Hypertensive intracerebral hemorrhage (ICH) is a relatively common reason for neurologic intensive care unit (ICU) admission and is associated with significant morbidity and mortality. Hypertensive ICH results from rupture of small penetrating arteries leading to intraparenchymal hematoma formation. While hypertension is the most significant risk factor for ICH, smoking, and excessive alcohol consumption also constitute risk factors. Supportive care, close neurologic monitoring and attention to potential complications form the basis of ICH management. Standard conservative measures in ICH consist of blood pressure and intracranial pressure (ICP) management in combination with control of hyperglycemia and hyperpyrexia, attention to common medical complications such as deep venous thrombosis and consideration of antiepileptic therapy. Close monitoring of neurologic status in an ICU is essential in ICH and for patients with elevated ICP invasive monitoring may be beneficial. Conservative management is the core principle with close attention to preventing and managing neurologic and medical complications.