The incidence of intracerebral hemorrhage over 13 years is compared between two Hisayama cohorts. Among men aged 40 years or older, the annual incidence declined significantly from 3.1/1,000 in the early cohort (1961–1970) to 1.2/1,000 in the recent cohort (1974–1983). Massive ganglionic hemorrhage decreased, while small or medium‐sized intracerebral hemorrhage increased in the recent cohort on pathologic or computed tomographic examination. These trends could be due to the reduced prevalence of hypertension in the Hisayama population. The association of serum total cholesterol with intracerebral hemorrhage is discussed based on the results during a 22‐year follow‐up period. (Stroke1988;19:48–52)