Stage 1 hypertension is usually asymptomatic, and blood pressure (BP) in this range is considered a low risk for hypertension-related acute incapacitation. However, all hypertensive drivers should be strongly encouraged to pursue consultation with a primary care provider to ensure appropriate therapy and healthcare education.
Stage 2 hypertension is considered an absolute indication for antihypertensive drug therapy, and the driver should seek initiation or evaluation of therapy to lower blood pressure (BP). Effective BP management includes routine primary provider follow-up and periodic screens for the presence of target organ damage and clinical manifestations of cardiovascular disease.
Stage 3 hypertension carries a high risk for the development of acute hypertension-related symptoms that could impair judgment and driving ability. Acute manifestations of elevated blood pressure (BP) can include sudden stroke, acute pulmonary edema, subarachnoid hemorrhage, aortic dissection, or aortic aneurysm rupture.
Meningismus, acute neurological deficits, abrupt onset of shortness of breath, or severe, ripping back or chest pain could signal an impending hypertensive catastrophe that requires immediate cessation of driving and emergency medical care. Symptoms of hypertensive urgency such as headache and nausea are likely to be more subtle, subacute in onset, and more amenable to treatment than a hypertensive emergency.
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