We often get questions from former students seeking advice or research that directly relates to their chosen profession. Recently we received a great Industrial Rehab/Physical Demands oriented question from a former student.

I was wondering if you had any information on blood pressure testing in the clinic for Physical Evaluation/Return to Work screenings. When is it safe to proceed with testing or should they get medical clearance from primary medical doctor? We have run into clients with high BP with the PE/RTW screen and would like to know if there are standards/protocols on when we should refer these individuals to get medical clearance prior to continuing the testing/actual job demands.

Back School instructor, Victor Zuccarello, was gracious enough to provide a very thoughtful and informative answer.

Hi.  I teach the FCE and Employment Testing Courses for The Back School and was asked to respond to your question regarding blood pressure contraindications for testing.

Most providers use a BP cut-off of no higher than 160 resting systolic and/or no higher than 100 resting diastolic.  According to the below chart by the American Heart Association one or both of these readings can indicate State 2 Hypertension:

What is the AHA recommendation for healthy blood pressure?

If I get this reading at rest, I will take it at least three times to ensure I have it correct and if it persists, I’ll have the subject lie down in a quiet area for 15 minutes and then re-check.  If it persists, I’ll send them out to be cleared by their family practice physician and require that clearance in writing.

I use the same procedure for resting heart rate. Providers vary on their cut-off for resting Tachycardia, however.  Some providers use a very conservative limit of 100 beats/min, but I use a more generous 120 beats/min for my limit.  My source for this guideline:

Adapted from the Working Group on Cardiac Rehabilitation & Exercise Physiology and Working
Group on Heart Failure of the European Society of Cardiology (2001).

Good luck to you.  I suggest you put safety first.