Hypertension and Military Service: Stages and Blood Pressure

The short answer: hypertension prevents conscription or not depending on the stage of the disease, not on a single reading. Article 43 of the Schedule of Diseases is built so that at identical figures — say 150 over 95 — the category may be either B-3 or V. The difference lies in whether the target organs are affected: the heart, kidneys, retinal vessels and major arteries.

Which fitness category hypertension yields

Note rows «v» and «g»: the pressure ranges overlap while the categories differ. The stage decides everything.

What separates stage I from stage II

The regulation describes stage I as follows:

Clause «g» covers stage I hypertensive disease with elevated blood pressure (at rest, systolic 140 to 159 mm Hg, diastolic 90 to 99 mm Hg)… Signs of target-organ damage are absent.

For stage II it requires left ventricular hypertrophy plus one or two changes in other target organs. And it sets concrete thresholds:

• Echocardiography: left ventricular mass index above 125 g/m² for men;
• ECG: Sokolow-Lyon index above 38 mm, Cornell product above 2440 mm × ms;
• Chest X-ray: cardiothoracic index above 50 %;
• Fundus: generalised or local narrowing of retinal vessels;
• Kidneys: microalbuminuria 30–300 mg/day or glomerular filtration rate 60–89 ml/min/1.73 m²;
• Major arteries: intima-media thickness above 0.9 mm or atherosclerotic plaques.

This is exactly why echocardiography, fundoscopy and a urine albumin test are not formalities: they move a case from clause «g» to clause «v».

Six months of follow-up and repeated monitoring

This condition rules out confirming the diagnosis on the spot:

The presence of hypertensive disease in persons assessed under columns I and II of the schedule of diseases must be confirmed by examination in inpatient conditions and by documented previous dispensary follow-up over at least 6 months with mandatory repeated 24-hour blood pressure monitoring.

Three things at once: an inpatient work-up, follow-up of no less than six months, and repeated ambulatory monitoring. One-off readings at an appointment, however high, do not satisfy this. What normal blood pressure by age looks like and why a single figure means little is covered separately.

When article 47 applies instead of 43

An important fork that is often forgotten:

Where a syndrome of elevated blood pressure is closely associated with autonomic disturbances (palmar hyperhidrosis, persistent "red" dermographism, lability of pulse and blood pressure on change of body position, etc.), assessment is carried out on the basis of article 47 of the schedule of diseases.

Article 47 covers neurocirculatory asthenia, with its own categories. In addition, where hypertension is secondary — caused by kidney or endocrine disease — assessment follows the underlying disease rather than article 43. Differential diagnosis is therefore mandatory in every case.

What your records must contain

• Repeated 24-hour monitoring — several studies, not one.
• Dispensary follow-up records covering at least 6 months, with dates.
• Echocardiography with the left ventricular mass index in g/m².
• An ECG with the Sokolow-Lyon index and Cornell product calculated.
• Fundoscopy, a urine microalbuminuria test and a calculated GFR.
• Ultrasound of the major arteries with intima-media thickness.
• A discharge summary — mandatory for columns I and II.
• The chart code is I10; with cardiac involvement I11.9 appears.

What is usually missing

• There are high readings at appointments but no ambulatory monitoring at all.
• Monitoring was done once, while the regulation requires it repeatedly.
• There is no dispensary follow-up — visits are scattered and span less than six months.
• No echocardiography, so the stage cannot be established.
• Kidneys and fundus were never examined — and those are the "one or two additional changes".
• No differential diagnosis with secondary hypertension; what generally lies behind persistently raised pressure is covered in the piece on hypertension.

Questions for your doctor

• Which stage of hypertensive disease do I have, and what is that conclusion based on?
• How many 24-hour monitoring studies were done, and what were the mean values?
• What is my left ventricular mass index on echocardiography?
• Is there microalbuminuria, and what is my glomerular filtration rate?
• Has secondary hypertension been excluded?

Blood pressure at departmental boards

The above concerns assessment under Government Decree No. 565. The Interior Ministry, National Guard, Federal Security Service and Emergencies Ministry use their own schedules of diseases with their own thresholds. A review under article 43 shows how complete your records are but is not their regulation.

The short version

With hypertension the stage decides, and the stage is set not by complaints or single readings but by target-organ damage with specific numeric thresholds. For a conscript a strict procedural requirement is added: inpatient work-up, six months of follow-up and repeated ambulatory monitoring. Without them even genuinely high pressure remains unconfirmed for the board. Only the military medical board determines the fitness category.