[Hypertension and aeromedical considerations]

ABSTRACT

Hypertension is the most prevalent risk factor for arterial disease in the industrialized world and is a frequently encountered clinical problem in the aircrew population. Arterial systolic and diastolic blood pressures are continuously varying quantities, influenced by a host of extraneous factors. Aviators with hypertension responsive to life-style modifications should have serial BP rechecks quarterly to semi-annually during the first year to assure success of the lifestyle modifications. Failure to achieve blood pressure control with lifestyle modifications, or an initial blood pressure average exceeding 160 mmHg systolic or 100 mmHg diastolic, requires initiation of pharmacotherapy. In this study we evaluate books, magazines, articles, guidelines and reliable websites related to aeromedical concerns and waiver considerations in aircrew with hypertension. Two major "types" of essential hypertension are generally recognized. One is characterized by suppressed renin activity and sensitivity to dietary sodium, the other by high renin activity and a lack of response to sodium intake. Thiazide diuretics are certainly the initial therapy of choice, particularly for older subjects. Aircrew with blood pressure that is controlled adequately with thiazides, with no other uncontrolled cardiovascular risk factors, and with no evidence of end-organ damage, are usually fit to return to unrestricted flying in military and civilian spheres. ACE inhibitors are an alternative initial choice in younger aviators, are positively indicated in patients with type 2 diabetes, and have no adverse effects on serum lipids. Hydrochlorothiazide [hctz], with or without triamterene or potassium replacement, can be used as a first line agent for treatment of hypertension in designated personnel. ACE inhibitors might have an adverse effect on G-tolerance have not been borne out by experience in either the US Air Force or the Royal Air Force [RAF], and the US Navy accepts these agents for unrestricted flying without G-tolerance testing