From the Research
Permissive hypertension is typically maintained for 24 hours in patients with acute intracerebral hemorrhage, as evidenced by the most recent study 1. The management of permissive hypertension is crucial in patients with acute stroke, including both ischemic and hemorrhagic types. The goal is to maintain cerebral perfusion to the affected area while minimizing the risk of further damage.
- In patients with acute ischemic stroke who are not receiving thrombolytic therapy, permissive hypertension is typically maintained for 24-48 hours, allowing blood pressure to remain elevated up to 220/120 mmHg 2.
- For patients who have received thrombolytic therapy, such as tPA, permissive hypertension is not recommended, and instead, blood pressure should be maintained below 180/105 mmHg to reduce the risk of hemorrhagic transformation 3.
- The physiological basis for permissive hypertension is that the autoregulation of cerebral blood flow is impaired in the area of the stroke, making the tissue dependent on systemic blood pressure for adequate perfusion 4.
- As the acute phase resolves and the risk of extending the infarct decreases, blood pressure can be more aggressively managed, with a goal of gradually reducing it to normal levels over several days 1.
- The choice of antihypertensive agent, such as clevidipine or nicardipine, should be based on the patient's individual needs and the institution's preferences, as both agents have been shown to be effective and safe for acute blood pressure reduction in patients with stroke 1, 5.