To investigate the association between aquaporin 4 (AQP4) gene polymorphism and delayed cerebral edema in patients with hypertensive intracerebral hemorrhage (HICH) in Shanxi. Methods: One hundred and thirty-seven HICH patients in Shanxi were recruited to the study. According to whether combined with delayed cerebral edema, they were divided into the case group (42 cases) and the control group (95 cases). Genotype was determined by polymerase chain reaction- sequence based typing for AQP4 gene rs1058424, rs3763043, and rs335931 polymorphism. In addition, other clinical data were collected for statistical analysis. Results: Compared to the control group, the case group showed higher age, higher ratio of patients with diabetes and persistent fever, greater baseline hematoma volume, and higher baseline National Institute of Health Stroke Scale (NIHSS) score (all P<0.05). Compared with the control group, frequencies of genotype TT and allele T of rs3763043 in the case group were both significantly increased (both P<0.05). Multivariate logistic regression analysis showed that carrying allele T of AQP4 gene rs3763043, fever, large hematoma volume, and high NIHSS score were risk factors of delayed cerebral edema for HICH patients. Conclusion: For HICH patients in Shanxi, carrying allele T of the AQP4 gene rs3763043, fever, large hematoma volume, and high NIHSS score were risk factors of delayed cerebral edema.