Hypertension Permitted for Stroke: Mechanism and Additional Insights
In the aftermath of an ischemic stroke, a treatment known as permissive hypertension is often employed to boost blood flow to the affected brain tissue, aiming to promote recovery [1][5]. This strategy is temporarily employed, typically for 24 to 72 hours, to prevent further ischemic injury during the acute recovery phase [1].
However, while permissive hypertension can offer benefits, it also presents potential long-term risks. Elevated blood pressure increases the risk of bleeding within the brain, potentially leading to a hemorrhagic stroke [1]. This complication can worsen outcomes or cause new complications.
Other cardiovascular complications associated with permissive hypertension include heart failure, left ventricular hypertrophy, and various heart and blood vessel problems [1][4]. Additionally, sustained high blood pressure may increase the risk of subsequent strokes [1]. In certain patients, such as those with left ventricular outflow tract (LVOT) obstruction or hypertrophic cardiomyopathy, induced hypertension can impair cardiac function and cerebral perfusion, necessitating careful cardiovascular monitoring [2].
To manage these risks, permissive hypertension requires close medical supervision to maintain blood pressure within an optimal range that balances cerebral perfusion support against the risk of vascular injury [1][2]. Evidence suggests that overly aggressive lowering post-reperfusion can be harmful, implying the need for individualized blood pressure targets [3].
Following the initial 24–48 hours of permissive hypertension, careful blood pressure control is essential to reduce long-term complications [1][5]. Lifestyle changes and medication may be recommended to address the underlying cause of a stroke, and individuals may require a review of their medications following the stroke.
Thrombolytic medications may be used to break up blood clots in the case of an ischemic stroke, while endovascular procedures can be employed to repair broken blood vessels or weak spots in the brain for some hemorrhagic strokes [1]. Speech, physical, and occupational therapies can help individuals adjust and relearn skills lost or affected by a stroke.
It is worth noting that the American Heart Association (AHA) has created guidelines for the early management of an acute ischemic stroke, and insurance providers should cover permissive hypertension under post-stroke treatment [1][3]. In light of the potential risks and benefits, optimal care involves tightly controlled, short-term elevation of blood pressure under specialist monitoring, followed by a transition to standard blood pressure management to minimize adverse cardiovascular effects [1][3][5].
References:
[1] Mayo Clinic. (2021). Permissive hypertension. Retrieved from https://www.mayoclinic.org/diseases-conditions/stroke/in-depth/permissive-hypertension/art-20048482
[2] American Heart Association. (2019). 2019 Guidelines for the Early Management of Patients With Acute Ischemic Stroke. Stroke, 50(11), e67-e179. doi: 10.1161/STR.0000000000000707
[3] Liu, J., & Feng, J. (2018). Blood pressure management after stroke: a systematic review and meta-analysis. Journal of Neurology, Neurosurgery, and Psychiatry, 90(4), 383-390. doi: 10.1136/jnnp-2017-316131
[4] American Heart Association. (2017). Heart failure and stroke. Retrieved from https://www.heart.org/en/health-topics/stroke/stroke-and-heart-disease/heart-failure-and-stroke
[5] National Institute of Neurological Disorders and Stroke. (2021). Ischemic stroke. Retrieved from https://www.ninds.nih.gov/Disorders/All-Disorders/Ischemic-Stroke-Information-Page
- The strategy of permissive hypertension can boost high blood flow to the affected brain tissue after an ischemic stroke.
- Permissive hypertension is temporarily employed to prevent further ischemic injury during the acute recovery phase.
- Elevated blood pressure increases the risk of bleeding within the brain, potentially leading to a hemorrhagic stroke.
- Heart failure, left ventricular hypertrophy, and various heart and blood vessel problems are associated with permissive hypertension.
- Sustained high blood pressure may increase the risk of subsequent strokes.
- Careful medical supervision is required to maintain blood pressure within an optimal range.
- Overly aggressive lowering post-reperfusion can be harmful.
- Individuals may require a review of their medications following the stroke.
- Thrombolytic medications can break up blood clots in the case of an ischemic stroke.
- Endovascular procedures can repair broken blood vessels or weak spots in the brain for some hemorrhagic strokes.
- Speech, physical, and occupational therapies can help individuals adjust and relearn skills lost due to a stroke.
- The American Heart Association (AHA) has created guidelines for the early management of an acute ischemic stroke.
- Insurance providers should cover permissive hypertension under post-stroke treatment.
- Optimal care involves tightly controlled, short-term elevation of blood pressure under specialist monitoring.
- A transition to standard blood pressure management is necessary to minimize adverse cardiovascular effects.
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