DOT medical card · Updated October 2026

DOT physical blood pressure requirements: the limits, your card length, and how to pass

Blood pressure is the number that most often shortens a CDL medical card. It doesn't just decide pass or fail — it decides whether you walk out with a 2-year card, a 1-year card, or 3 months to fix it.

The DOT blood pressure chart

Certified medical examiners follow FMCSA's hypertension guidance. The top number (systolic) or bottom number (diastolic), whichever is in the higher stage, decides where you land:

Reading	Stage	Medical card	What happens next
140/90 or lower	Normal / controlled	Up to 2 years	At least yearly if you're being treated for high blood pressure
140–159 / 90–99	Stage 1	1 year	Get it under 140/90 to keep annual cards
160–179 / 100–109	Stage 2	One-time 3 months	Under 140/90 within 3 months = 1-year card from the original exam date
180 / 110 or higher	Stage 3	Disqualified	Once under 140/90, certified every 6 months

Source: FMCSA guidance on certification by hypertension stage. Your examiner makes the final call and can certify for less time if something else needs monitoring.

Stage 2: how to turn a 3-month card into a 1-year card

A 3-month card is a warning, not the end of your career. It's a one-time certificate, so the clock matters:

1. See a doctor this week. Telehealth works from the truck. Bring the examiner's reading.
2. Start or adjust treatment. Most blood pressure medicines are inexpensive generics.
3. Track it. A home cuff and a log of readings shows the examiner it's controlled.
4. Go back before the 3 months run out. Under 140/90 gets you a 1-year card dated from your original exam.

Drivers who miss the window can't get a second 3-month card. That's where having a doctor already lined up — and a plan that pays for the visit — makes the difference.

Stage 3: the road back

At 180/110 or higher you can't be certified that day. Once treatment brings you under 140/90, you can be certified again, but on a 6-month cycle instead of 1 or 2 years. That means more exams, more fees and more time off the road until things stay stable.

Already on blood pressure medication?

Taking blood pressure medicine does not disqualify you. Drivers being treated for hypertension should expect a card of 1 year at most, even when their reading is under 140/90. The examiner will also ask about side effects — dizziness or fatigue that could affect driving — so tell your doctor what you do for a living when they choose your medicine.

How to get an honest reading on exam day

A lot of drivers fail on a reading that isn't their real number. A few things push blood pressure up in the moment:

• Caffeine, nicotine and energy drinks in the hours before the exam.
• Decongestants in many cold and sinus medicines.
• Rushing in late after a long drive or a fight with traffic.
• White-coat nerves. If your first reading is high, it's reasonable to ask whether it can be rechecked after you've sat quietly for a few minutes.

Take your regular medicine as prescribed — don't skip it to "test clean," and don't change anything without asking your doctor.

The real fix: a doctor between physicals

The DOT physical usually isn't covered by health insurance (here's why). But everything that keeps you under 140/90 is: primary care visits, generic blood pressure medicine, lab work and follow-ups. A driver who sees a doctor once or twice a year keeps 2-year cards. A driver with no coverage finds out at the exam.

If you're an owner-operator, your ACA subsidy is based on net income after expenses, not gross settlements — many drivers who think they earn too much actually qualify. See health insurance for owner-operators or check the real cost for truck drivers.

Related: all DOT physical requirements · how long a DOT physical is good for · CDL blood pressure and health insurance · sleep apnea and your CDL

General information, not medical advice. Your certified medical examiner makes the certification decision. Confirm current standards with your examiner or FMCSA.