What tests can be done to prevent cerebral hemorrhage due to high blood pressure?

For patients with high blood pressure, if they want to prevent cerebral hemorrhage, there is no need to blindly stock up on a bunch of high-priced tests. A solid monitoring of blood pressure itself and basic screening related to vascular damage can avoid more than 90% of risks.

I met Lao Zhou at a community free clinic a while ago. He has been hypertensive for 11 years. He only remembers taking antihypertensive drugs and has never had a re-examination. Recently, he always feels swollen and dizzy in the back of his head. He pestered the doctor to prescribe a full physical examination package worth tens of thousands of dollars. In the end, the doctor only asked him to do a head CTA of several hundred yuan, and found out a 2mm unruptured intracranial aneurysm. They intervened in time and solved the problem before it could rupture or bleed.

Many people have misunderstandings about the examination to prevent cerebral hemorrhage. They think that the more expensive it is, the more accurate it is. In fact, this is not the case. You have to choose according to your own physical condition.

Daily blood pressure monitoring at home is actually the most cost-effective test. Don’t think that the electronic blood pressure monitor at home is inaccurate. If you can measure your resting blood pressure at three fixed time periods in the morning, afternoon and evening for a month, and write down the value fluctuations, the reference value is much higher than going to the hospital to take a measurement once in a while. After all, blood pressure rising and falling is like the water pressure of a water pipe jumping repeatedly, and the already hardened blood vessel wall is most likely to be broken.

In addition to daily blood pressure measurements, don’t take routine blood tests for half a year to a year seriously. Blood lipids, blood sugar, and homocysteine ​​are all “little moths” that quietly gnaw at the elasticity of blood vessels. Especially in our country, many hypertensive patients have H-type hypertension with high homocysteine. The risk of cerebral hemorrhage is three times higher than ordinary hypertension. This item only costs a few dozen yuan per test. If it is really high, just follow the doctor’s advice and take some folic acid to bring it down. It is very cost-effective.

As for the brain examination that everyone is most concerned about, you have to choose according to your needs. If your blood pressure is relatively stable and you don’t have frequent headaches, numbness on one side, or inexplicable dizziness, a regular head CT scan every 1 to 2 years is enough to detect early warning signs such as old microbleeds and white matter lesions. ； If your blood pressure always fluctuates up and down, you have a family history of smoking, alcoholism, or aneurysms, or you have frequent headaches or temporary darkening, you can do a CTA or MRA of your head and neck to see if there are any "time bombs" hidden in your head such as intracranial aneurysms or vascular malformations. There is currently no absolute advantage or disadvantage between these two examinations. MRA does not require contrast agent and does not cause radiation, but the price is slightly higher. CTA is cheaper and has higher imaging clarity. It only requires a small amount of contrast agent and is not suitable for people who are allergic to iodine. You can choose according to your own situation.

Many institutions now recommend digital subtraction angiography (DSA), saying it is the gold standard for checking cerebral blood vessels. In fact, this practice has been controversial in the industry. DSA is an invasive examination and requires hospitalization. Unless a suspected aneurysm has been discovered by CTA or MRA and the nature needs to be further confirmed to prepare for surgery, there is no need to do ordinary screening. It will cost more money and run the risk of infection.

I met a 37-year-old man in the clinic before. He had never been screened for high blood pressure for 4 years. After staying up all night for a week, he had a headache until he vomited. After a CTA test, he found that he had three aneurysms in his head. Fortunately, they had not ruptured. Otherwise, he would probably not be saved if he was not sent to the hospital in time. Don’t think that you are young and don’t take it seriously. As long as you have a history of high blood pressure for more than 3 years, no matter how old you are, it is best to do a basic screening of cerebral blood vessels first.

To put it bluntly, the more expensive the examinations to prevent cerebral hemorrhage, the better. It is much more effective to adapt to one's physical condition and do all the basic items that should be done than to randomly buy a bunch of high-priced examinations.