To observe the effect of intensive hypotension during the hyperacute phase on patients with cerebral hemorrhage in the basal ganglia. Methods: A total of 70 patients with basal ganglia hemorrhage were randomly divided into the control group or enhanced group, with 35 in each. Treatment in the control group utilized an ordinary antihypertensive strategy, while that in the enhanced group used an enhanced antihypertensive strategy. CT scans were performed to measure hematoma volume before treatment and 24 hours after treatment, and the incidence of hematoma enlargement within 24 hours of treatment was calculated. The Glasgow Coma Scale (GCS) score and National Institutes of Health Stroke Scale (NIHSS) score were obtained before, 24 hours after, and 14 days after treatment to assess consciousness and neurological function. The Barthel Index (BI) was used to evaluate ability in activities of daily life before and 14 days after treatment. Patient deaths within 30 days of hospitalization were recorded. Results: In both groups, hematoma volume showed an increase 24 hours after treatment, but the enhanced group showed a smaller volume than the control group (P<0.05). The enhanced group yielded a smaller proportion of patients with hematoma enlargement compared to the control group (P<0.05). There was no significant difference in GCS and NIHSS scores between the two groups (both P>0.05). Fourteen days after treatment, the enhanced group showed higher GCS and BI scores and a lower NIHSS score compared to the control group (all P<0.05). There was no significant difference in mortality between the 2 groups (P>0.05). Conclusion: For patients during the hyperacute period of mild basal ganglia hemorrhage, the use of intensive antihypertensive treatment can strengthen treatment effectiveness, limit hematoma enlargement, and protect nerve function.