Medical qualification

DOT physical blood pressure: guidance

CDLP editorial · 5 min read
Published Nov 2, 2026 · Updated Nov 8, 2026

What blood pressure do you need to pass a DOT physical?

It depends on your readings, history and the examiner’s review. The federal standard bars high blood pressure likely to harm safe commercial driving. It gives no single number as a pass mark. FMCSA’s January 2024 Medical Examiner’s Handbook gives guidance by stage. This includes shorter card periods and follow-up numbers. Those guidelines do not promise that a given reading will pass. Bring your history and treatment details to a certified examiner. Discuss treatment with your clinician.

If this is your situation, start here
Your situation	Start with…
You have a recent reading	Read the stages and their conditions
You need a follow-up exam	Check which threshold applies
You are preparing records	Bring a useful health history

49 CFR 391.41(b)(6) states the safety standard. The numbers below come from FMCSA’s January 2024 handbook. That paragraph itself gives no number as a cutoff. Both were checked November 2, 2026.

This explains guidance for medical cards. It gives no medical advice. Use the full DOT physical guide to prepare for the appointment. For the separate knowledge exam, free general knowledge practice remains available.

Read the stage guidance with its conditions

Source: FMCSA Medical Examiner’s Handbook, 2024 Edition, January 22, 2024, §4.6.2, printed pages 26–27; checked November 2, 2026. This table summarizes advisory guidance. The examiner applies the standard to each person.

FMCSA handbook blood-pressure guidance — January 2024 edition
Handbook category	Reading described, mmHg	Certification guidance
Stage 1	Systolic 140–159 and/or diastolic 90–99	May certify for one year; annual examinations thereafter should be at or below 140/90.
Stage 2	Systolic 160–179 and/or diastolic 100–109	May give a one-time three-month certificate; if treatment is tolerated and BP is at or below 140/90, may certify for one year.
Stage 3	The handbook states at or above 180 systolic and 110 diastolic	Do not qualify until BP is at or below 140/90 and treatment is tolerated; may then certify for six months, with six-month rechecks.

The table keeps the handbook’s distinct wording for Stage 3. A high systolic or diastolic reading alone is not proof you are safe or qualify. Ask the examiner what your readings mean.

A follow-up threshold is not a universal pass mark

FMCSA’s hypertension guidance issued April 1, 2014, checked November 2, 2026, says a driver below 140/90 may get a two-year card. A driver treated for diagnosed high blood pressure should be certified at least yearly. The January 2024 handbook gives the fuller stage guidance in the table.

More about A follow-up threshold is not a universal pass mark

The handbook has Stage 1 guidance for a later exam. If BP is below 160/100 but above 140/90, it describes a one-time three-month card. It advises a yearly card if the examiner does not know how severe BP was before treatment. Those guidelines have conditions.

Give the examiner the history behind the current reading. A prior short card can affect the review. So can treatment response and other health findings. The table alone cannot promise how long a card will last.

Prepare a useful medical history

Ask the examiner’s office which treatment records it needs. The medical report and health-history walkthrough explains where those details belong. Bring a correct drug list and relevant clinician records. Use the office’s secure process. This helps the examiner check your health and its effect on safe driving.

The handbook covers checking high readings and the effects of treatment. Let the examiner conduct that assessment. Do not change drugs, hide history or try to change a reading to get a card.

Separate clinical treatment from certification

Your treating clinician manages health care. The certified examiner decides if your health meets commercial driving rules. They may need to share records. A treatment plan does not promise a card.

Ask which facts are missing and which follow-up the examiner needs. Check what the decision means for your card. Direct treatment questions to your clinician. This guide cannot diagnose high blood pressure or settle your exam result.

Plan training around the actual medical result

Use the certificate and examiner’s instructions when planning dates with a school or employer. If you need more health review, plan that step first. A course start date does not mean your health qualifies.

The CDL requirements guide explains the wider steps to get a license. Medical fitness is one part of the process. Passing a knowledge quiz does not replace it.

Your next-step checklist

I know the difference between the regulation and advisory guidance.
I have my accurate medical and treatment history.
I asked the examiner which records to bring.
I will follow clinical advice without changing treatment to influence the exam.
My training plan reflects the actual certification decision.

Use this as a planning checklist. Selections stay on this page and are not submitted.

Questions drivers ask

Does §391.41 print a 140/90 pass mark?

No. Paragraph (b)(6) states a safety standard. These stage numbers and card guidelines come from FMCSA’s January 2024 handbook.

Does a reading below a table threshold guarantee a medical card?

No. The examiner checks the full exam, history and standards. This table cannot decide if you qualify.

Can blood-pressure treatment affect certification?

The handbook asks examiners to consider treatment tolerance and effects. Discuss your records with the examiner and treatment questions with your clinician.

Should I change medication before the exam?

Do not change treatment to affect an exam. Ask the prescribing clinician about treatment. Give the examiner correct facts.

Which handbook version does this page use?

The FMCSA Medical Examiner’s Handbook, 2024 Edition, dated January 22, 2024, particularly §4.6.2. The source was opened November 2, 2026.

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Sources checked Nov 2, 2026. Federal baselines and named state examples are distinguished in the article. Your licensing agency and written program terms govern your case.

Prepared by CDLP editorial from the sources above. No independent instructor, legal or financial review is claimed.