Objective To explore the relationship among high homocysteine hypertension(H-type hypertension), early enlargement of hypertensive intracerebral hematoma and its clinical outcome and death within 3 months. Methods A total of 298 cases with primary cerebral hemorrhage were selected in this study. The data including general information,brain CT scan results within 6 and 24 h, the values of homocysteine(Hcy), blood glucose,cholesterol and fibrinogen, and the scores of National Institute of Health Stroke Scale(NIHSS)were collected. After 3 months follow-up, modified Bathel(MBI)scores and the death tolls were collected as well. Results The increase of plasma Hcy level(odds ratio[OR]=0.356, 95% confidence interval [CI]: 0.131-0.826;P＝0.021)and the elevation of systolic pressure(OR=1.021,95% CI: 1.002-1.028;P＝0.045)were independent risk factors of enlargement hematoma of primary cerebral hemorrhage. The increase of plasma Hcy level(OR=1.031, 95% CI: 1.021-1.278;P＝0.035)and the elevation of systolic pressure(OR=1.141, 95% CI: 1.011-1.072;P＝0.034)were the independent risk factors of clinical poor outcome. Besides,the elevation of systolic pressure(OR=1.023,95% CI: 1.007-1.051;P＝0.021), higher blood glucose(OR=1.382,95% CI: 1.221-1.673;P＝0.004), and the increase of Hcy level(OR=1.521, 95% CI: 1.025-8.096;P＝0.023) were the independent risk factors of death within 3 months. Conclusion H-type hypertension is the independent predictor of early enlargement of hematoma and clinical outcome and death of primary cerebral hemorrhage.