- Short answer
On a DOT physical, a reading at or under 140/90 with no blood pressure medicine can earn a card of up to two years. 140 to 159 over 90 to 99 means a one-year card, 160 to 179 over 100 to 109 means a one-time three-month card, and 180/110 or higher disqualifies until it comes down. Life insurers publish their own limits, and in the broker guides we checked the top class stops at 135/85 to 141/86, well under the DOT line.
- Prices checked
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- Applies to
- Interstate CDL holders, company drivers and owner-operators, treated or untreated
On this route
The DOT blood pressure tiers
The federal rule says a driver must have no current diagnosis of high blood pressure likely to interfere with safe driving.1 The numbers examiners use come from FMCSA guidelines that took effect September 30, 2003, as summarized by the Teamsters union.2 A 2025 driver guide gives the same tiers.3
| Reading | Stage | First card | After that |
|---|---|---|---|
| 140/90 or less | Normal | Up to 2 years if no blood pressure medicine | Every 2 years |
| 140 to 159 / 90 to 99 | Stage 1 | 1 year | 1 year if the reading is 140/90 or less at recheck. Still 141 to 159 / 91 to 99, a one-time 3-month card |
| 160 to 179 / 100 to 109 | Stage 2 | One-time 3 months | Once treated to 140/90 or less, 1 year counted from the first exam |
| 180/110 or higher | Stage 3 | Disqualified | Once 140/90 or less, 6 months from the disqualifying exam, then every 6 months |
Checked November 10, 2026. Sources 2 and 3. Guidelines, not a hard rule. The examiner decides.
Two details matter. Either number can put you in a stage, so 150/85 is Stage 1. And examiners have some room. The guideline says one high reading alone is not enough to diagnose high blood pressure, and the examiner should write down the data behind the decision.2
On blood pressure medicine
Medicine does not disqualify a driver. The guideline ties the two-year card to readings at or under 140/90 with no medicine in use, and it says drivers on medicine should be free of side effects that could affect driving.2 A driver guide puts it plainly. Medicine is fine, but you will usually get a one-year card and need follow-up checks.3
So a driver whose pressure is well controlled on medicine is often on a yearly card for as long as the medicine is in the picture. That yearly card is not a mark against you. It reflects the follow-up the guideline calls for.
Talk to a licensed agent
We compare several insurance companies and call you back with prices. You decide.
Get my priceOr call (305) 699-5857How life insurers read the same numbers
A life insurer does not care which DOT stage you are in. It looks at your readings over time, your medicine and what else is going on, then fits you into a rate class. Each insurer sets its own limits. Two consumer broker sites publish the ceilings below, and both say they vary by insurer and age.45
| Rate class | Broker A limit | Broker B limit |
|---|---|---|
| Preferred Plus | 135/85 | under 141/86 |
| Preferred | 140/88 | 145/90 |
| Standard Plus | 145/90 | 152/92 |
| Standard | 150/92 | under 161/91 |
Checked November 10, 2026. Broker A is source 4 (treated or untreated, controlled at least one year, varies by age and company). Broker B is source 5 (medicine allowed at the top classes by most insurers if nothing else is going on). Published broker summaries, not any one insurer's rules.
- Readings a broker guide places in a Standard class or better
- DOT Stage 3, disqualified at the exam
The chart shows the main point. Every Standard-or-better band in both guides ends by about 160 systolic. A reading that earns a one-year DOT card can still fall in a Standard class, but almost all of Stage 2 sits past both guides' Standard line, where neither guide lists a class.
Why a one-year card and a life application line up
A yearly card for blood pressure usually means one of two things, a Stage 1 reading or a medicine. Both show up on the life side anyway. Insurers check prescription records and medical history on their own, so the diagnosis and the medicine are part of the file whether or not you mention your card.6 Answer every question on the application truthfully.
The rate class turns on control, not on the diagnosis. Broker A's limits apply to readings that have been controlled for at least a year, treated or not.4 Broker B says most insurers allow medicine at the top classes as long as there are no other conditions.5
Getting back to a two-year card
The guideline path is laid out in the table above. A Stage 1 driver who reads 140/90 or less at recheck gets another one-year card. A Stage 2 or Stage 3 driver moves back to yearly or six-month cards once treated to 140/90 or less.2 The two-year card in the guideline goes to readings at or under 140/90 with no medicine in use.
Whether to start, change or stop a medicine is a decision for your own doctor, never for a card length. A driver guide also notes that the DOT weighs blood pressure control over a long stretch, not one day.7 Bring your doctor's records and a list of your medicines to the exam, and ask the examiner what follow-up that examiner wants.
Blood pressure and the rest of the file
Blood pressure rarely travels alone. A CPAP supplier suggests a sleep study for drivers with high blood pressure, diabetes or a past stroke.8 Both the examiner and the underwriter look at the whole picture. Our sleep apnea guide covers that side, and the medical card guide lists every card length and what triggers it. To see how blood pressure fits with your record and route, start at life insurance for drivers or try the DOT card and rate class checker.
Questions people ask
What blood pressure fails a DOT physical?
Under the guideline, 180/110 or higher disqualifies at that exam. 160 to 179 over 100 to 109 gets a one-time three-month card, and 140 to 159 over 90 to 99 gets one year (source 2).
Can I get a two-year card on blood pressure medicine?
The guideline ties the two-year card to readings at or under 140/90 with no medicine in use, and drivers on medicine usually get one year (sources 2 and 3). Your examiner decides your card.
Will high blood pressure stop me getting life insurance?
Usually not when it is controlled. Two broker guides place controlled readings up to about 150 to 160 systolic in a Standard class or better, with the exact line set by each insurer (sources 4 and 5).
Does one bad reading count?
For the DOT, the guideline says one high reading is not enough to diagnose high blood pressure (source 2). Life insurers usually look at your readings over time, so ask the insurer how it weighs a single reading.
Sources (8)
- Cornell Law School LII, 49 CFR 391.41, Physical qualifications for drivers, opened November 10, 2026. law.cornell.edu
- International Brotherhood of Teamsters, Revised Blood Pressure Guidelines for Commercial Drivers, no page date, opened November 10, 2026. teamster.org
- TruckingHQ, Passing Blood Pressure for a DOT Physical, 2026 Guide, December 26, 2025, opened November 10, 2026. truckinghq.com
- Zander Insurance, Health Class Guidelines for Term Life Insurance, no page date, opened November 10, 2026. zanderins.com
- LifeInsure.com, Life Insurance With High Blood Pressure, updated August 17, 2026, opened November 10, 2026. lifeinsure.com
- Ogletree Financial, Life Insurance With Sleep Apnea, updated December 28, 2025, opened November 10, 2026. ogletreefinancial.com
- Driver Resource Center, DOT Physical Blood Pressure Requirements, February 6, 2025, opened November 10, 2026. driverresourcecenter.com
- CPAP.com, 8 Common Sleep Apnea and DOT Compliance Questions Answered, updated August 5, 2026, opened November 10, 2026. cpap.com
