NRCME Blood Pressure Guidelines: Hypertension and Driver Certification

Blood pressure evaluation is one of the most critical and most frequently tested topics on the NRCME exam. Hypertension is extremely common among commercial drivers, and knowing the exact certification guidelines is essential for both the exam and clinical practice.

FMCSA Blood Pressure Classification and Certification

The FMCSA uses a specific blood pressure classification system that determines certification periods:

Stage 1: Systolic 140–159 or Diastolic 90–99

Drivers in this range may be certified for a maximum of 1 year. Annual recertification is required, and the examiner should counsel the driver on lifestyle modifications and the importance of blood pressure management. If the driver is on antihypertensive medication, they should be stable on their current regimen.

Stage 2: Systolic 160–179 or Diastolic 100–109

A driver with Stage 2 hypertension may receive a one-time certificate for up to 1 year. The driver must initiate or adjust treatment and return for recertification with blood pressure readings below Stage 2 levels. If the blood pressure remains in the Stage 2 range at the follow-up visit, the driver should not be recertified until adequate control is achieved.

Stage 3: Systolic 180+ or Diastolic 110+

Drivers with Stage 3 hypertension should not be certified. The driver must be treated and achieve blood pressure below 140/90 before being considered for certification. This is a clear disqualification on exam day.

Normal: Below 140/90

Drivers with blood pressure below 140/90 may be certified for up to 2 years, assuming no other disqualifying conditions are present.

Common Exam Scenarios

The NRCME exam frequently presents blood pressure scenarios that test your ability to apply these guidelines. Common question types include:

• Borderline readings: A driver presents with BP of 158/98. What certification period? (Answer: Stage 1, certify for max 1 year)
• Follow-up visits: A driver was given a 1-year certificate for Stage 2 HTN. They return with BP 148/92. What do you do? (Answer: Now Stage 1, can recertify for 1 year)
• Multiple readings: Questions about whether to average readings, which reading to use, and how to handle white-coat hypertension
• Medication considerations: Whether specific antihypertensive medications affect driving ability

Key Points to Memorize

• Below 140/90 = 2-year certification
• 140–159 / 90–99 (Stage 1) = 1-year maximum
• 160–179 / 100–109 (Stage 2) = One-time 1-year certificate, must improve
• 180+ / 110+ (Stage 3) = Do not certify
• Use the higher classification if systolic and diastolic fall into different stages
• Treated hypertension with BP below 140/90 can receive a 2-year certificate

Practice These Scenarios

Blood pressure questions are among the most common on the NRCME exam and also among the most straightforward to prepare for—the numbers are concrete and the guidelines are specific. Drilling these scenarios until the classification and certification decisions are automatic will earn you easy points on exam day.

Our NRCME practice tests includes dozens of blood pressure and hypertension scenarios across different clinical presentations.