Blood pressure variability plays a critical role in determining the prognosis of acute ischemic stroke combined with hypertension.

Background: Individuals with hypertension exhibit high blood pressure variability (BPV), which is associated with an increased risk of acute ischemic stroke (AIS) and poor post-stroke outcomes. Therefore, managing BPV may help reduce the incidence of AIS and improve patient prognosis. Aim: This prospective cohort study investigated the effects of BPV regulation on the prognosis of patients with AIS and hypertension, using modified Rankin Scale (mRS) and National Institutes of Health Stroke Scale (NIHSS) scores as primary outcomes to inform individualized treatment strategies. Methods: Patients with AIS from December 2021 to June 2024 were included in the study and divided into two groups based on systolic BPV (SBPV) measured more than 24 h after symptom onset: the control group (SBPV 10-20%) and the observation group (SBPV outside 10-20%). The observation group received antihypertensive regimen adjustments based on 24-h ambulatory blood pressure monitoring (ABPM) during hospitalization, and the group was subsequently stratified into Groups 1 and 2 according to the improvement in SBPV assessed at the two-week outpatient follow-up after the intervention. Additionally, modified Rankin Scale (mRS) and National Institutes of Health Stroke Scale (NIHSS) scores were collected during the acute phase and again after 90 days. Results: A total of 75 patients were included. The observation group had higher acute-phase diastolic BPV ( Conclusion: Despite the small sample, our findings suggest that BPV may serve as a prognostic marker for functional outcomes in AIS. Tailored antihypertensive therapy aimed at reducing BPV showed a preliminary association with improved patient prognosis.