Intracerebral hemorrhage (ICH) is still a devastating stroke, with high mortality. Arterial hypertension (AHT) is the most common cause of primary ICH, causing changes in the wall of small vessels, leading to its rupture. Recent studies have attempted to understand the basic mechanisms of tissue damage around the hematoma. These days there is a debate regarding biochemical changes in this area, usually recognized as edema. Detection with the gradient-echo T2 weighted MRI of old and silent microhemorrhages in a patient with ICH as a radiological expression of a microangiopathy of small vessel poses questions regarding its predictive value of risk of bleeding recurrence. The object of our review is to analyze the present data that explains the interaction between chronic hypertension and primary ICH.