Permissive hypertension is a technique that maintains higher blood pressure following a stroke. To do so, doctors typically reduce a person’s hypertension medication for 24-48 hours after a stroke.

Maintaining high blood pressure after a stroke can help protect the brain. Every year in the United States, over 795,000 people have a stroke. However, individuals of any age can have a stroke, and the risk increases as a person gets older.

A stroke occurs when a blockage, such as a blood clot, prevents blood from entering the brain.

Doctors sometimes implement permissive hypertension following certain types of stroke. It may promote blood flow to blood vessels in the brain.

This article explores permissive hypertension treatment and how it may help with stroke recovery. We also look at general guidelines, potential side effects, and alternative stroke treatments.

A blood pressure monitor that doctors use in permissive hypertension.Share on Pinterest
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Permissive hypertension is a treatment for a stroke. Doctors use the method to keep a person’s blood pressure levels higher than usual to maximize blood flow to the brain, promoting faster recovery.

According to 2016 research, doctors usually keep the blood pressure at this elevated rate for approximately 24–48 hours.

Generally, a person who has had a stroke has high blood pressure and will likely already be on blood pressure medications. To carry out permissive hypertension, a doctor may stop this medication, which raises blood pressure levels.

The above research suggests that 84% of individuals with a stroke have high blood pressure. It also states that those with low blood pressure or severely elevated levels could have worse outcomes following a stroke.

Doctors often carry out permissive hypertension following an acute ischemic stroke.

Acute ischemic stroke is the most common type of stroke that occurs when there is a blockage to the brain, preventing blood flow. It affects approximately 700,000 individuals each year.

Permissive hypertension is a temporary procedure that increases blood pressure to optimize blood flow to a certain level. This is so a person can receive other necessary treatments.

Treatments in combination with permissive hypertension may include:

  • Thrombolysis: A process where a person receives clot-busting drugs through an intravenous line directly into their veins.
  • Recanalization: This is where doctors restore the blood flow within the arteries.
  • Collateral vasculature: This refers to the alternate blood vessels in a person’s body. It provides an alternative route for the blood flow if there is a blockage in another area. Doctors may be able to help optimize this system.

High blood pressure is the leading cause of stroke, and individuals may have high blood pressure before their stroke. However, lowering it too much and too quickly could further damage the body.

Doctors may also administer permissive hypertension to individuals with a trauma-related brain injury.

In 2019, the American Heart Association (AHA) set out guidelines regarding the early management of an acute ischemic stroke.

The AHA created these guidelines for safety reasons because severe hypertension could result in the following complications:

  • Hemorrhagic transformation: This is where the blood-brain barrier allows peripheral blood into the brain.
  • Hypertensive encephalopathy: This is a brain dysfunction resulting in:
  • Organ problems: This includes complications relating to the:
    • heart
    • lungs
    • kidneys

The guidelines state to keep the blood pressure less than or equal to 220/120 millimeters of mercury for the first 24–48 hours of permissive hypertension.

Permissive hypertension does not cause any side effects itself. However, it does present several risks because high blood pressure can cause further complications in the body.

Permissive hypertension is safe for most individuals at suggested guideline levels.

A person may develop a hemorrhagic stroke if blood pressure becomes too high. A hemorrhagic stroke occurs due to weakened blood vessels. It results in bleeding in the brain and presents further complications.

An insurance provider should include permissive hypertension in their coverage, which will likely come under post-stroke treatment.

A doctor may review a person’s medications following a stroke. If there is a change in medication, a person should check whether their insurance provider covers the costs.

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A doctor will determine the most suitable treatment following a stroke. All stroke cases are different, so this may vary between people.

Doctors may order several brain scans so they can identify the type of stroke.

For an ischemic stroke, a person may receive thrombolytic medications to break up blood clots within the body. Research suggests this is an effective therapy if a person has it within the first 3 to 4.5 hours after a stroke.

Doctors must stop the bleeding in the brain if a person develops a hemorrhagic stroke, which can involve emergency surgery. Endovascular procedures are a potential treatment for some hemorrhagic strokes. Doctors perform them in an area has its blood supply cut off to repair broken blood vessels or weak spots.

As many as 1 in 4 people who have had a stroke will have another within 5 years. Therefore, it is vital to address the underlying cause of the stroke.

Doctors may recommend lifestyle changes, such as more frequent exercise or dietary changes. They may also prescribe medication to address any health problems.

A person may receive the following therapies after a stroke:

These therapies can help them adjust and relearn any skills people may have lost or have become more challenging due to the stroke.

Permissive hypertension keeps a person’s blood pressure high following a stroke or similar medical emergency. This treatment is temporary and should last 24–48 hours.

The increased pressure may improve blood flow to the brain. However, there are some risks relating to maintaining high blood pressure. The AHA released a series of guidelines to ensure blood pressure does not go beyond a certain level or for too long.

A person should have insurance coverage for permissive hypertension, usually in any post-stroke treatment coverage. Alternative treatments are also available for people, including medications, surgery, and lifestyle changes. Individuals can discuss the most suitable options with their doctor.