Acute hypertension is associated with hematoma enlargement and poor clinical outcomes in patients with intracerebral hemorrhage (ICH). However, the method of controlling blood pressure (BP) during the acute phase of ICH remains unknown. The aim of this study is to show current strategies about this issue in Japan. Questionnaires regarding antihypertensive treatment (AHT) strategies were sent to neurosurgeons, neurologists and others responsible for ICH management in 1424 hospitals. Of 600 respondents, 550 (92%) worked at hospitals wherein acute ICH patients are managed and 548 (99.6%) of them agreed with the application of AHT within 24 h of ICH onset. Most answered that the systolic BP threshold for starting AHT was 180 mm Hg (36%) or 160 mm Hg (31%), which differed significantly between neurosurgeons (median, 160 mm Hg) and neurologists/others (180 mm Hg, P<0.001). The goal of lowering systolic BP was to reach a maximum of 140, 150 or 160 mm Hg according to 448 respondents (82%) and 209 (38%) intensively lowered systolic BP to <or=140 mm Hg. Nicardipine was the first choice of intravenous drug for 313 (57%) and the second choice for 146 respondents (27%). However, 141 (26%) thought that nicardipine is inappropriate mainly because of a conflict with a description of contraindications on the official Japanese label for this drug. In conclusion, the present Japanese respondents, especially neurosurgeons, lower BP more aggressively than recommended in domestic and Western guidelines for managing acute ICH patients. Nicardipine was the most frequent choice of antihypertensive agent.