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The role of N-terminal pro-brain natriuretic peptide (NT-proBNP) in patients with hypertensive intracerebral hemorrhage (HICH) is poorly understood. This study aimed to investigate the secretion pattern of NT-proBNP in patients with HICH and to assess its relationship with hematoma size, hyponatremia, and intracranial pressure (ICP).This prospective study enrolled 147 isolated patients with HICH. Blood samples were obtained from each patient, and values of serum NT-proBNP, hematoma size, blood sodium, and ICP were collected for each patient.The peak-to-mean concentration of NT-proBNP was 666.8 ± 355.1 pg/mL observed on day 4. The NT-proBNP levels in patients with hematoma volume >30 mL were significantly higher than those in patients with hematoma volume <30 mL (P < .05). In patients with severe HICH, the mean concentration of NT-proBNP was statistically higher than that in patients with mild–moderate HICH (P < .05), and the mean level of NT-proBNP in hyponatremia group was significantly higher than that in normonatremic group (P < .05). In addition, the linear regression analysis indicated that serum NT-proBNP concentrations were positively correlated with ICP (r = .703, P < .05) but negatively with blood sodium levels only in patients with severe HICH (r = −.704, P < .05). The serum NT-proBNP levels on day 4 after admission were positively correlated with hematoma size (r = .702, P < .05).The NT-proBNP concentrations were elevated progressively and markedly at least in the first 4 days after HICH and reached a peak level on the fourth day. The NT-proBNP levels on day 4 were positively correlated with hematoma size. There was a notable positive correlation between plasma NT-proBNP levels and ICP in patients with severe HICH. Furthermore, only in patients with severe HICH, the plasma NT-proBNP levels presented a significant correlation with hyponatremia, which did not occur in patients with mild–moderate HICH.