Hypertension is a common disease in life, which brings great trouble to the life of the elderly. Hypertension often leads to pathological changes in the small arteries at the base of the brain, which are highlighted by glassy or fibrous degeneration and focal hemorrhage, ischemia and necrosis in the walls of these small arteries, weakening the strength of the vessel walls, appearing as limited dilatation, and forming tiny aneurysms. Hypertensive cerebral hemorrhage is the result of a dramatic increase in blood pressure caused by emotional excitement, excessive mental and physical effort, or other factors, which leads to rupture and bleeding of the diseased cerebral vessels. Among them, rupture of the doublestem artery is the most common, and the others are the thalamic penetrating artery, the thalamic geniculate artery and the posterior internal choroid plexus artery, in that order. Therefore, hypertensive cerebral hemorrhage has its own particular site of predilection. According to the statistics of the bulk of cases, 55% of them are in the cortical nucleus (external capsule) area, 15% in the subcortical white matter of the cerebral lobe, 10% in the thalamus, 10% in the pontocerebrum, and 10% in the cerebellar hemispheres. It is extremely rare that the hematoma occurs in the medulla oblongata or midbrain. Sometimes the hematoma may expand into the ventricles of the brain, but usually does not penetrate the cerebral cortex causing subarachnoid hemorrhage. Pathologically, the hematoma causes compression of the surrounding brain tissue, ischemia, cerebral infarction, necrosis, and severe cerebral edema, which predisposes to acute intracranial pressure increase and brain herniation. The clinical features are the sudden onset of severe headache, which is often accompanied by agitation, drowsiness or coma. When the hematoma expands and the cerebral edema worsens, the intracranial pressure increases, causing brain herniation crisis such as dilated pupils on the side of the hematoma, respiratory disturbance, slowed pulse rate and increased blood pressure. This is followed by central failure. When the bleeding volume is low, the hematoma can absorb and dissipate on its own, and the symptoms gradually resolve. Based on the history and clinical features of hypertension, it is generally not difficult to make a clinical diagnosis. Brain CT and MRI scans are most helpful for diagnosis, not only to confirm the diagnosis early, but also to accurately understand the site of hemorrhage, the amount of hemorrhage, the extent of its spread, the presence of ventricular penetration and the condition of the brain tissue surrounding the hematoma. How to treat Surgical treatment of hypertensive cerebral hemorrhage should be valuable only when non-surgical treatment has failed and the hemorrhage has not yet caused primary or secondary fatal damage. The aim of surgical treatment is to eliminate the hematoma, lower the intracranial pressure, relieve the occurrence and development of cerebral herniation, improve cerebral circulation, and promote early recovery of the compressed brain tissue. In conclusion, the treatment of hypertensive cerebral hemorrhage is selective. If the hemorrhage is small, it can be treated by internal medicine, and if the hematoma is large, such as the volume of hematoma in the external or internal capsule area reaches 20 ml or more, timely craniotomy or brain stereotactic surgery to remove the hematoma often helps to release the brain from pressure and promote recovery. Stereotactic hematoma aspiration is precise in localization and has little surgical damage, especially for hematoma removal in deep brain or important functional areas. Surgical treatment is sometimes difficult to achieve in patients who are in a coma or in a state of cerebral tonicity because of the rapid onset of the disease and its deterioration within a short period of time. Non-surgical treatment includes absolute bed rest, sedation and blood pressure stabilization, application of dehydrating drugs, hemostatic drugs, maintenance of water and electrolyte balance, supportive therapy, and attention to keeping the respiratory tract unobstructed. Comatose patients should be meticulously cared for, and complications such as pneumonia and gastric hemorrhage should be prevented and treated promptly, and postoperative medical aspects are still required.