Objective To observe the the therapcutic efficacy of differential antihypertensive treatments on the elderly acute cerebral hemorrhage with different amounts of bleeding. Methods 86 elderly patients with acute cerebral hemorrhage combined by hypertension were randomly divided into two groups:active antihypertensive group and regular antihypertensive group (n=43 for each group),among which 62 cases aged (68.9±5.3) years were in hemorrhage of small amount (volume ＜30 ml),24 cases aged (70.8 ± 5.7) years in large amount hemorrhage (volume ≥30 ml).The patients in active antihypertcnsive group received intravenous antihypertensive drugs within 1 hour of treatment in the following 7 d to reach systolic pressure 140-160 mm Hg.In contrast,in the control group the patients' systolic pressure reached 180-200 mm Hg at early stage.The hematoma volume was measured by CT before treatment and at 3 d and 7 d after treatment.NIH stroke scale (NIHSS)was used before treatment and 7 d and 28 d after treatment Results In the patients with small amount of bleeding,NIHSS scores and the total efficacy rate at 28 d after treatment and hematoma size at 3 d after treatment were better in active antihypertensive group than in regular antihypertensive group [(4.8±2.7) scores,86.67％ aud (2.4±0.6) ml vs.(7.6±3.9) scores,53.13％ and (8.1±3.1) ml,all P＜0.01]. However,for the patients with large amount of bleeding,there were no statistical differences in the above indexes between the two differential strategies (all P＞0.05).Conclusions Active antihypertensive therapy may inhibit early hematoma volume,improve prognosis and enhance clinical efficacy for the patients with small bleeding,but no clinical significance for the patients with large amount of bleeding.