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Hypertension is a significant risk factor for intracerebral hemorrhage (ICH). The importance of managing blood pressure to reduce the risk of ICH has been recognized. However, few studies have focused on ICH outcomes due to untreated hypertension.We conducted a 5-year, retrospective, multicenter study of 490 consecutive ICH patients with histories of untreated-hypertension (n = 56), treated-hypertension (n = 314), and normotension (n = 120). Demographics, symptom onset, vital signs, laboratory tests, and CT imaging were documented alongside in-hospital treatments, complications, and length of stay.Untreated-hypertension subjects were found to be significantly younger than treated-hypertension. They were found to have lower rates of anticoagulant use (p < 0.01), antiplatelet use (p < 0.01), and hyperlipidemia (p < 0.01) than subjects with treated-hypertension.In a multivariate model, untreated-hypertension, age ≥65 years, ≥3 outpatient antihypertensive medications, and hematoma volumes ≥30 ml were all associated with significantly increased in-hospital mortality. In contrast, mortality was lower in patients receiving ≥3 antihypertensive medications while in-hospital.Subjects with untreated-hypertension were younger and had fewer comorbidities when compared with treated-hypertension and were similar when compared to normotensive individuals. Once demographic and in-hospital factors were accounted for, untreated-hypertension subjects demonstrated significantly increased in-hospital mortality following ICH when compared with normotensive individuals.Untreated-hypertension subjects were younger and had fewer comorbidities when compared with treated-hypertension.Untreated-hypertension subjects demonstrated significantly increased in-hospital mortality following ICH.Untreated-hypertension subjects were found to have lower rates of anticoagulant use, antiplatelet use, and hyperlipidemia.Untreated-hypertension subjects had significantly longer neuro-ICU stays than the treated-hypertension group.