Background: The number of persons reaching the age 80 years and over is increasing in most populations. Literature focusing on hypertensive intracerebral hemorrhage (ICH) inthis age group is lacking. Therefore, we aimed to analyze the main clinical characteristics of ICH of the advanced old age, in the context of hypertension. Methods: From 1999 to 2003 we studied 56 hypertensive very elderly patients presenting with ICH (50% women; age 80–99 years). As controls, 168 hypertensive gender-matched persons with ICH, aged <80 years, were randomly selected by a 3:1 factor for clinical comparisons. Results: Compared with their younger counterparts, the very elderly patients had a trend for fewer cases of obesity (34 vs. 49%, p = 0.05) and diabetes mellitus (12 vs. 24%, p = 0.06), had lower systolic, diastolic and mean blood pressure measures (in all, p < 0.01) and more cases with hematoma extension into ventricles (p = 0.02). Thalamic hemorrhage was more frequent in the very elderly patients than in controls (43 vs. 28%, p = 0.04). In multivariate analysis, age, Glasgow coma scale score at hospital admission, ICH volume and infratentorial location were independent predictors of inhospital mortality, in all persons combined. In the very elderly group exclusively, Glasgow coma scale score was the only factor independently associated with mortality. Conclusions: ICH occurring in hypertensive patients aged ≧80 years has several differences from that seen in younger people; however, these differences do not seem to impact on early outcome.