Abstract: Objective To investigate the impacts of blood pressure (BP) variability on neurological deterioration in patients with acute ischemic stroke after intravenous thrombolysis (IVT). Methods The clinical data of 134 patients after IVT in Department of Neurology, Affiliated jinhua Hospital, Zhejiang University School of Medicine from January 2020 to September 2020 were retrospectively analyzed, including hour-to-hour BP measurements. BP variability profiles, including average squared difference between successive measurements (sv), standard deviation (sd) were calculated. Early neurological deterioration (END) was defined as the National Institutes of Health Stroke Scale > 4 or death within 24 hour after IVT. The binary logistic-regression model was performed to determine the independent risk factors of END. Results Among134 patients, with mean age 67 year and median NIHSS 5,11 (8. 2%) patients achieved END. Compared with non-END group, END group has higher systolic BP sd (18 vs 14, t=-2.567,P=0.011),systolic BP sv (22 vs 17, t= -1.988, P=0.049). diastolic BP sd (13 vs 9.8.t= -2.431, P=0.016). Systolic BP sd, systolic BP sv and diastolic BP sd were related to the occurring of END independently. Conclusions SP variability is negatively associated with neurological deterioration occurring within 24h following ischemic stroke with intravenous thrombolysis.