Q: What is hypertension?
Hypertension (high blood pressure) occurs when the pressure in a pilot’s arterial system is higher than normal. Blood pressure fluctuates with the pumping cycle of the heart. During contraction (systole) blood pressure increases as blood is pumped out of the heart into the aorta, while during relaxation (diastole) the heart fills with blood and blood pressure falls. Normal blood pressure is 120 (systolic) over 80 (diastolic) which is measured in millimetres of mercury (mmHg).
AvMed fact - did you know? The standard atmospheric pressure of 1013 hPa = 760 mmHg - about 6 times our normal systolic blood pressure!
Q: Why is it relevant to pilots?
Hypertension (like high oil pressure in an aircraf) increases the over-all load & stress on the system. Prolonged untreated hypertension can cause damage to a pilot’s: eyes, heart, kidneys & cerebral (brain) blood vessels (all these are needed to fly). It also increases the risk of: retinal eye disease, ischaemic heart disease (the cause of “heart attack”), heart muscle disease, kidney disease & stroke. All of these diseases have the potential to ground a pilot permanently!
In a similar way, as pilots we must regularly check our engine pressures in-flight (& if raised take immediate action). Because elevated oil pressures can damage the engine, or rupture the oil circulation system. Leading to a gradual or catastrophic loss of oil pressure, engine failure, then a forced grounding! So as pilots we must monitor our own T's & P's.
Q: What are the symptoms & how is it diagnosed?
Hypertension is known as a “silent killer” because symptoms, such as headache, visual disturbances, dizziness & chest pain, are not experienced until the disease is quite advanced.
It is usually discovered during a routine GP consultation or an aviation medical examination. It is then formally diagnosed when BP is 140/90 on 3 separate occasions or by 24-hour ambulatory blood pressure monitoring (ABPM).
AvMed fact - did you know? the CASA standard for blood pressure is less than 150/90 (which is actually higher than the diagnostic criteria for Grade 1 hypertension)
Q: What causes it?
There are two main types of hypertension based on the cause:
1. Primary (or Essential) hypertension (the most common form) occurs in the absence of a single identifiable cause but typically develops due to multiple risk factors such as: advancing age, obesity, excessive salt intake, alcohol consumption, smoking, atherosclerosis (hardening of the arteries due to high cholesterol) & genetics.
2. Secondary hypertension (the less common form) is caused by medical conditions or medications such as: obstructive sleep apnoea (OSA), excessive caffeine consumption, thyroid disease, chronic kidney disease, adrenal tumours, illicit ampehtamines (like ecstasy or methamphetamine), steroid medications & some contraceptive pills.
Q: How is it treated?
Hypertension is usually effectively controlled with a combination of life-style (or risk factor) modification and prescribed medications.
Lifestyle modification includes: losing weight (if overweight or obese), ceasing smoking, exercising regularly (45 mins x 3 times per week), reducing salt, alcohol & caffeine consumption.
Medications: while most anti-hypertensive medications ARE compatible with flying after a ground-trial period (up to a week), some are not. So always check with your DAME who can provide information to you, your GP or cardiologist on anti-hypertensive medications that are most compatible with flying.
Q: What can I do about it?
As Pilots we need to focus on maintaining our health, just as we pay attention to the regular maintenance of the aircraft we fly. The easiest way is by forming good habits (like brushing our teeth - it’s easy because its habitual).
Here are 5 good health habits for pilots:
Dietary habit - low salt, low sugar & low saturated fat diet with plenty of low GI carbohydrates, leafy green vegetables, fruit & lean meat like fish & chicken (drink alcohol & coffee in modest quantities or skip it all together)
Exercise habit - regular aerobic & resistance exercise ideally 20 to 30 mins every day but at least 30 to 45 mins x 3 per week
Sleep habit - go to bed at a consistent time & get at least 7 to 9 hours of sleep daily
Weight - maintain a healthy weight - if you start having to let your belt out a notch or have weight to lose - then work with your GP & or a dietician to lose it.
GP habit - find a good GP you like & trust & check in with them once or twice a year
Got more questions?
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