Introduction: Acute kidney injury (AKI) occurs frequently in patients with aortic dissection and is associated with increased hospitalization and early mortality. It is unclear whether AKI is a consequence of the aortic syndrome itself or attributable to rapid hemodynamic changes that result from strict blood pressure and heart rate goals. The objective of this study was to evaluate the effect of systolic blood pressure (SBP) reduction on risk of AKI in patients with aortic syndromes, with the hypothesis that patients who experience AKI will have a higher magnitude of SBP reduction. Methods: This was a single-center, retrospective cohort study conducted at an academic medical center. Patients were ≥18 years old, hospitalized from January 1, 2015 to December 31, 2021 with an aortic syndrome, and treated with antihypertensive infusions. The primary outcome was the difference between maximum SBP reduction in the no-AKI and AKI group at 4, 8, 12, and 24 hours. Secondary outcomes were accuracy of maximum SBP reduction in predicting AKI and the optimal SBP cutoff that predicts AKI. Student’s t-test was used to compare maximum SBP reduction between cohorts. Receiver operating characteristic (ROC) analysis was used for the secondary outcomes. Area under the curve (AUC) and SBP cutoff point were calculated as part of the ROC analysis. Chi-squared test was used to calculate risk of AKI when exceeding the SBP cutoff. Results: A total of 71 patients were analyzed (n = 48, no-AKI; n = 23, AKI). Seventy-six percent of patients had Type B aortic dissection, and mean SBP at baseline was 176 ±26 mmHg. For the primary outcome, there was a significant difference in maximum SBP reduction at all time points between the no-AKI and AKI group (4 hours, 47 vs 70 mmHg; 8 hours, 56 vs 82 mmHg; 12 hours, 62 vs 87 mmHg; 24 hours, 69 vs 95 mmHg; p < 0.001 for all comparisons). Maximum SBP reduction over 4, 8, 12, and 24 hours yielded an AUC-ROC of 0.77, 0.80, 0.79, and 0.79, respectively. Lowering SBP ≥54 mmHg within the first 4 hours significantly increased risk of AKI (OR, 6.65; 95% confidence interval, 1.88-19.72; p < 0.001). Conclusions: Patients with aortic syndromes who experience AKI have a higher magnitude of SBP reduction than those who do not experience AKI. Maximum SBP reduction appears to be an accurate predictor of AKI.