Overview Hypertensive cerebral hemorrhage is one of the worst prognoses for hemorrhagic stroke because the site of hemorrhage is mostly located in the basal ganglia region of the internal capsule, which brings together the conduction tracts of one hemisphere. Therefore, after hemorrhage in this area, patients tend to have varying degrees of contralateral limb dysfunction, such as hemiparesis. The onset of hypertensive cerebral hemorrhage has the following characteristics: (1) Obvious age characteristics, with middle-aged and elderly people being the high-risk group. This is due to the high incidence of hypertension in this population. Clinically, we have treated some young patients, the youngest of whom was only 29 years old, who usually have hypertension without paying attention and effective treatment. (2) Seasonality is obvious, and winter is the high incidence season of this disease. Clinically, we have observed a significant increase in the number of such patients when the temperature plummets. Treatment Treatment of hypertensive cerebral hemorrhage is divided into two categories: conservative treatment and surgical treatment. Conservative treatment is mainly used for patients with a small amount of bleeding and also for patients with other organ dysfunction in the body that cannot tolerate surgery. For patients with more bleeding and patients with significant symptoms of intracranial hypertension, surgical treatment is the primary means of saving the patient’s life. The results of STICH, a multicenter randomized clinical study that included the largest number of patients with spontaneous cerebral hemorrhage (1033), showed that early surgical treatment did not offer a significant advantage over conservative treatment in terms of prognostic improvement. Although there are many caveats to the interpretation of this result, the choice of treatment option is an important factor affecting prognosis. Surgical options are mainly divided into traditional craniotomy and minimally invasive surgery (including hematoma cavity placement and drainage and endoscopic suction). With the widespread use of microscopic techniques in brain surgery, craniotomy has become a mature technique, which has obvious advantages in minimizing the total amount of blood, rapidly relieving intracranial hypertension, and controlling ruptured vessels under direct vision; while minimally invasive surgery has certain advantages in terms of operating time and patient physical condition requirements. Prognosis Overall, the prognosis of patients with hypertensive cerebral hemorrhage is relatively poor, with foreign reports that only about one fifth of patients can live on their own one year after the onset of the disease. Age, bleeding volume, state of consciousness, and whether or not it breaks into the ventricles are all independent factors associated with prognosis. The proper formulation and implementation of treatment protocols, prevention and treatment of complications, and post-acute rehabilitation also influence the final outcome. The mortality and disability rates of hypertensive cerebral hemorrhage are quite high and place a great burden on patients and their families, so effective prevention is the best treatment. Effective control of blood pressure in hypertensive patients is extremely important, especially the monitoring of blood pressure and adjustment of medications when the temperature drops suddenly.