Essential arterial hypertension and its effects on driving

Arterial hypertension (AH) is a chronic disease most commonly seen in industrialised countries, the cause of which is unknown in 90 to 95 per cent of patients

Its progress can lead to very serious complications for patient

Essential arterial hypertension is a disease with many causes and components, which are related not only to hereditary and genetic factors, but most frequently to causes such as a salt-rich diet, environmental stress and obesity.

The development of the illness is associated with generalised arteriosclerosis and the complications it causes in the great organs, such as myocardial hypertension, myocardial ischemia, heart failure, ventricular arrhythmia, the possibility of sudden death, renal failure, aortic aneurysm, peripheral vasculopathy, cerebral infarct caused by thromboembolism and cerebral haemorrhage.

All of these are serious complications, and mean driving must not be undertaken for prolonged periods of time, in many cases permanently.

Advice

The doctor will advise the patient ways of methods with which he can combat the factors predisposing him to AH, recommending he lose weight, eat a low salt diet and do exercise.
This advice also helps to make driving more comfortable.
Patients with established internal organ damage are precluded from driving.
If the doctor sees the organs affected by the patient’s high blood pressure are improving during successive medical check ups, he can state in a report that the patient is well enough to drive again without any increased risk so long as his blood pressure (AH) remains stable.

Characteristics of the behaviour of arterial hypertension

The development and evolution of arterial hypertension varies greatly from one patient to another, and therefore recommendations relating to driving must be tailored to the individual circumstances and characteristics of each driver.
Moderate to high hypertension: is controlled by a low-salt diet, weight loss, and/or medical treatment at low doses.
Labile arterial hypertension: transitory and occasional oscillations without clinical repercussions. These are frequently observed during periods of stress or by people suffering from anxiety.
Borderline hypertension: Arterial hypertension which remains on the limits of normality without requiring treatment, but which needs periodic control.
Serious arterial hypertension: When diastolic blood pressure is in excess of 115 mm Hg without treatment. Treatment starts with high doses of medication, which require strict control to prevent possible organ damage.
Refractory arterial hypertension: if the condition is not controlled in spite of correctly following a regime of triple drug therapy prescribed appropriately in terms of dose and associations.
Malign hypertension: High AH results associated with generalised arterial lesions caused by fibrinoid necrosis, with effects on the retina and on occasions presenting neurological, cardiac and renal symptoms.
Urgent hypertensive attack: this occurs when diastolic AH is over 120 mm Hg with or without symptoms, with mild or moderate damage to great organs, without immediate risk of death. This requires speedy treatment and should be brought under control within the first 24 hours.
Hypertensive emergency: An increase in AH accompanied by a serious lesion in the great organs that can lead to death if not treated immediately.

Advice

When serious, refractory or malign hypertension remains untreated, driving is not allowed.
If the clinic symptoms develop favourably, the doctor will be able to evaluate the patient’s ability to drive.
Urgent hypertensive attacks and emergency hypertension preclude the patient from driving during the acute attack and also later, until the patient has been correctly diagnosed, treated and stabilised without affecting visceral lesions that could diminish his or her capacity to drive.
The signs and symptoms of HTA.
Primary arterial hypertension can remain asymptomatic until the patient develops complications.
Symptoms such as headaches are frequently caused by other conditions which would equally affect people with normal AH.
When arterial hypertension produces vertigo, headaches, fatigue, visual disturbances, reddening of the face, epistaxis and nervousness, this leads to the suspicion that this patient may need to be studied, treated and strictly controlled.
Complicated AH includes left-ventricular failure, aterosclerotic cardiopathy, haemorrhages and retinal irritation, cerebrovascular failure with or without cerebrovascular events, and renal failure.
Hypertensive encephalopathy is an acute or sub-acute condition caused by serious hypertension, which is characterised by headaches, blunting, confusion or stupor and convulsions. It is often accompanied by advanced retinopathy.

Advice

Hypertensive patients with throbbing headaches and brain blunting, should be treated quickly and it should be determined whether or not the patient has secondary or essential AH.
Whilst the patient has symptoms and his AH figures are high, he must not drive, and therefore he must be given clear, convincing explanations as to why.
If the arterial hypertension is secondary and symptomatic, until a definitive diagnosis is made, the risks of the causal disease have been established the treatment has been satisfactorily established, the patient may not drive.
Therefore, driving is not advised when patient suffers from symptomatic hypertension, whether or not this is refractory to medical treatment, as these situations make driving difficult and increase the risks involved.
If the visceral lesions are serious or there is evidence of hypertensive encephalopathy, driving must not be allowed.
If the patient knows that he has hypertension and is driving when the symptoms appear, he should park the car safely as soon as possible in a place where there is no risk of causing an accident, calm down and wait until the symptoms subside.
If he does not get better, then he should ask to be taken to the nearest medical centre, where a doctor can take his blood pressure, confirm the diagnosis and initiate the appropriate treatment.
Patients with symptomatic hypertension must not drive themselves to the medical centre.

Advice on Essential arterial hypertension

The doctor will advise the patient ways of methods with which he can combat the factors predisposing him to AH, recommending he lose weight, eat a low salt diet and do exercise.
This advice also helps to make driving more comfortable.
Patients with established internal organ damage are precluded from driving.
If the doctor sees the organs affected by the patient’s high blood pressure are improving during successive medical check ups, he can state in a report that the patient is well enough to drive again without any increased risk so long as his blood pressure (AH) remains stable.

Advice on Characteristics of the behaviour of arterial hypertension

When serious, refractory or malign hypertension remains untreated, driving is not allowed.
If the clinic symptoms develop favourably, the doctor will be able to evaluate the patient’s ability to drive.
Urgent hypertensive attacks and emergency hypertension preclude the patient from driving during the acute attack and also later, until the patient has been correctly diagnosed, treated and stabilised without affecting visceral lesions that could diminish his or her capacity to drive.

Advice on The signs and symptoms of HTA

Hypertensive patients with throbbing headaches and brain blunting, should be treated quickly and it should be determined whether or not the patient has secondary or essential AH.
Whilst the patient has symptoms and his AH figures are high, he must not drive, and therefore he must be given clear, convincing explanations as to why.
If the arterial hypertension is secondary and symptomatic, until a definitive diagnosis is made, the risks of the causal disease have been established the treatment has been satisfactorily established, the patient may not drive.
Therefore, driving is not advised when patient suffers from symptomatic hypertension, whether or not this is refractory to medical treatment, as these situations make driving difficult and increase the risks involved.
If the visceral lesions are serious or there is evidence of hypertensive encephalopathy, driving must not be allowed.
If the patient knows that he has hypertension and is driving when the symptoms appear, he should park the car safely as soon as possible in a place where there is no risk of causing an accident, calm down and wait until the symptoms subside.
If he does not get better, then he should ask to be taken to the nearest medical centre, where a doctor can take his blood pressure, confirm the diagnosis and initiate the appropriate treatment.
Patients with symptomatic hypertension must not drive themselves to the medical centre.