Intracerebral Hemorrhage Prevention: Ranking the Methods that Slash Risk by 50%—From Home BP Monitoring to Advanced Treatments

Intracerebral Hemorrhage (ICH) is a disease where the risk can be “almost certainly reduced” by adopting appropriate measures. Since the chance of severe disability is high once the disease occurs, prevention is paramount.

Intracerebral Hemorrhage Prevention Methods Ranked by Evidence

Rank	Prevention Method	ICH Risk Reduction (Research Data)	Specific Action Steps
1	Strict Management of Hypertension	Approx. 50–70% ↓ (Most Effective)	Measure BP daily at home → Target <130/80 mmHg in clinic, and <125/75 mmHg at home.
2	Smoking Cessation	Approx. 40–50% ↓	Eliminate completely (including e-cigarettes).
3	Moderate Alcohol Consumption(Men: <25g/day, Women: <12.5g/day)	Approx. 30% ↓	Limit to 1 gou (180ml) of sake or one large bottle of beer.
4	Appropriate Use of Anticoagulants/Antiplatelet Drugs	Some drugs increase bleeding risk by 2–5x	Consult your doctor to confirm: “Is it truly necessary?” and “Does it carry a high bleeding risk?”
5	Exercise (150 minutes of moderate intensity/week)	Approx. 25–30% ↓	Brisk walking, swimming, cycling, etc.
6	Salt Reduction (<6g/day)	Approx. 20–25% ↓	Limit to one cup of miso soup and a small amount of pickles.
7	Regular Brain Checkups (for age 40+)	Early detection of asymptomatic microbleeds and unruptured aneurysms	Annual checkups recommended, especially if there is a family history of ICH or SAH.

Prevention Checklist by Age and Risk Status: What You Should Start Now

Your Situation	Immediate Action Steps (Priority Order)
Ages 40-50, Slightly High Blood Pressure	1. Buy a home BP monitor → Measure every morning. 2. Reduce salt + walk 30 minutes daily. 3. Get a Brain Checkup (MRI) within one year.
Ages 60+, BP ∼140–160 mmHg	1. Take prescribed antihypertensive medication diligently. 2. Keep salt intake below 6g. 3. Prevent falls (remove tripping hazards at home, strength training).
Taking Anticoagulants (Warfarin/DOAC) for Atrial Fibrillation	1. Ask your doctor for a bleeding risk assessment (HAS-BLED score). 2. Adopt a lifestyle to avoid head injuries. 3. Regular head CT/MRI checks.
Family (Parent/Sibling) had ICH/SAH at a young age	1. Get an MRA (Brain Angiography) as soon as you turn 40. 2. Strictly maintain BP below 120/80 mmHg.
Drinking ≥2 gou of sake (or equivalent) daily	1. Reduce intake to 1 gou first. 2. Have 2 complete alcohol-free days per week. 3. Lower liver enzyme levels as well.

“New Prevention Methods” Gaining Attention in 2025

Checking for Microbleeds
- A large-scale study found that people with 10 or more small bleeding scars (microbleeds) on their MRI had fewer ICH events if they targeted strict blood pressure control (in the 110–120 mmHg range).
Treatment for Sleep Apnea Syndrome (SAS)
- Using a CPAP machine suppresses sudden nighttime blood pressure spikes, reducing ICH risk by approximately 30%.
SGLT2 Inhibitors and GLP-1 Receptor Agonists (Diabetes Medications)
- These are being recognized for their effects in lowering blood pressure and strengthening blood vessels, even in people without diabetes (Consult with a doctor).

Example of a Daily Routine to Drastically Reduce ICH Risk

Time	Action
Morning	Measure BP immediately upon waking → If ≥135, have a salt-free breakfast.
Breakfast	Miso soup with plenty of ingredients and low salt, centered on natto and vegetables.
Commute	Walk one station or cycle.
Lunch	Bring your own lunch (or a low-salt option like a convenience store onigiri + salad).
Evening	Limit alcohol to one medium glass of beer (or equivalent).
Night	20 minutes of stretching or walking.
Before Bed	Measure blood pressure again.

By simply maintaining this routine, your risk of cerebral hemorrhage in 5 years will be less than half.