Hypertensive intracerebral hemorrhage (ICH) is the deadliest, most disabling and least treatable form of acute cerebral accident. A large number of patients die in a short time after the hemorrhage. However, the risk factors of early death in this pattern are still in debate. A case control study of 273 patients with hypertensive ICH admitted to our hospital was carried out. The patients were divided into the death group and survival group according to clinical outcome during hospitalization. Any possible risk factors were assessed using univariate and multivariate analysis. The logistic regression analysis revealed that the following four factors were independently associated with early death: age [odds ratio (OR), 0.966; 95% confidence interval (CI), 0.936-0.997; P=0.0327], GCS score (OR, 1.192; 95% CI, 1.090-1.303; P<0.001) and systolic pressure (OR, 0.939; 95% CI, 0.772-1.142; P<0.001) at admission, and hematoma volume (OR, 0.8000; 95% CI, 0.807-0.959; P=0.0037). Cranial computed tomography imaging is an important examination method to evaluate the clinical outcome. Effective prevention of hypertension and adequate reduction of blood pressure at admission are recommended as the major measures to improve the prognosis of hypertensive ICH.