The 60-year-old Li found that he had high blood pressure for more than ten years, and suddenly suffered cerebral hemorrhage a few days ago and was sent to the hospital for rescue. The family feels very strange, old Li found that after high blood pressure more than ten years ago, he has not broken off, and he has been eating aspirin to prevent cerebrovascular disease according to the requirements of doctors, how can he still get cerebral hemorrhage now?
In fact, for patients with high blood pressure, taking aspirin to prevent cerebral infarction is very necessary, but there must also be enough attention to cerebral hemorrhage!
As we mentioned before, aspirin has the effect of inhibiting thrombosis, can reduce the occurrence of cardiovascular and cerebrovascular events such as myocardial infarction and cerebral infarction, and reduce the risk of cardiovascular and cerebrovascular death. Therefore, there is no dispute that aspirin is used for secondary prevention of atherosclerotic cardiovascular disease! (Link "Should we eat aspirin in the end", "How should we eat aspirin") But aspirin is a double-edged sword for the prevention and treatment of cerebrovascular diseases, and we must pay attention to changes in blood pressure at any time during use, otherwise we may lose sight of one or the other.
According to the latest "2018 China Hypertension Prevention and Treatment Guidelines (Revised Edition)", it is recommended that patients with hypertension complicated by atherosclerotic cardiovascular disease (ASCVD) require long-term secondary prevention with low-dose aspirin (100 mg/day); when acute onset of thrombosis is combined, such as acute coronary syndrome (ACS), ischemic stroke or transient cerebral insufficiency (tia), obliterated peripheral atherosclerosis, Aspirin in combination with a p2y12 receptor inhibitor such as clopidogrel and ticagrelor should be recommended in accordance with guidelines.
The 2018 China Guidelines for the Prevention and Treatment of Hypertension (Revised Edition) believes that the benefits of antiplatelet therapy for the primary prevention of cardiovascular and cerebrovascular diseases are mainly reflected in high-risk groups, such as hypertension with diabetes, hypertension with chronic renal disease (ckd), and cardiovascular risk between 50 and 69 years old. Primary prophylaxis can be achieved with low-dose aspirin (75 to 100 mg/day), and clopidogrel 75 mg/day may be used instead of aspirin intolerance.
Clinical studies have found that aspirin can reduce the relative risk of major cardiovascular events in hypertensive patients with well-controlled blood pressure by 15%, reduce the relative risk of myocardial infarction by 36%, and there is no increase in intracranial hemorrhage. (Links to "Should We Eat Aspirin", "How Should We Eat Aspirin")
Long-term use of aspirin in patients with hypertension must pay attention to stabilizing blood pressure control after < 150/90 mmhg to start the application to avoid an increased risk of intracranial hemorrhage. When blood pressure exceeds 150/90 mmhg, blood pressure should be controlled first, and the use of aspirin should be suspended. (Links to "Should We Eat Aspirin", "How Should We Eat Aspirin")
Specifically, high blood pressure is accompanied by 2 or more of the following risk factors:
1. Smoking;
2. Men over 50 years of age or postmenopausal women;
3. Abnormal blood glucose or blood lipids;
4. Obesity (bmi greater than 24);
5. Hyperhomocysteinemia;
6. Family history of early-onset cardiovascular disease.
You may also understand that aspirin has a certain risk of bleeding, so patients who need to take aspirin for a long time have the following precautions:
1. Take aspirin under the guidance of a doctor, generally the doctor will let the patient take aspirin after the blood pressure control is relatively stable (< 150 / 90 mmhg). If taken without authorization without proper control of blood pressure, it may increase the risk of cerebral hemorrhage.
2. Because long-term use of aspirin may increase the risk of gastrointestinal bleeding, it is best to perform a digestive system examination before application. If there is Helicobacter pylori infection, Helicobacter pylori should be given radical treatment. Proton pump inhibitors are used for prevention if there is a chronic gastrointestinal disorder, if the age > 65 years, or if other drugs may increase the risk of gastrointestinal bleeding.
3. Patients with active stomach ulcers, severe liver disease, and bleeding disorders should be contraindicated with aspirin (links "Should we eat aspirin?", "How should we eat aspirin").
High blood pressure patients like Lao Li taking aspirin and having cerebral hemorrhage often occur, this is because in patients with hypertension, the misunderstanding is that "taking aspirin can prevent stroke", do not know that high blood pressure itself is one of the most common causes of cerebral hemorrhage! Because patients with hypertension who have been ill for many years tend to ignore the question of whether blood pressure is controlled to meet the standards. When blood pressure rises, the risk of bleeding will be greatly increased by taking aspirin, an antiplatelet drug, at the same time!
Although Lao Li knows that he has hypertension and insists on taking antihypertensive drugs for more than ten years, he has forgotten the doctor's advice to often measure blood pressure behind his head, and he feels that as long as he takes antihypertensive drugs, his blood pressure will not be high, so he rarely monitors blood pressure. In fact, his real situation is that although he is taking antihypertensive drugs, his blood pressure is not well controlled, and he does not know that his blood pressure is already very high, which has led to the occurrence of cerebral hemorrhage accidents.
It is especially important to remind patients with high blood pressure that although they take antihypertensive drugs, they must also regularly monitor blood pressure changes, especially patients who take aspirin. Hypertensive patients are best to choose to measure blood pressure in the early morning, because this period of blood pressure is generally the highest peak of blood pressure throughout the day, and it is also the time period when cardiovascular and cerebrovascular diseases are most likely to occur, and controlling the blood pressure during this period is conducive to the control of blood pressure throughout the day. If not recommended by your doctor, do not use aspirin without authorization. If your doctor tells you you need to use aspirin, don't be afraid to use it for fear of the risk of bleeding.