With the win, Hillgrove evened its season series with McEachern. The Indians won the first game 41-39 on Jan. 29.
Hillgrove (13-9, 6-6) held a slight advantage most of the way, leading 13-12 at the end of the first quarter, 28-23 at halftime and 40-35 at the end of the third quarter.
"We wanted to divide the game up into small parts," Hillgrove coach Ed Morris said. "We were up at the half and I told the kids at halftime to win the third quarter and not worry about the fourth quarter - just take it one part at a time."
Brandon Waters scored 17 points and Marcus Dortch added 14 to lead Hillgrove.
Trey Fletcher led McEachern (15-7, 8-5) with 14 points, while Lo'ren Hall added 12 and Dimar Hill had 10.
McEachern had the early advantage, leading 6-4 with 4:31 remaining in the first quarter.
Hillgrove bounced back as Brandon Clark scored on a layup. Then, after Hill committed an offensive foul, Dominic Early hit a 3-pointer and Dortch scored on a transition layup to complete a 7-0 run that gave the Hawks an 11-6 lead with 2:38 left.
McEachern cut Hillgrove's lead to 11-10 with 1:08 left, but the Hawks held on for a 13-12 advantage at the end of the first quarter.
After holding a slight lead through most of the second quarter, with McEachern tying the game on five different occasions, Hillgrove began to stretch its lead out with a 9-2 run that began late in the first half and lasted through midway through the third quarter.
With the game tied 23-all with 1:36 remaining in the first half, Rhodis Eason hit a 3-pointer and Waters scored on a transition layup to give Hillgrove a 28-23 halftime lead.
Hillgrove continued its momentum at the beginning of the third quarter as Eason blocked a shot by McEachern's Marcquis Roberts, and Waters took it in for a transition layup to increase the Hawks' lead to 30-23 with 7:25 left.
After a couple of free throws by McEachern's Rory Anderson, Waters hit a jumper to give Hillgrove what would be its biggest lead of the game, 32-25 with 5:41 left.
McEachern would eventually cut Hillgrove's lead to 47-45 with 2:37 remaining in the game, but the Hawks stayed in control the rest of the way.
McEachern 72, Hillgrove 53: The No. 9 Lady Indians turned up the defensive intensity in the third quarter to come from behind for the Region 4AAAAA win.
Eighth-ranked Hillgrove led 32-29 at halftime and were up 46-39 late in the third quarter when McEachern stormed back with a 23-0 run to take control of the game.
Dominique Wilson scored 29 points and Pachiyaanna Roberts added 26 to lead the way for McEachern (18-5, 10-3).
Reka Hall scored 19 points and Mackenzie Engram added 12 for Hillgrove (15-4, 7-4).