After you have had an ischemic stroke,missive hypertension is a treatment approach a doctor may use. A stroke is when a clot in the blood stops the flow of blood to a specific area of the brain. Higher blood pressures may have benefits.

“You will likely need to be hospitalized after you have had a stroke. During this time, healthcare professionals will monitor your blood pressure to make sure it doesn’t get too high.”

Outside the hospital,missive hypertension is not usually used. Permissive hypertension is a topic to be kept up to date on, and it has some risks and benefits.

Permissive hypertension is an approach where a doctor will hold or lower the dosages of blood pressure-lowering medications for up to 48 hours immediately following a stroke. As a result, a person’s blood pressure will usually be higher than ranges that are typically accepted.

Research hasn’t been fully conclusive that permissive hypertension is the best approach after a person has a stroke. However, some research studies have indicated that higher blood pressures may help to promote blood flow to the blood vessels in the brain, which may not have received blood during a stroke.

For good reason, your brain fits snuggly inside your skull. If it swells, there isn’t a lot of room to expand. Normally, as long as your blood pressure is in a certain range, your brain gets the blood flow it needs. If your blood pressure is too low, your brain may not receive enough blood. If your blood pressure is too high, your brain can swell, and bleeding risks are increased.

“If you have had a stroke, your brain tissue can be damaged. The same rules and pressures may not work this time. Your brain can’t regulate blood flow as well, so you may need higher blood pressures to make sure it gets the blood it needs.”

The idea behind permissive hypertension is this concept. We will look at the benefits of higher blood pressure after a stroke.

High blood pressure is a major contributing factor to stroke — and patients admitted with stroke often have higher than standard blood pressures. One of the reasons why blood pressure may be so high during a stroke is because the body is attempting to get more blood to the brain.

When a person has an ischemic stroke, they have a clot that’s blocking blood flow to an area of the brain. Think of this like a log falling across a stream, preventing water from flowing to the other side. The body tries to increase blood pressure as a way to get around the obstruction, much like if there was a significant increase in water flow, the water could go over the log.

The argument for keeping blood pressure high after a stroke has several reasonings. First, those who experience a stroke typically already have high blood pressures. Lowering their blood pressure too much could affect the way their body works because their bodies are used to “running” on higher blood pressures.

The brain is trying to reestablish blood flow after it was blocked. Higher blood pressures can result in more brain blood flow.

One study found that patients cared for at home after a stroke had more functional improvements than those cared for at an acute rehab facility after a stroke. The acute rehab facility controlled blood pressure more tightly, not allowing for as much permissive hypertension.

The researchers theorize that the return to function after strokes is negatively affected by too-tight blood pressure controls.

In 2019, the American Heart Association (AHA) released updated “Guidelines for the Early Management of Patients With Ischemic Stroke.” Included in these guidelines are blood pressure management recommendations. These recommendations depend upon how a doctor is treating the stroke.

The chart shows the blood pressure recommendations by treatment.

Treatment Blood Pressure Recommendations
Intravenous alteplase Careful lowering to less than 185 systolic and 110 diastolic before administering.
Mechanical thrombectomy (removing the clot) Keep blood pressure at 185/110 or less before the procedure.
Supportive treatments If they don’t have certain medical history (heart failure, coronary stent, or pre-eclampsia/eclampsia), initiate treatments if blood pressure is greater than 220 systolic or 120 diastolic.
The first goal should be to decrease blood pressure by about 15% of their pressure when they came to the hospital.

Drug-Induced Hypertension is not well established according to the guidelines of the American Heart Association. Doctors should study each patient and their medical history before setting a blood pressure goal, according to their guidelines.

Always follow your doctor’s recommendations

“Permissive hypertension recommendations are a general recommendation. They aren’t meant for everyone.”

“If you or a loved one has had a stroke, following a doctor’s recommendations is the best plan.”

Permissive hypertension can present risks because extremely high blood pressure can increase a person’s risk of changing an ischemic stroke (due to a blood clot) to a hemorrhagic stroke. A hemorrhagic stroke is where an artery in the brain bursts and there’s significant bleeding in the brain.

Doctors won’t usually recommend permissive hypertension methods for poststroke care for those who have a left-ventricular assist device (LVAD). This device works to assist a heart that’s poorly functioning.

Research has also shown permissive hypertension can actually decrease (instead of increase) blood flow to the brain. As a result, permissive hypertension on a patient with an LVAD can be a potentially dangerous approach.

“Permissive hypertension doesn’t have a special code or regimen for insurance or Medicare. If you have had a stroke, temporarily stopping your blood pressure-lowering medications may be a part of your treatment.”

When you have recovered from a stroke, your doctor may assess the medications you take to determine what you should continue taking and if you need new medications. You can review your insurance plan and Medicare benefits at this time to find out what medications they cover.

Caring for yourself after a stroke

“Knowing you had a stroke in the first place can be overwhelming, even if you don’t experience long-term deficits. Some steps to help you care for yourself after a stroke.”

  • If there is a program in your area, ask your doctor. These programs help patients recover from a stroke.
  • Use the American Stroke Association’s Stroke Support Group Finder to locate a support group near you.
  • Evaluate your home for potential fall risks. After a stroke, you’re more at risk of falling. Make sure you have sturdy furniture, uncluttered floors, and slip-proof bathtub surfaces.
  • Get help from a counselor. Depression is a high risk after a stroke. It can help to see a counselor sooner.

It may seem like an unusual approach after a stroke. It is not often that a doctor tells you not to take your medication. Permissive hypertension may help improve stroke recovery for the right patients.

Having higher blood pressure can help the brain get back to normal after a stroke. You will only be able to do this while you are in the hospital.

You shouldn’t stop taking your blood pressure medications under any other circumstances, unless a doctor directs you to do so. Talking with your doctor is the best way to understand your stroke recovery.