High blood pressure can keep drivers off the job-and that costs the utility money
by Talia Foster
Every time a commercial driver gets behind a truck’s steering wheel, there’s a certain degree of risk. For the driver, a sedentary job with limited access to healthy food and exercise raises blood pressure and the risk of cardiovascular disease, including a heart attack or stroke. For both the driver and nearby motorists, this poses a danger if the driver should become incapacitated while driving.
To help mitigate this risk, the Department of Transportation restricts commercial driver’s licenses (CDLs) to drivers who meet certain standards for healthy blood pressure. This means that employers of commercial drivers face not only the liability of the risk of a major crash, but also disruptions in the workforce as hypertensive drivers are disqualified. Employers must pay for frequent monitoring of drivers with hypertension to be sure that treatment is controlling their blood pressure. Self-insured employers typically pay for the treatment necessary to achieve control.
More stringent guidelines were introduced in 2003 by the DOT, focusing more attention on blood pressure control. The new guidelines classify blood pressures higher than 140/90 mmHg as hypertensive-a stricter standard than the benchmark of 160/90 mmHg in the old guidelines. Blood pressure ranges for different severity levels of hypertension, Stages 1, 2, and now 3 under the new guidelines, were recommended to create a higher standard. The new guidelines also require more frequent monitoring of blood pressure among CDL employees, with little time to control high blood pressures before disqualification. (See Figure 1.)
Predictably, these more rigorous guidelines have placed more commercial drivers at risk of losing their certification and potentially their livelihood. Two studies examined the records of 501 CDL employees working for Georgia Power Company, a Southern Company, and 540 working for Southern California Edison, during the period when the new guidelines were introduced. Under the old guidelines, 99 percent of SCE drivers and 95 percent of Georgia Power drivers had “normal” blood pressure (referred to as “controlled” blood pressure in people who were being treated for hypertension). But under the new guidelines, only 89 percent of SCE employees and 82 percent of Georgia Power employees were classified as having “normal” or “controlled” blood pressure. Ten percent of SCE employees and 16 percent of Georgia Power employees had Stage 1 hypertension, meaning that employees must control their blood pressure within 3 months or lose their CDL. Another 1 percent and 2 percent had Stage 2 hypertension and were immediately disqualified, with the possibility of regaining their certification in three months with a major reduction in blood pressure.
It is clear that the new guidelines provide a stronger incentive for companies to help their CDL employees maintain a healthy blood pressure and control hypertension. Unfortunately, national trends in cardiovascular risk factors are not working to their advantage, with skyrocketing obesity rates contributing to deterioration in cardiovascular health across the country. Almost one-third of all working-age adults are obese, including nearly half of the Georgia Power CDL employees in the study mentioned above. Obese workers have four times the rate of hypertension of normal-weight employees, so it should not be surprising that 41 percent of the Georgia Power drivers either had high blood pressure at the time of the study or had suffered problems with hypertension in the past. This proportion is much higher than the equivalent national average for adult men, currently 25 percent.
The high obesity and hypertension rates among the Georgia Power CDL drivers underscore the central challenge faced by drivers, employers, and regulators-to ensure the health, safety and continued employment of individuals whose profession actually makes it difficult for them to maintain a healthy lifestyle.
In an effort to counteract the costs of hypertension, estimated to exceed $1,000 per hypertensive employee, many self-insured employers have begun to implement disease management and health promotion programs. A number of studies have shown that these types of interventions improve clinical outcomes. In studies focusing on hypertension, disease management programs have been found to reduce the top blood pressure number (systolic blood pressure) by approximately 2 to 12 mmHg, compared with employees not offered the program. While this degree of reduction may seem small, it has the potential to move a large number of employees with Stage 1 hypertension back into the “normal/controlled” range in which blood pressure will not interfere with CDL certification.
In 2004, Georgia Power Company implemented a disease management and health promotion program to help CDL employees maintain or restore a healthy blood pressure. The program, which was designed specifically for commercial drivers, continuously provided all current CDL employees with educational materials explaining the importance of blood pressure control, for lowering their cardiovascular risk and maintaining their CDL certification. Employees also received resources to help them understand and manage hypertension. These included treatment information, suggested questions for their physicians, and record-keeping tools. Employees received verbal counseling during their periodic medical examinations for CDL certification, and/or during multiple employee health fairs during 2004. If needed, employees were referred by the corporate medical director back to their personal physicians or cardiologists for follow-up. The program also supplied tools to Georgia Power to aid the company’s efforts to help their employees maintain a normal blood pressure.
After the program, approximately one-third fewer drivers had uncontrolled hypertension. This effect was consistent across subgroups; of obese employees, employees with diabetes, and employees on antihypertensive medications, fewer had uncontrolled high blood pressure after the intervention.
While the economic impact is being evaluated, it is clear that moving CDL employees into lower-risk categories extends their certification period, reducing the frequency and costs of medical examinations while benefiting employee health. More employees at lower risk also translates into fewer disqualifications, lower staff turnover, and a smaller chance of a serious road accident. In the end, companies managing a commercial fleet can take care of business by taking care of their employees.
Talia Foster is an associate director of outcomes research at Abt Associates, Inc., a clinical research and consulting company headquartered in Cambridge, Mass. Abt Associates is working with Novartis Pharmaceuticals Corporation, Georgia Power, and Southern California Edison to evaluate strategies for helping employers and their commercial drivers achieve better health.