FMCSA sets specific blood pressure thresholds for CDL drivers. Here is exactly what each reading means for your medical certificate — and what to do if your BP is elevated on exam day.
Under 49 CFR Part 391.41, a commercial driver must not have a current clinical diagnosis of hypertension likely to interfere with the ability to operate a commercial vehicle safely. In practice, FMCSA uses four stages based on your reading on exam day.
Stage
Normal
Stage 1
Stage 2
Stage 3
Reading
Below 140/90
140–159 / 90–99
160–179 / 100–109
180/110 or higher
Certificate
24 months
12 months
12 months
Disqualified
Notes
Full 2-year card
Annual renewal required
Annual renewal; follow-up recommended
Must control BP below 140/90 before returning
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Stage 3 means you cannot drive that day
A reading of 180/110 or higher is an immediate disqualification. You will need to get your blood pressure under control and return with documentation from your treating physician before a medical examiner can certify you.
Medications
Can You Have a CDL with High Blood Pressure Medicine?
Yes. FMCSA does not prohibit CDL drivers from taking antihypertensive medication. The standard is whether your blood pressure is controlled on the day of examination and whether the medication itself causes side effects that could impair safe driving.
Medications that are generally acceptable
✓ACE inhibitors (lisinopril, enalapril) — well-tolerated, no significant driving side effects
✓ARBs (losartan, valsartan) — generally acceptable, rare dizziness risk
✓Calcium channel blockers (amlodipine, diltiazem) — generally acceptable
✓Thiazide diuretics (hydrochlorothiazide, chlorthalidone) — generally acceptable
✓Beta-blockers (metoprolol, atenolol) — acceptable; examiner may note fatigue risk
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Bring your medication list to the exam
Arrive with a complete list of your medications including dosages. If possible, bring a letter from your prescribing physician confirming your diagnosis and that your medication does not impair your ability to drive safely.
What the examiner evaluates
The medical examiner looks at three things: (1) your blood pressure reading on exam day, (2) the medication you are taking and its known side effects, and (3) whether you have any related conditions such as cardiovascular disease or kidney damage. If your BP is controlled and your medication is well-tolerated, most drivers pass without issue.
Exam Day Tips
How to Prepare for Your DOT Physical if You Have High Blood Pressure
1
Take your medication as prescribed
Do not skip your blood pressure medication before the exam. Take it on your normal schedule.
2
Avoid caffeine 2–3 hours before
Coffee, energy drinks, and some teas can temporarily raise blood pressure. Skip them the morning of your exam.
3
Arrive early and rest
Sit quietly for at least 5 minutes before your BP is taken. Walking in rushed or stressed will spike your reading.
4
Bring your medication list and physician letter
A letter from your treating doctor can help the examiner understand your treatment history and current control level.
5
Ask to rest and recheck if your reading is high
If your first reading is in Stage 3 territory, ask to sit quietly for 10–15 minutes and be retested. Many examiners will allow one recheck before recording a disqualifying result.
Frequently Asked Questions
Blood Pressure & DOT Physical — FAQ
FMCSA allows blood pressure up to 179/109 (Stage 2) to pass a DOT physical. Stage 1 (140–159 / 90–99) earns a 1-year certificate instead of 2. Stage 2 (160–179 / 100–109) also earns a 1-year certificate. Stage 3 (180/110 or higher) disqualifies you until your BP is controlled below 140/90.
Yes. Most blood pressure medications are acceptable for CDL drivers under FMCSA rules. The examiner will review your medication list and may request a note from your treating physician. The key requirement is that your BP is controlled — typically below 140/90 on the day of exam.
If your BP is 180/110 or higher (Stage 3), you will not pass that day. The examiner may allow you to rest and recheck once. If it remains at Stage 3, you will need to return after your BP is controlled below 140/90 with a note from your treating physician.
Normal BP (below 140/90): up to 24 months. Stage 1 hypertension (140–159 / 90–99): 12 months. Stage 2 hypertension (160–179 / 100–109): 12 months with a follow-up exam required. Stage 3 (180/110+): disqualified until controlled.
Anxiety-driven spikes (white coat hypertension) can temporarily elevate your BP enough to affect your certificate duration. Arrive well-rested, avoid caffeine, and sit quietly for 5 minutes before the reading. If elevated, ask to rest and be re-checked before the examiner records a Stage 3 result.
Not always required, but strongly recommended. Bring your current medication list and, if possible, a note from your prescribing physician confirming your diagnosis, dosage, and that the medication does not cause side effects incompatible with safe driving (such as dizziness or fatigue).
Most antihypertensives are acceptable. However, some medications carry side effects — like excessive drowsiness or dizziness — that may concern the examiner. Beta-blockers, ACE inhibitors, ARBs, and calcium channel blockers are generally well-tolerated. The examiner evaluates the whole picture: your BP reading, medication list, and side-effect profile.
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