Who writes this page?
I have been through the pilot medical examination about twenty times, and before flying, I spent six years taking blood pressures and attaching electrodes at CHUV in Lausanne. So I have seen first-hand how much a single measurement can vary. But I am not a doctor: this page makes no diagnosis, discusses no treatment and prejudges no medical fitness, yours least of all.
In short
Regarding blood pressure, the European text does contain a number: 160 mmHg systolic and/or 95 mmHg diastolic. Three details that are often forgotten to mention with it: it only applies to Class 1, it applies "with or without treatment", and it refers to a blood pressure consistently exceeding these values, not a single measurement taken on a Tuesday morning. Regarding diabetes: insulin treatment = unfit, Class 1 as well as Class 2. Without insulin, the text states unfitness unless it can be demonstrated that blood sugar control is achieved and stable. And depending on the criterion in question, the text provides for either unfitness, further evaluation, or referral to the medical assessor: the two criteria above are unfitnesses.
Why these two topics on the same page
Hypertension and diabetes have little in common medically. In terms of medical fitness, however, they illustrate the same mechanism, and two reading errors I see constantly recurring.
First error: believing that a number decides everything. Some criteria are indeed written unfitnesses; others open a stage. The European regulation sets criteria; when a criterion is not met, it opens a process: further evaluation, referral to the medical assessor of the licensing authority, or assessment in consultation with them. Second error, symmetrically: believing there is no line at all and that "it's negotiable". On insulin-treated diabetes, there is a line, it is written in one sentence, and no AME can move it on their own initiative.
A point that this page will apply from start to finish: we distinguish what is written in the regulation from what is written in the acceptable means of compliance (AMCs), and we distinguish both from what circulates by word of mouth. This is not legal pedantry, it's what makes the difference between information that stands up before a doctor and forum information.
Blood pressure: what the text says, point by point
The applicable point is MED.B.010 (cardiovascular system) of Annex IV to the European regulation on aircrew, as drafted in Implementing Regulation (EU) 2019/27. Its subparagraph (c) is entirely dedicated to blood pressure, and it consists of four points.
A methodological detail before the table: only the version published in the Official Journal of the Union is authentic. The numerical criterion is quoted below in this version; the other three subparagraphs are summarised and are therefore not direct quotations.
| Subparagraph | What it provides |
|---|---|
| (c)(1) | Blood pressure is recorded at each examination. MED.B.010 falls under the section applicable to Classes 1 and 2; for LAPL, another point (MED.B.095) includes blood pressure among the examination items. In all cases: there is no such thing as an examination "without the cuff". |
| (c)(2) | Blood pressure outside normal limits triggers further evaluation of the cardiovascular system and of the medication, to determine whether a conclusion of unfitness is required under the following points. In other words: the measurement does not conclude the matter, it opens an examination. |
| (c)(3) The numerical criterion | The only number in the text. Applicants for a Class 1 certificate who present with symptomatic hypotension, or whose blood pressure at examination consistently exceeds 160 mmHg systolic and/or 95 mmHg diastolic, with or without treatment, shall be assessed as unfit. |
| (c)(4) | The initiation of medication for the control of blood pressure shall require a period of temporary unfitness until the absence of significant side effects has been established. The text sets no duration. This is an unfitness linked to starting the medication, not to the illness itself. |
These four lines are much richer than the "160/95" that often circulates on its own. Three expressions are worth dwelling on.
"Consistently exceeding": a single measurement is not the criterion
The text does not say "a blood pressure greater than 160/95". It says a blood pressure consistently exceeding these values at examination. This is a fundamental nuance, and it is what justifies a doctor retaking the measurement, repeating it, making you wait, or requesting a follow-up. This is not complacency: it is a literal reading of the criterion. What this means in your case, however, is up to them to say.
"With or without treatment": being treated doesn't reset the bar
This is the point that is often misunderstood. The criterion applies to the blood pressure observed, whether or not you are taking medication. There is no more lenient threshold because you are being treated. And what the treatment should aim for is not a fitness criterion: your doctor determines that, and it cannot be deduced from a regulatory text.
"Class 1": the number only applies to Class 1
The regulation sets no numerical blood pressure threshold for Class 2. This obviously does not mean that blood pressure doesn't matter: subparagraphs (c)(1) and (c)(2) apply to both classes, and the aeromedical assessment remains fully applicable. It means there is no numerical bar in the text to cling to, and therefore even less a bar to apply to yourself. The LAPL falls under a distinct regime, which this page does not cover for blood pressure.
The number is in the regulation, not in the AMCs
On most topics related to fitness, the distribution is as follows: the regulation establishes a principle, and the acceptable means of compliance (AMCs), published by the European agency and modifiable by decision, contain the numerical values. This is what I have observed elsewhere, and it is what one spontaneously assumes.
Here, it's the other way around. The 160/95 is in the regulation itself, in MED.B.010(c)(3). And the corresponding AMC, AMC1 MED.B.010, point (j), dedicated to blood pressure, contains no value in mmHg. It deals with something else: the cardiovascular assessment upon discovery of hypertension, the agreement of the medical assessor on the treatment, and the reassessment after initiation.
Consequence of this mechanism: changing this number would mean changing the regulation, and not merely taking an agency decision, which is the usual route when a value lives in an AMC.
What really happens at the "blood pressure" station
The view from the pilot and the nurse: I've been on the other side of the cuff
Before flying, I spent years taking blood pressures in the hospital. What you learn very quickly is how much a measurement shifts depending on the conditions in which it is taken: arm position, cuff size, what happened in the preceding minutes. These are measurement conditions that the healthcare professional controls, not levers for the candidate, and they are certainly not tricks to apply before an examination. It's simply the reason why we repeat a measurement instead of carving it into the file.
And there is the "white coat" effect, which is not a myth: in some people, blood pressure rises just from being measured. On the day of the medical, with professional stakes behind it, there is no reason for this effect to be any less. What that means for your file is for the doctor to say, not me, and especially not you. But knowing that the phenomenon exists avoids panicking over a first number.
One thing is non-negotiable, and it's worth writing in bold: never stop, reduce, or postpone a treatment on your own before a medical examination. Not to "get a better number", nor to "see what happens". It's medically dangerous, it's visible, and it's the best way to turn a medical question into a fitness problem. If the treatment raises a question for you, it should be asked of your treating doctor and your AME, before the big day.
Antihypertensive medication: what is written, and what is not
The regulation names no medication. It is the AMC that indicates that antihypertensive treatment should be agreed by the medical assessor of the licensing authority, and lists classes of drugs that may be acceptable.
I am intentionally not reproducing this list here. Not because it is secret (the exact reference is in the margin of this page, for your doctor), but because a list of therapeutic classes laid out before a reader immediately becomes a comparison with their own prescription, and a conclusion about their own file. It is neither a prescribing guide nor a list to choose from. The choice of a molecule belongs to your doctor, based on your condition, and its acceptability in aviation is a matter for the medical assessor.
Never ask for a change in treatment for licensing reasons. If the question arises, it is up to your doctor and your AME to raise it, not you.
Starting a treatment: what it triggers
Two texts converge at the same point, and it is better to know them in advance.
On one side, MED.B.010(c)(4): the initiation of medication for the control of blood pressure requires a period of temporary unfitness until the absence of significant side effects has been established. On the other, MED.A.020, which deals with the decrease in medical fitness: the holder of a medical certificate must, without undue delay and before exercising the privileges of their licence, seek aeromedical advice, notably when they have started the regular use of any medication. For a Class 1 or 2 certificate, this advice is sought from an aeromedical centre or an AME.
Translated into plain language: starting an antihypertensive drug is not an event you keep for your next medical. It is an event that triggers, immediately, a declaratory procedure. And to avoid any misunderstanding: treatment is decided with your doctor, without regard to the licensing calendar. It is the declaration that must be made without undue delay, not the treatment that adjusts to a certificate's deadline.
Diabetes: a clear line, and a lot of noise around it
The applicable point is MED.B.025, 'metabolic and endocrine systems', in the same section of the text. It is brief, and it leaves no room for interpretation.
| Situation | What the regulation states (Classes 1 and 2) |
|---|---|
| Metabolic, nutritional or endocrine dysfunction in general | Fitness is possible provided that the condition is demonstrated to be stable and subject to a satisfactory aeromedical assessment. |
| Diabetes mellitus requiring insulin Core rule | Unfit. The sentence is unconditional and without exception in the text, and it makes no distinction between Class 1 and Class 2. |
| Diabetes mellitus not requiring insulin | Unfit unless it can be demonstrated that blood sugar control is achieved and stable. The burden of proof is therefore on the candidate. |
| Medication other than insulin for blood sugar control | Class 1: referral to the medical assessor of the licensing authority. Class 2: fitness assessed in consultation with them. A European mechanism, not a national peculiarity. |
Two remarks on this table. First: the text says "diabetes mellitus requiring insulin", not type 1 or type 2. It is the treatment that dictates the rule, not the diagnostic label. This distinction is regulatory, and you do not debate it holding your licence: you discuss it with the doctor prescribing your treatment, and with an AME for the fitness aspect.
A sentence not to be misread, and I prefer to write it in black and white: no choice of treatment should be made based on a licence. If a treatment is proposed to you, the question of whether it suits you is a medical one, and it is resolved with your doctor, not with a fitness regulation in front of you. The consequences for your licence are dealt with afterwards, with an AME, in that order.
Second remark: the regulation names no antidiabetic molecule and sets no HbA1c value. The substance — which molecules, with what possible limitations — falls under the AMCs and individual assessment. I am not detailing it here: I have not collated this AMC in its entirety, and half an AMC on such a subject is worth nothing.
What about the LAPL? MED.B.025 falls under the section of the text applicable to Classes 1 and 2. The LAPL certificate comes under another point, MED.B.095, which describes the content of the examination and contains no criteria regarding diabetes or insulin. The regulation therefore states nothing categorical or numerical on this point for the LAPL; the matter is referred to the acceptable means of compliance, which I have not consulted for this page. So I stop here: this is a question to ask an AME or the approved general medical practitioner, not a web page.
The reference you should no longer cite: ARA.MED.330 no longer exists
Whenever insulin-treated diabetes and aviation are discussed, one reference keeps coming up: ARA.MED.330, 'special medical circumstances', in Annex VI of the same regulation, which is addressed to the authorities. It is frequently presented as an individual exit route, the 'derogation' one simply has to apply for. Two problems: it never was that, and this point has been deleted.
Implementing Regulation (EU) 2024/2076 of 24 July 2024 repeals ARA.MED.330, with effect from 13 February 2025. The European agency followed by removing the corresponding acceptable means of compliance and guidance material (Decision 2025/002/R of 3 February 2025). The reason given in its preparatory opinion: the vast majority of stakeholders consulted felt that the content of this point was unethical and allowed for unequal treatment.
What remains is a transitional measure (Article 3a of Regulation 1178/2011): authorities already engaged in a protocol whose validity was set before 13 August 2024 can continue it until its expiry, or join it. Nothing more. No new protocol can be opened on this basis.
And what the point said, when it did exist, was already not what it is made out to be. Here is the mismatch, because it continues to circulate.
| What is often read | What the text provided for, before its deletion |
|---|---|
| "It's a derogation you can apply for." | It was a framework for a medical evaluation protocol, opened when a new technology, medication or procedure could justify assessing applicants as fit when they did not fully meet the requirements. Developed by a competent authority in cooperation with at least one other; never upon a candidate's application. |
| "My AME can do it for me." | The text was explicit: aeromedical centres and AMEs could only issue a medical certificate on the basis of such a protocol if so instructed by the licensing authority. |
| "A certificate obtained like that is valid everywhere." | The privileges were restricted to aircraft registered in the Member States participating in the protocol, with the limitations set therein. |
| "So Europe now allows insulin." | No, and even less so since the point's deletion. The rule in Part-MED has not changed: insulin = unfit. A protocol opened in one State did not alter the regulation, did not extend automatically, and was never a right. |
I am not saying nothing will ever change: fitness regulations evolve, and this one has just done so. I am saying that as of the day this page is written, there is no individual route to apply for. If a professional project depends on it, the question must be put in writing to the licensing authority concerned, before committing to anything, and especially before paying for any training.
A word on the American system (FAA)
Aviation is not just about Europe, and EASA rules are often contrasted with the pragmatism of the American FAA. For an FAA licence, on these two topics, the approach is indeed very different: it is protocol-driven, heavy, and entirely centralised.
| Topic | The FAA approach (United States) |
|---|---|
| Blood pressure | The numerical threshold there is 155/95, applicable to all classes. The FAA manages antihypertensives via protocols (CACI or Special Issuance). A precise list of acceptable and unacceptable medications is published in the AME guide (CACI Hypertension). |
| Insulin-treated diabetes | The FAA has no absolute unfitness rule for insulin. However, diabetes requiring hypoglycaemic medication is on the list of disqualifying conditions (14 CFR § 67). Potential fitness (including Class 1) goes through a Special Issuance procedure, which demands very strict continuous criteria: wearing a continuous glucose monitor (CGM), medical reports provided by a Board Certified specialist, regular data transmission to the FAA. It is the authority, and only the authority, that grants or renews the authorisation. |
It's a different philosophy: there is no absolute principled barrier, but the management of the file shifts directly to the authority level (Aeromedical Certification Division), with a continuous and heavy burden of proof on the candidate. An AME cannot decide on fitness alone for these files.
What this page will not tell you
I might as well write it in black and white, because this is precisely what people come looking for on this kind of page.
| What you might be looking for | Why you won't find it here |
|---|---|
| "Will I be fit?" | No honest person can say this in writing, without examining you and without your file. This decision belongs to your AME, and if necessary to the medical assessor of the authority. |
| A target blood pressure value to reach | That would be a therapeutic objective, therefore a medical course of action. The only number this page quotes is a regulatory criterion; the two should not be confused. |
| An "acceptable" HbA1c value | The regulation gives none, and I have not collated the corresponding AMC in its entirety. An approximate figure on this subject would be worse than no figure at all. |
| The proportion of files that "get through" | No public statistics establish this. A reassuring impression is not data. |
What this page can do, however: allow you to arrive at the medical knowing which text applies, what exactly it says, and which process is initiated if a criterion is not met.
Frequently asked questions
Is there an official blood pressure threshold for pilots?
If my blood pressure is high on the day of the medical, is it over?
Can I fly if I take medication for hypertension?
Should I inform someone if I start taking medication?
Should I stop my treatment before the medical to get a better number?
Can you be a pilot with diabetes?
Does ARA.MED.330 allow me to get a derogation for insulin?
I read that the United States allows insulin-treated pilots.
What about the LAPL?
What does "referral to the medical assessor" mean?
To go further
For the medical as a whole: the overview page on the medical examination (classes, validities, age limits) and preparing for your medical, which details the blood pressure station and the white coat effect in particular. Station by station: what the medical examines. If a point is problematic: unfitness and appeals. The hub: pilot health.
The pages of Le Labo remain freely accessible, including this one. Alongside them, there is now a paid guide: the reverse schedule before the medical, the precise questions to ask the AME, the appendices by country. Nothing that is free today will go behind a paywall.
A medical file with nuances needs preparation; it cannot be improvised
The regulation says what remains possible. It does not say what documents to gather, in what order to ask for them, or from whom. Yet this is where the difference lies between a file processed in one go and a file that bounces back and forth three times.
The guide reviews six situations one by one, including blood pressure discovered on the day, sleep apnoea, and diabetes. Chapter reviewed by three approved aeromedical examiners.
View the guide, 59 €You fly, therefore you pass the medical examination
The guide takes it from end to end: the dated reverse schedule, the documents to prepare depending on whether it's an initial issue or a revalidation, the list of stations, and the options available if fitness is not granted on the day.
View the guide's table of contents