ABSTRACT Introduction This study investigated the association between the fetal‐type posterior cerebral artery (FTP) and hypertensive thalamic hemorrhage (HTH). Method Patients with hypertension who met the admission criteria between January 2020 and August 2022 were retrospectively analyzed and divided into the HTH and non‐HTH groups based on the presence or absence of thalamic hemorrhage, respectively. In addition to whether the variable was an FTP, other variables with unbalanced distributions between the two groups were used as matching factors for 1:1 propensity score matching, and other variables that were not used as matching factors were used as covariates for conditional logistic regression. Results A total of 722 patients were included in the study, with 115 in the HTH group and 607 in the non‐HTH group. After propensity score matching, 114 patients were included in both groups. The multivariate logistic regression analysis showed that the FTP ( p = 0.003, odds ratio [OR]: 2.712, 95% confidence interval [CI]: 1.407–5.225) and homocysteine levels ( p = 0.007; OR: 1.051; 95% CI: 1.014–1.089) were significantly correlated with the occurrence of HTH. Conclusion The incidence of FTP is not low, and it is an independent risk factor for HTH. Early recognition and appropriate monitoring are warranted for cases of FTP.