mandatory waiting period. Once your blood pressure is controlled through medication or lifestyle changes, you can return for recertification immediately. Many drivers return within 2-4 weeks after starting or adjusting medication.

Q: Will I get a 1-year or 2-year certificate with high blood pressure?

Blood pressure below 140/90 qualifies for a 2-year certificate. Readings between 140-159/90-99 (Stage 1) receive a 1-year certificate. Readings between 160-179/100-109 (Stage 2) may receive a one-time 1-year certificate, but you must achieve below 140/90 for subsequent certifications.

Q: Does Charlotte DOT Exam Center take multiple blood pressure readings?

Yes. If your initial reading is elevated, our examiners will allow you to rest and take additional readings. We want to give you the best chance of achieving certification, and we understand that a single elevated reading doesn’t always reflect your typical blood pressure.

Q: What should I do the night before my DOT physical to lower blood pressure?

Avoid caffeine, alcohol, and high-sodium foods for 24 hours before your exam. Get a full night’s sleep (7-8 hours). Take your regular blood pressure medication as prescribed. Arrive early to your appointment so you’re not rushed or stressed.

Charlotte DOT Exam Center Location

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Areas We Serve

Charlotte DOT Exam Center serves commercial drivers throughout the Charlotte metropolitan area including Charlotte, Pineville, Matthews, Mint Hill, Ballantyne, South Charlotte, Huntersville, Concord, Gastonia, Indian Trail, Monroe, Mooresville (NC), and Rock Hill, Fort Mill, Tega Cay (SC).