Blood pressure is the single most common cause of shortened DOT medical card cycles. The federal standard categorizes blood pressure into three stages, each of which dictates how long the resulting medical card will be valid.
Stage 1 — under 140/90
Blood pressure below 140/90 mmHg results in a standard 24-month medical card. This is the goal for any driver who wants to minimize DOT-physical hassle. White-coat hypertension (elevated readings only at the doctor's office) is common — ask your examiner for a re-check at the end of the visit when you're calmer, or bring a 24-hour ambulatory monitoring report from your primary doctor.
Stage 1 hypertension — 140–159 / 90–99
Blood pressure in this range results in a 1-year medical card. The driver must be re-examined annually until blood pressure is controlled below 140/90 or moves to a different stage. Many drivers in this range are placed on a single antihypertensive medication and return to a 24-month cycle within 6 to 12 months.
Stage 2 hypertension — 160–179 / 100–109
Blood pressure in this range may result in a 3-month temporary card, conditional on aggressive treatment and re-evaluation. Once the driver demonstrates controlled blood pressure (under 140/90) on stable medication, the card is upgraded to 1-year cycles.
Stage 3 hypertension — 180/110 or higher
Blood pressure at this level is disqualifying. The driver may not be issued any DOT medical card until blood pressure is brought under control. Once controlled, a 6-month card is typically issued, with progression to 1-year and eventually 2-year cycles.
Practical advice
If you know your blood pressure has been creeping up, see your primary doctor and start treatment before your DOT physical, not at it. A driver who walks into the exam already on a stable antihypertensive medication and within range gets a full 24-month card; a driver who shows up and runs 165/105 the day of the exam ends up on a 3-month conditional cycle. Read our DOT physical guide.