Objective: To investigate the correlation of abnormal lipid metabolism with cerebral microbleeds (CMBs) in hypertension patients. Methods: Fifty patients with simple hypertension patients, 50 patients with hypertension CMBs, and 66 normal patients as the control group were selected, TC, TG, HDL, LDL and Apo-A, Apo-B level were detected and compared, and further the relevance of the lipid levels and incidence of CMBs was analyzed. Patients were examined by T1-weighted imaged (T1WI), T2-weighted imaged (T2WI), diffusion weighted imaging (DWI) and susceptibility weighted imaging (SWI). The incidence, number and distribution of CMBs were statistically analyzed, and the correlation between CMBs and TC, TG, HDL, LDL and Apo-A, Apo-B and imaging findings were analyzed. Results: CMBs lesions in patients with hypertension were mainly distributed in basal ganglia region. Age is the independent risk factors of cerebral hemorrhage, and hypertension is the first risk factors. Compared with the control group, the levels of TC, TG, Apo-B was significantly increased in the experimental group, HDL significantly reduced; Apo-A level reduced significantly, Apo-B level increased significantly in the hypertension with CMBs group. The abnormal detection rate of LDL and HDL in CMBs was as high as 31.76% and 37.64%. Conclusion: There is a direct correlation between serum lipid level and the occurrence of CMBs. Lipid metabolism is of great importance in the cerebral vascular diseases, and is a key risk factor of CMBs.