Acute hypertensive response is the elevation of blood pressure above normal and premorbid values that initially occurs within the first 24 hours of symptom onset in patients with intracerebral hemorrhage (ICH). We reviewed the existing data pertinent to acute hypertensive response derived from scientific guidelines, randomized trials, non-randomized controlled studies, and selected observational studies. Chronic hypertension and intracerebral hemorrhage Incidence of intracerebral hemorrhage and hypertension Spontaneous, non-traumatic ICH from intraparenchymal blood vessels makes up approximately 8–15% of all strokes. Approximately 80–85% are primary spontaneous ICH which are either secondary to arterial hypertension or cerebral amyloid angiopathy. It is estimated that 70% of the primary spontaneous ICH cases are attributed to arterial hypertension while roughly 5–20% are secondary to cerebral amyloid angiopathy. A total of 15–20% of stroke cases are attributed to secondary spontaneous ICH, related to oral anticoagulation (∼ 4–20%), tumors (∼ 5%), vascular malformations (∼ 1–2%) and more uncommon reasons, such as sinus venous thrombosis, cerebral vasculitis, drugs, eclampsia, and others (∼1%). Risk factors for intracerebral hemorrhage Hypertension is the most frequent and most important risk factor for ICH. A rigorous identification of modifiable (hypertension, smoking, low cholesterol levels, diabetes, increased alcohol consumption, and drugs) and un-modifiable (increased age, male gender, and cerebral amyloid angiopathy) risk factors that contribute to ICH and its recurrence must be carried out due to the high morbidity and mortality associated with it.