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Blood pressure

Direct renin inhibitors

Direct renin inhibitor
Other names: aliskiren, Tekturna

FAA guidance

Acceptable with conditions.

Wait

7 days

no-fly ground trial when starting a new blood pressure medication

Examiner

CACI: the examiner can issue when the condition's worksheet criteria are met. Applicants for first- or second-class must provide the worksheet's information annually; applicants for third-class with each required exam

FAA label

ACCEPTABLE

Source: FAA, Antihypertensive (HTN, blood pressure medication). FAA date 30 September 2026. Checked by Crosscheck 14 October 2026

The FAA lists direct renin inhibitors as acceptable blood pressure medication when the certification criteria are met, with a seven-day ground trial when starting, and says the examiner should issue, if the pilot is otherwise qualified, when the pilot is on three or fewer medications.

Track your medications
Compare FAA documents: Direct renin inhibitorsWhat each of the three FAA documents says, in plain wordsOpen

The Guide's hypertension table says the number of medications counts each component (for example, lisinopril/HCTZ is 2 medications), and that with 4 or more acceptable medications the examiner should defer.

  • 7 days after starting: no flying

FAA rule for blood pressure medication: The FAA's hypertension worksheet (CACI) refers to the antihypertensive sheet for acceptable medications, and allows combinations of up to 3 of the classes it lists -- alpha blockers, beta-blockers, calcium channel blockers, diuretics, ACE inhibitors, ARBs, direct renin inhibitors and direct vasodilators -- and lists centrally acting antihypertensives, such as clonidine, as not acceptable. The Guide's hypertension table says the number of medications counts each component (for example, lisinopril/HCTZ is 2 medications), and that with 4 or more acceptable medications the examiner should defer. FAA, CACI – Hypertension Worksheet

Show the FAA's words: Direct renin inhibitorsThe official FAA wording: two passages, each with its document and dateOpen
FAA, Antihypertensive (HTN, blood pressure medication) · FAA date 30 September 2026
Seven-day (7) no fly/ground trial is required when starting a new hypertension (HTN) medication to verify no side effects.
AME should issue (if otherwise qualified) if the airman is on 3 or fewer medications
ACCEPTABLE HTN Medications (when certification criteria are met)
Direct renin inhibitors
FAA, Guide for Aviation Medical Examiners – Item 36. Heart – Hypertension · FAA date 23 March 2023
B . Treated with 3 or fewer* acceptable medications .
Follow the CACI – Hypertension Worksheet .
C . Any of the following:
Treated with 4 or more* acceptable medications;
DEFER
Notes: *Number of medications counts each component. (Example: lisinopril/HCTZ is 2 medications.)
Sources and dates: Direct renin inhibitorsThree FAA documents, with the FAA's date and when Crosscheck checked themOpen

See also

Medication guidance alone does not determine whether a pilot is medically qualified to fly. The underlying condition, dosage, side effects, medication combinations, and certification history may affect FAA eligibility.

For informational purposes only. Not legal or medical advice.