Objective To investigate the effects of super-early intensive antihypertensive treatment on the enlargement of hematoma, plasma matrix metalloproteinase 9 (MMP-9), brain edema and neurological function in patients with acute basal ganglia hemorrhage. Methods Totally 134 patients who had spontaneous super-early basal ganglia hemorrhage within the previous 4 hours were prospectively studied and randomly divided into strengthening antihypertensive group (67 cases) and normal antihypertensive group (67 cases). In the strengthening antihypertensive group 60 patients had completed three brain CT scans, while in the normal antihypertensive group 62 patients had completed three brain CT scans. The antihypertensive agents were used intravenously to reduce systolic blood pressure (SBP) to the level of 130-140 mmHg or 160-180 mmHg within 1 h after treatment, then SBP was maintained for 24 h. Before and after treatment, the National Institutes of Health Stroke Scale (NIHSS) score and modified Rankin Scale (mRS) score were assessed, plasma MMP-9 was detected and cranial CT was performed. The hematoma volume, number of cases of hematoma enlargement and edema volume were measured and compared between both groups. Results The NIHSS score in the strengthening antihypertensive group was significantly lower than that in the normal antihypertensive group on the 14th day after treatment (P < 0.05). On the 90th day after treatment, the proportion of moderately and severely disabled patients or death cases in the strengthening antihypertensive group was significantly lower than that in the normal antihypertensive group (P < 0.05). The hematoma volume and number of cases of hematoma enlargement in the strengthening antihypertensive group were significantly smaller than those in the normal group at 24 h after treatment (P < 0.05). The edema volume was significantly smaller in both groups and plasma MMP-9 level was significantly lower in the strengthening antihypertensive group than in the normal group on the 5th d after treatment (all P < 0.05). Conclusions Super-early strengthening antihypertensive treatment could prevent expansion of intracerebral hematoma, relieve perihematomal edema, reduce plasma MMP-9 level, and improve neurologic function of patients with basal ganglia hemorrhage.